JP2002524141A - 複数の円板を含むピーナッツ眼鏡形胸腰部椎間板プロテーゼ - Google Patents

複数の円板を含むピーナッツ眼鏡形胸腰部椎間板プロテーゼ

Info

Publication number
JP2002524141A
JP2002524141A JP2000568430A JP2000568430A JP2002524141A JP 2002524141 A JP2002524141 A JP 2002524141A JP 2000568430 A JP2000568430 A JP 2000568430A JP 2000568430 A JP2000568430 A JP 2000568430A JP 2002524141 A JP2002524141 A JP 2002524141A
Authority
JP
Japan
Prior art keywords
housing
prosthesis
disc
intervertebral disc
disc prosthesis
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.)
Pending
Application number
JP2000568430A
Other languages
English (en)
Inventor
ヴィンセント ブライアン
Original Assignee
スパイナル ダイナミックス コーポレイション
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by スパイナル ダイナミックス コーポレイション filed Critical スパイナル ダイナミックス コーポレイション
Priority claimed from US09/786,073 external-priority patent/US6749635B1/en
Publication of JP2002524141A publication Critical patent/JP2002524141A/ja
Pending legal-status Critical Current

Links

Classifications

    • 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
    • A61F2/441—Joints for the spine, e.g. vertebrae, spinal discs made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2/30721—Accessories
    • A61F2/30742—Bellows or hose-like seals; Sealing membranes
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30004—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis
    • A61F2002/30014—Material related properties of the prosthesis or of a coating on the prosthesis the prosthesis being made from materials having different values of a given property at different locations within the same prosthesis differing in elasticity, stiffness or compressibility
    • A—HUMAN NECESSITIES
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    • A61F2002/30113—Rounded shapes, e.g. with rounded corners circular
    • A61F2002/30121—Rounded shapes, e.g. with rounded corners circular with lobes
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30108—Shapes
    • A61F2002/3011—Cross-sections or two-dimensional shapes
    • A61F2002/30112—Rounded shapes, e.g. with rounded corners
    • A61F2002/30113—Rounded shapes, e.g. with rounded corners circular
    • A61F2002/30121—Rounded shapes, e.g. with rounded corners circular with lobes
    • A61F2002/30123—Rounded shapes, e.g. with rounded corners circular with lobes with two diametrically opposed lobes
    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/3013—Rounded shapes, e.g. with rounded corners figure-"8"- or hourglass-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A61F2002/30133—Rounded shapes, e.g. with rounded corners kidney-shaped or bean-shaped
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
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    • A—HUMAN NECESSITIES
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    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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  • Prostheses (AREA)

Abstract

(57)【要約】 小さな輪郭を有する、ピーナッツ眼鏡形状のプロテーゼ円板装置が提供される。装置ハウジングは、長手方向に分かれた二つの中空半部（２２、２４）を有し、この二つの半部間には、複数の円板形状の弾性体（４１、４２）が含まれ、この弾性体は、重合体による種類であっても、またはヒドロゲルを含むものであってもよい。これらの弾性体は、分かれた円筒形ハウジングの各々の内部に位置する凹状表面（５１、５２）内にあってもよい。ハウジング半部は、最大の生理的な負荷の下でも、直接互いに接触することはない。殻の形状は、人間の脊椎の胸腰部での椎骨間の空間を比較的簡易に供給することを可能にする。

Description

【発明の詳細な説明】
【０００１】 （技術分野） 本発明は、胸腰部脊椎用の独特の椎間板プロテーゼの設計及び使用に関する。
一つ又はそれ以上の卵形の弾性プロテーゼ核を、金属セラミック又は重合体物質
からなるピーナッツ形状のハウジングであって、長手方向に二つの区画にわかれ
るような形状を有するハウジング内に連続して配置することにより、脊椎の胸又
は腰部分へのインプラントの際に、小さな開口部を通じる装置の配置を可能にす
る、薄い輪郭を有するプロテーゼを作ることができる。
【０００２】 米国特許第５，６７４，２９６号をここに参照し編入する。
【０００３】 （背景技術） 椎間板ヘルニアを含む退行性椎間板疾患は、疾患が無ければ臨床上安定した脊
椎に、局地的な痛み、神経根障害、脊髄障害などの障害症状を引き起こす場合が
あり、また外科的治療以外に対しては感応が鈍い場合がある。退行性椎間板疾患
の症状を取扱うために、非侵襲性療法が効果的でない場合には、いくつかの外科
的治療が利用可能である。これらの外科的治療は、開頭減圧術、椎間板切除術、
癒合などを含む。これらの療法は、特に椎間板切除術及び癒合の手続きでは、臨
床上の症状を軽減するが、患部機能脊椎ユニット（functional spinal unit）（
ＦＳＵ）によっては通常又は通常に近い範囲の動き及び緩衝作用を回復しない。
この結果、元の外科手術位置に隣接する脊椎円板における退行性作用が進行する
場合がある。この退行性作用の結果、更なる外科的介入が必要になる場合もある
。
【０００４】 目標となる椎間板空間への接触を可能にするために、開口手術及び内視鏡によ
る技法がしばしば使われる。背部、後側部、及び腹側のアプローチによって、器
械類を配置することが可能になり、これにより、退行した椎間板の露出及び骨移
植片又は癒合かごの挿入を助け、骨の癒合を達成する。
【０００５】 解剖学的構造に配慮するため、また腹側腰部脊椎における最低限の侵襲性外科
的技法に関連する器械の大きさの制限のため、自然の椎間板と等しい大きさの機
能的椎間板プロテーゼは、重要な管構造（critical vascular）との機械的な干
渉に起因する危険性を作り出す。
【０００６】 安定性、椎骨間の間隔、及び前湾を保持しつつ、ＦＳＵの全範囲の動きを可能
にし、二つの隣接した椎骨間の緩衝を提供する機能的椎間板プロテーゼが求めら
れる。
【０００７】 （発明の開示） すなわち、本発明の目的は、小さな又は狭い輪郭を有する椎間板プロテーゼの
提供である。例示する新しいプロテーゼは、ピーナッツの殻のような外形を有す
る。該ピーナッツ形ハウジングは、長手方向に分けられた二つの半部からなる。
各ハウジングの半部はいつでも、その内部に含まれる円板形状の弾性体によって
、他の半部から分けられている。また、各ハウジングの半部は、毎日の生活の活
動中にハウジングがさらされるであろう負荷を支えるために十分な強度を有する
。円板核は、円板核が置換える自然の椎間板の径よりも小さな径を有し、ピーナ
ツ形ハウジングの凹状殻内部に配置される。インプラントを外科的に配置するた
めに使用可能な、制限された解剖学上の空間によって課せられる制約にあうよう
ハウジングが構成される。またハウジングは小さく、内視鏡による処理に使われ
るような、インプラント処理や器械類を利用する。
【０００８】 本発明の更なる目的は、椎骨体又は骨上の凹状の組合わせ表面と係合する形状
寸法を提供し、これにより、対向する係合した椎骨又は椎骨体の適切な安定性及
び適切な配置を提供することである。
【０００９】 もう一つの目的は、脊椎癒合かごがインプラントされた場合などに必要となる
ことのある、骨移植片採収の第二の外科サイト（surgical site）の必要性を回
避することである。
【００１０】 本発明の更なる目的は、被覆の提供であり、これにより弾性体によって占めら
れる、二つのハウジング半部間の空間を完全に取り巻き囲むことである。これに
より、破片（debris）のプロテーゼ外への移行を制限し、装置内へ癌にかかった
組織が発展（ingrowth）ことを制限し、プロテーゼ核の周りに、潤滑剤を含むこ
とができる密閉空間を形成する。
【００１１】 更に本発明のその他の目的は、ハウジング半部間の動きが可能な椎間板プロテ
ーゼの提供である。
【００１２】 本発明の更なる目的は、ハウジング半部間に緩衝効果を提供する椎間板プロテ
ーゼの提供である。
【００１３】 本発明の更なる目的は、単独で又は、同様のプロテーゼと平行な列で使用でき
る椎間板プロテーゼの提供である。
【００１４】 更にもう一つの目的は、潤滑、間隔をあける、及び／又は緩衝の目的のために
、液体（例えば、塩水注射流体、ヒアルロン酸、又は、例えばヒドロゲル物質を
含む類似した潤滑流体物質）を、被覆内に閉じ込められ部分的に円板によって占
めれるハウジングの内部空間へ供給できる、一つ又はそれ以上の出入口を有する
ハウジングの提供である。プラグやネジなどを設け、該物質の供給に続いて、閉
じた出入口を密閉することもできる。
【００１５】 本発明のその他の目的及び利点は、後述の詳細な説明を読み図面を参照するこ
とによって、当業者には明らかになるであろう。図面中では、同様の部品には同
様の符号を付す。
【００１６】 （発明を実施するための最良の形態） 本発明は、好適な実施形態に関連して説明されるが、この説明は本発明を該実
施形態に制限するよう意図されるものではないことを理解されたい。これに反し
て、この説明は、添付する請求項に定義された本発明の精神及び範囲内に含まれ
るであろう全ての代替案、変形例、及び均等なものを含有するよう意図される。
【００１７】 上述の目的を達成するために、例示する新しい椎間板プロテーゼ１０は、図に
示すように、ピーナッツ形ハウジング２０を有する。ハウジング２０は、ハウジ
ング上半部２２と、ハウジング下半部２４とを備える。
【００１８】 図２、図３、及び図４に特に示すように、複数の弾性及び粘弾性円板４１及び
４２が、ハウジング上半部２２とハウジング下半部２４との間に挟まれ、これに
よりハウジングの両半部を他方の半部から距離をおいて保持し、ハウジング半部
間、したがってインプラント患者の脊椎の、所定の範囲の動きを可能にする。こ
の代わりに、円板４１及び４２は適切なヒドロゲルから形成されてもよい。円板
は、比較的軟らかで弾性を持つ内部を有し、比較的硬く耐性に優れた外部を有し
ていてもよい。望まれるならば、一般的に円錐形の突起物又は柱２９が、円板４
１及び４２内に形成された凹部３３に一致し、これにより安定性及び過剰な動き
に対する制限を提供してもよい。また望まれるならば、これらの柱２９に、小さ
な通路３１を設け、組立てられたインプラントの内部への流体又はゲルの供給を
可能にしてもよい。図３に示すように、円状ワイヤ（circulage wire）３７及び
３８又はその他の既知の装置を、殻（shell）の両半部２２及び２４のへりに形
成された溝４１（図８）と一致させ、これにより米国特許第５，６７４，２９６
号に示唆されるように、流体保持被覆３９を取り付け保持してもよい。
【００１９】 ポート３１を殻の半分２２及び２４に形成し、組立てられたインプラント内部
への潤滑流体又はゲルの供給を可能にすることもできる。ポート３１はその後、
望まれるならば、プラグやネジなどで密閉でき、供給された流体又はゲルの、そ
の後の漏洩又は遺失を予防することもできる。凹部（recess）４７及び４８は、
骨が内に伸びることを可能にし、したがって、堅固で永久的な、かみ合う椎骨表
面への、インプラントの取付けを可能にする。
【００２０】 プロテーゼ装置１０は、脊椎の胸部又は腰部に、小さな外科的開口部を通じて
インプラントできる。二つ又はそれ以上の円板４１及び４２を含む一つの装置２
０を使うことにより、又は、各々が二つ又はそれ以上の卵形円板を並べて（seri
es）有する、二つのこのような装置２０を平行して配置することにより、機能脊
椎ユニット（ＦＳＵ）の全範囲の動きを達成できる。円板状物質が弾性及び粘弾
性の性質を有し、上部及び下部ハウジング部材の間隔がその内部に配置された卵
形円板によって保たれるように、ハウジングが分かれている場合、緩衝効果を実
現できる。
【００２１】 図５及び図９に示唆されるように、各卵形円板４１及び４２を、ハウジング内
に形成された又は含まれる凹状表面５１及び５２によって部分的に囲み、保持し
てもよい。該凹状表面５１及び５２は、各卵形円板４１及び４２の上部及び下部
表面の形状を受け入れるように輪郭を定められる。これにより、二つ又はそれ以
上の半部又は対になった殻２３及び２４を備えるハウジング２０は、円板４１及
び４２の表面上を滑動及び／又は回転でき、一体化した空間の間隙及び動きを可
能にする。
【００２２】 装置は、開口又は内視鏡を含む最小限の侵襲性技法を介して、又は、様々な既
知の外科的な腹側、背部、側面、又は他のアプローチによって、十分な解剖空間
が利用可能な場所で挿入できる。プロテーゼは、単一の円筒形ユニットとして挿
入されるが、その最終的な位置は、ハウジングの一つの半部が、尾側の椎骨の上
側端版を有する頭側の椎骨のみと接触するように残される位置である。円筒形ハ
ウジングの両半部間の円板形の椎骨体は、二つ又はそれ以上の凹状表面を有し、
複数の方向への滑動及び回転により、移動を可能にし、ハウジングに課せられる
生理的な負荷に応答して緩衝効果を提供する。
【図面の簡単な説明】
【図１】 新しい脊椎プロテーゼの平面図である。
【図２】 図１に示すプロテーゼの端面図である。
【図３】 図１の線３−３の平面で実質上切り取られた断面図である。
【図４】 新しいプロテーゼの拡大図である。
【図５】 新しいプロテーゼに含まれる一つの棚板の内部の平面図である。
【図６】 図５に示す殻の半部の側面図である。
【図７】 図５及び図６に示す殻の半部の端面図である。
【図８】 図７に示す殻の半部の部分図であり、インプラント被覆及び円状
ワイヤと係合するよう適合された半部のへり形状を詳しく示す。
【図９】 殻の半部の内部を示す拡大図である。
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Claims (13)

    【特許請求の範囲】
  1. 【請求項１】 椎間板プロテーゼであって、上半部と下半部とを備えるピー
    ナッツ形状のハウジングと、前記ハウジングの上半部及び下半部の間に挟まれ、
    前記両ハウジング半部を互いに隔離するよう保持する複数の弾性及び粘弾性円板
    と、を組合わせて有することを特徴とする椎間板プロテーゼ。
  2. 【請求項２】 請求項１に記載の椎間板プロテーゼであって、前記円板の形
    状が卵形であることを特徴とする椎間板プロテーゼ。
  3. 【請求項３】 請求項１に記載の椎間板プロテーゼであって、各円板が、前
    記ハウジング内に形成された凹状表面によって、部分的に囲まれていることを特
    徴とする椎間板プロテーゼ。
  4. 【請求項４】 人間の脊椎内に固定される椎間板プロテーゼであって、頭側
    椎骨の下側端板及び癌にかかった骨と係合するピーナッツ形状のハウジング上半
    部と、尾側椎骨の上側端板及び癌にかかった骨と係合するピーナッツ形状のハウ
    ジング下半部と、前記両ハウジング半部間に挟まれた複数の別個の弾性円板と、
    を有することを特徴とする椎間板プロテーゼ。
  5. 【請求項５】 請求項４に記載の椎間板プロテーゼであって、各円板が、前
    記両ハウジング半部の一つに形成された凹状表面によって部分的に囲まれている
    ことを特徴とする椎間板プロテーゼ。
  6. 【請求項６】 請求項１に記載の椎間板プロテーゼであって、各ハウジング
    半部の内部の少なくとも一部が、凹状表面によって形成されることを特徴とする
    椎間板プロテーゼ。
  7. 【請求項７】 人間の脊椎内に配置される複数の椎間板プロテーゼであって
    、各プロテーゼが、頭側の骨の下側端板及び癌にかかった骨と係合するハウジン
    グ上半部と、尾側の椎骨の上側端板及び癌にかかった骨と係合するハウジング下
    半部と、前記両ハウジング半部間に挟まれた弾性物質と、を有することを特徴と
    する椎間板プロテーゼ。
  8. 【請求項８】 請求項７に記載の複数の椎間板プロテーゼであって、前記プ
    ロテーゼの殻が、その外部表面に形成され、骨が内へ伸びることを可能にするた
    めの凹部を備えることを特徴とする椎間板プロテーゼ。
  9. 【請求項９】 人間の脊椎インプラントに使うための粘弾性プロテーゼ円板
    であって、前記円板が粘弾性の性質を有し、また、硬直なハウジング上半部及び
    下半部の内部に形成された凹状表面との滑動係合のために、凸状の外部表面を有
    することを特徴とするプロテーゼ円板。
  10. 【請求項１０】 請求項９に記載の円板であって、前記円板が比較的柔らか
    い弾性の内部を有し、比較的硬く耐性に優れた外部を有することを特徴とする円
    板。
  11. 【請求項１１】 椎間板プロテーゼであって、局所的な角度（local angle
    ）又は眼鏡状の形を形成する外部表面を備えるハウジングであって、少なくとも
    二つの剛直な、対向して相補的となる部分を備えるハウジングと、前記ハウジン
    グ部分間に挟まれた少なくとも一つの弾性及び粘弾性円板であって、前記ハウジ
    ング部分を互いに隔離して保持し、前記ハウジング部分間に緩衝効果を提供し、
    前記ハウジング部分間からの制限された動きを可能にする円板と、を組合わせて
    有することを特徴とする椎間板プロテーゼ。
  12. 【請求項１２】 請求項１１に記載の椎間板プロテーゼであってさらに、前
    記ハウジング半部に取付けられた被覆を備えることを特徴とする椎間板プロテー
    ゼ。
  13. 【請求項１３】 請求項１１に記載の椎間板プロテーゼであって、密閉可能
    なポートが前記ハウジング内に形成され、前記ポートが、潤滑剤又は潅水剤（ir
    rigant）を、核とハウジング内部表面との間の空間に供給できる通路を形成する
    ことを特徴とする椎間板プロテーゼ。
JP2000568430A 1998-09-04 1999-09-03 複数の円板を含むピーナッツ眼鏡形胸腰部椎間板プロテーゼ Pending JP2002524141A (ja)

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US9927798P 1998-09-04 1998-09-04
US60/099,277 1998-09-04
PCT/US1999/020457 WO2000013619A1 (en) 1998-09-04 1999-09-03 Peanut spectacle multi discoid thoraco-lumbar disc prosthesis
US09/786,073 US6749635B1 (en) 1998-09-04 1999-09-03 Peanut spectacle multi discoid thoraco-lumbar disc prosthesis
US10/443,422 US20030199982A1 (en) 1998-09-04 2003-05-22 Peanut spectacle multi discoid thoraco-lumbar disc prosthesis

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CA2342633A1 (en) 2000-03-16
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