CA2329363C

CA2329363C - Articulating spinal implant

Info

Publication number: CA2329363C
Application number: CA002329363A
Authority: CA
Inventors: Joseph C. Cauthen
Original assignee: Warsaw Orthopedic Inc
Current assignee: Warsaw Orthopedic Inc
Priority date: 1998-04-23
Filing date: 1999-04-23
Publication date: 2007-12-11
Anticipated expiration: 2019-04-23
Also published as: US6179874B1; JP2002512079A; CA2329363A1; EP1075236A1; WO1999053871A1

Abstract

A spinal implant (10) for intervertebral disc replacement.
The implant is formed from two hemicylindrical elements (20, 22), each engaging one of an adjacent pair of vertebrae (12, 14). An articulating ball-and-socket joint between the two elements (20, 22) resists compression and lateral movement between the vertebra, but allows pivotal movement, thereby preserving mobility. Fusion chambers (30, 34) are provided for allowing bone ingrowth to fuse the elements to the vertebrae (12, 14). Biocompatible, bioreabsorbable struts, shims (82), fillers and/or end caps (90) are provided for temporary stabilization of the first (20) and second hernicylindrical (22) elements. Bone chips removed from the vertebrae during implantation or bone growth stimulators can be inserted into the fusion chamber (30, 34) or otherwise applied to the implant to enhance bone ingrowth.

Description

DESCRIPTION
AR'I'1CULATING SPINAI., livil'LnN'I
i3ackEr-ound of thc Invention Field of thc Invention:
Thc invention relates gcncrally to a spinal inlplant for use in intcrvcrtcbral disc replacernent; and rnore specifically relates to an articulating inlplant that fuses to adjacent vertebrae by botte ingrowth, thus restoring proper ittterver-tebt-al spacing, and elinlinating nerve root and/or spinal cord compression, while preserving spinal Ilcxibility.

llescription of Related Art:
'I'he spinal column is formccl from a nunlbcr of vertcbrac, which in their normal state are separated from one anothcr by cartilaginous itttervertebral ctiscs. These discs fornl a cushion between adjacent vertebrae, resisting compression along the support axis of the spinal column, but permittittg linlited movernent between the vertebrae to provide the cllaracteristic flexibility of ttle healthy spine. Injury, disease or other degenerative disorders nlay cattse one or more intervertebral discs to shrink, collapse, detetiorate or beconle displaced, henliated or otherwise danlaged. This can lead to conipression of adjacent nervc root(s) or the spinal cord caUstrlg chronic and often disabling pain, and in advanced circurnstances, irreversible paralysis of upper and/or lower limbs.

A number of devices and methods have been suggested for the replacement of danlaged or dislocated intervertebral discs. One common approach is to pennanently stabilize or "fuse"
the adjacent vcrtebrac to nlaintain the propcr intervertebral spacing and eliminatc relative movement between the vertebrae. Variotrs methods of vcrtebral stabilization have bccn developcd. For example, autogcnous grafts of drnvcl-sllaped scctions of bone have bcen implanted between the vertebrae to cause bone growtii across tile intcrvertebral space, thereby fusing the adjacent vertebrae into one bone niass. Illis procedurc disadvantageously requires the harvest of donor bone for the graft froni other parts of the paticnt's body, typically requiring a separate surgical procedure and restrltatit increases in coniplications and expense. A.n altematiVe source is cadaver bone, with potential complications of transniissible diseases, inipaired graft incorporation, collapse or displacenient. A furlher development to this method of vertebral stabilization involves the iniplantation of a perforated cylindrical bone basket between adjacent vertebrae. Bone fragments produced in preparing the vertebrae for the iniplantatioti are inserted into the bone basket to promote bone growth into, througli and around the basket.
Vertebral stabilization by fusion of adjacent vertebrae has proven successfitl in permanently preserving intervertebral spacing, but has been found to present a number of disadvantages. Fusion of adjacent vertebrae necessarily elirninates a portion of tiie spine's normal range of niotion, thereby reducing the subject's spinal flexibility.
Additionally, fusion of the vertebrae increases the stresses imposed on adjacent mobile portions of the spinal column, often hastening the subsequent breakdown of nonnal joint surfaces above and below the fused vertebrae.
It has also been proposed to replace an injured intervertebral disc with a prosthesis which is "jointed" to pennit relative tnovement between vertebrae. I'reviously-known devices of this type generally have been found to suffer from inadequate attachnient between the prosthesis and the ver-tebrae. The intended niovenient between the components of previously-krrown jointed prostheses can cause relative motion between the prostliesis and adjacent bone surface(s). Because such niotion would disrupt bone ingrowth, jointed prostheses have generally been considered incompatible with attachrnent by bone ingrowth. In addition, because tiie joint elenients of these devices typically must occupy a substantial vertical extent in order to achieve the desired range of niotion, and yet niust fit within the intervertebral space, attachtnent of such devices generally has been by use of flat plates or surfaces provided on either side of the joint elemetits as points of fixation to the vertebrae. This attacliment may be accomplislied by compressive or friction fits, spiked projections, screws or pins, compleniented in some instances with tissue ingrowth into porous surfaces. These mechanisms of attachmerit, however, may lack the degree and strength of fixation desired. Moreover, several such devices have used attachment flanges which extend beyond the strrfaces of the vertebrae to which the device is attached. This has been found undesirable, as the extending flanges may interfere with or injure adjacent tissue.
For exatnple, it has been reported tiiat flanges extending into ininiediately adjacent delicate esophageal area may interfere with swallowing and speech, or cause perforation and potentially fatal infection. An additional drawback to the use of screw and pin connections is the potential for such coruiectors to dislodge and cause injury.
"I'hus, it can be seen that a need yet exists for a spinal implant effective in permanently rnaintaining irttervertebral spacing to prevent nerve or spinal cord compression while preserving as tnuch of the natural range of nlotion betwecn the affeclcd vcrlcbrac as possihic. A neeci furlher exists for such a device which is capable of fornring, a pcnnanent, strong attaclinlent to the vertcbrac and yet clocs not protrude bcyond lhe cxtcrltal surfaccS to which 1t is attached.
SLIII, another ncccl cxists for a nlethocl of replacing a dantagccl or displacccl clisc, which Inctbod maintains intervericbral spacing to prevent nerve and spinal cord compression, wllile hreservinf, thc natural relative inotiorl betwcen the vertebrae. It is to tlie pr()visi()rl of a clevice ancl methocl mceting these and othcr neetis that thc present invention is pr-itnarily directcd.

Bricf Surnrllarv of thc Invention According to one aspect of the present invention, there is provided a spinal implant comprising: a first elernent comprising a first articulation surface and a first outer surface adapted to engage a first vertebra; a second element comprising a second articulation surface and a second outer surface adapted to engage a second vertebra; characterized in that said first articulation surface comprises a rocker extending along a length of said first element, said second articulation surface comprising a channel extending along a length of said second element, at least a portion of said rocker engaged within said channel to allow relative movement between said first element and said second element, and to resist axial compression along a support axis.

I3ricfly described, in a prefcn'ed for-m, thC l)rescnt invention comprises a spinal implant includinl; a first elcment having Grst'cotlnection nlcant for cnt;af*inb a first vertebra. 'I'he firsl connectiorl mcans includes a first fusiorl chamber having at least one npening thercin for facilitating horle ingrowth into the first fusion chamber to fusc thc first clcnlcnt to the frrst vertebra. Tile implant also inclucics a second element having secand connection mcans for engaging a second vertebra. The seeond conneetiorl nlcans includes a second itrsion chamber having at least one opening therein for facilitating borie ingrowth into the second fusion cllaniber z$ to fuse the second element to the second vertebra. 'file implant also inciudes internal articulation means, coupling the first clement to the second elcment, i'or allowing reiative rnovcment between the first element and the scconcl element. The tcrm "internal articulation incaris," is intended to mean a device that permits relative nlotion between components of the device, rather than betwccn the device and an external structure such as adjaccnt bonc or other tissuc.

In specific embodiments of the subject invention, the first and second eletnent may have eithen cctnicylindrical or henlielliptical shaped outer surfaces. The first and second elenlents each having ail outer wall pcrforated with one or more openings provided tllerein to allow bone ingrowth into the fusiorl chanibers, and having BbLIttrrlg Joiilt surfaces forming thc intcmal 3a articulation means. In a further lucferred embodinient, Lhe joint surfaccs arc forrnccl as eilt*acinf;
coneave and convex surfaces to create a ball-and-socket type joint (or groove and channel, or other such joint), which allows relative pivotal motion hetwccn the vcrtchrae, but resists compression thercbclween.

The first and second elements can join to form a single clement which can be irnplanted using methods siniilar to those followed in the implantation of previously-knoxvii non-articuiating vcrtebral fusion implants. Temporary stabilizing nicans can bc provided for rigidly coupling the first and second clcments by interposition of biorcabsorbable elements to permit implantation and cnable bone ingrowth into (lic fusion chambers and fusion of the first and second elements to adjacent bone during an initial stabilization period, after which said temporary means biodegrades permitting articulation betwecn the first and second elements.
"I'he present invention can be further described as comprising a spinal implant having a first articulation surface, a second articulation surface engaging at least a portion of the first ai-ticulation surface along a support axis generally parallel to the spinal colunui, first connection means for connectinf; the first at-ticulation surface to a first vertebra, and second connection means for connectingthe second ar-ticulationsurface to a second vertebra. The first and second articulation surfaccs resist axial compression between the first and seconcl elements in the direction of thc support axis, but allow relative pivotal motion between the first and second elements. At Icast one, and pr-efcrably botli, of the fii-st connection means and the second connection nieans comprise a fusion chamber havingat least one opening therein tor facilitatin~
bone inerowth, thereby pcrmancntly and securely affixing the implant in place.
In another preferred form, the prescnt invention compr-ises a niethod of maintaining an intervertebral space between a first vertebra and a seconcl vertebra. "l'he metliod includes the steps of removinga section of tiic fii-st vertebra to form a cavity therein, mountinba first element of a spinal implant within the cavity for-mecf in thc fir-st vertebra, and connecting a second element of the spinal implant to the seconcl vertebra. The Grst element inclu(les a first articulation surface and a first fusion cliambcr havingat least one opening thcrcin li)r facilitating bone incrowtlr from tlie frrst ver-tebra.The second eleni ent includesa sccond articulationsurface, wherein the fii-st and second articulation surfaces adjoin to form a joint allowing relative pivotal movement between the first ancl second elements but preventinb relative compression between the firstand secondelements. In a furtlier preferred embodiment, the nietliod may also incltrcfc the removal of a section of the second vertebra to form a cavity for receivingthe second elenient.
The second elernetit may also include a second fusion chambet- for facilitatin~; bone ingrowth from the second vertebra. l3one fragments formed by the removal of vertebral sections to accommoclate implantation or bone browth stimulating compounds or devices may be inserted into the ftrsion chamber(s) to enhance bone ingrowth.
These and other objects, features and advantages of the present invention will be niore readily widerstooci with r-eference to the following detailed description, reacl in conjunction with tltc accompanying drawing figures.

Brief Descrintion of tbe Drawings T'igtn-e IA and IiZ show a perspective view of a spinal implant accordinb to onc cylindrical form of the present invention.

WO 99/53871 I'CT/US99/08898 Fignre 2 shows a cross-sectional side view of the spinal implant of Figure 1.
Figure 3 shows a cross-sectional etid view of thc spinal implant of rigtn-c 1.
Figtire 4a is ati end view of a spinal implant in silu according to the cylindrical for of the prescnt inventioti.
5 Figure 4b is a side view of a spinal implant in-situ according to the cylincirical form of the present invention.
Figure 5 is a cross-sectional end view of another enibodimcnt of the prescnt invention.
Figure 6a shows a cross-sectional end view of an elliptically shaped spinal implant of the subject invention.
Figtire 6b shows a cross-sectional end view of an altcrnative elliptically shaped spinal implant of the subject invention.
Figtire 7 shows a cross-sectional side view of the tapered spinal implant.
Figare 8 shows a cross-sectional end view of a spinal implant with a rockcr and channel articulating nieans.
Figure 9 shows a cross-sectiotial end view of a spinal implant with a rocker and liour-glass channcl articulating means.
Figures l0a & 10b show a perspective view of a spinal implant with a rocker and alteniative hour-glass channel articulating means.
Figures l la & llb show a perspective view of a spinal implant with a rocker and alternative liour-glass cltannel articulating means.
Figtire 12 is an end view of a spinal implant iir-situ according to the elliptical forin of the present invention.
Figure 13 is a side view of a spinal itnplant in-situ according to the tapered fonn of the present inventioti.
Figure 14 shows a surgical instrunient for cutting an elliptical section in between spinal vertebra.

Detailed Disclosure of the Invention Referring now in detail to the figures wherein like reference nunibers represent like parts tliroughout, preferred forzns of the present invention will now be described.
As seen in Figs. 1-3, one embodiment of the present invention comprises a spinal iniplant 10, generally cotnprising a first element 20 and a second element 22. The first elenient 20 is coupled to the second element 22 by an internal articulation nieans 24 for allowing relative pivotal niovenient bet-vveen the first and second elements.

Figures 4A and 4I3 show the spinal implant 10 of the prescnt invention installed ilr silu, between a first vertebra 12 and a second vertebra 14. Tlie implant 10 is sliown iniplanted into an anterior aspect of the vertebral body, between the fifth cervical and sixth cervical vertebra.
The device and niethod of the present invention, however, are applicable to anterior and posterior approaches to the vertebrae.

As seen best in Figs. 2-3, the first element 20 of the implant 10 coniprises first connection tneans, in the fortn of a first fusion chaniber 30, for engaging the first vertebra 12.
At least one opening 32 is fornied in the first ftision chainber 30, to facilitate bone growth into, through and around the first fusion chamber 30 frorn the first vertebra 12, to fuse the first element to the first vertebra 12. Preferably, a pluraiity of openings 32 are provided to further promote bone ingrowtli. Fusion by bone ingrowth has been found to provide a tnore permanent, rigid connection between the implant 10 and the skeletal structure than provided by other knowii connection rneans.

"I'he second elenient 22 of the iniplant 10 comprises a second connection means for engaging the second vertebra 14. The seconci connection means preferably conlprises a seconci fusion chamber 34, substantially similar in construction to the above-described Iirst fusion charnber 30, and coniprising at least one opening 36 formed therein for facilitating bone growth into, through and around the second fusion chanibcr 34 from the second vertebra 14.
Alternatively, the second connection means can comprise an adhesive connection, screw connection, pin connection, or any otlier effective alternative connection means. I-Iowever, the provision of a second ittsion chaniber 30 is preferred, as it provides a more pet-nianent and secure coupling than other known attachmetit nieans. Although the first element 20 and fit-st vertebra 12 are depicted in the figures as above the second elenient 22 and second ver-tebra 14, it will be understood that the present invention equally comprehends the reverse configuration wlierein the first element, as described herein, is attached to a first vertebra lower on the spinal column than the second vertebra to which is attached the second elenient. The first and second elements can be fabricated froni bioconipatible materials including, without liniitation, titanium, surgical alloys, stainless steel, chrome-inolybdenum alloy, cobalt chromium alloy, zirconiuni oxide ceramic, nonabsorbable polymers and other anticipated biocompatible metallic or polymeric materials.

Iteferring now to Figs. 2-3, the articulation nieans 24 of tiie present invention preferably coniprises a first articulation surface 40 provided on the first element 20, and an abutting second articulation sur= e 42 provided on the second elernent 22. 1'he first and second articulation surfaces 40,42 are preferably fabricated froni or coated with low-friction, wear and impact-WO 99/53871 1'CT/1JS99/08898 resistant, biocompatible niaterials, such as, for example, titanium, stainless steel, surgical alloys, chrome molybdenum alloys, cobalt cbroznium alloy, zirconium oxide eeramic, non-absorbable polymers and other biocompatible tnetallic or polynieric materials. 7'he articulation meatis 24 resists axial cotnpression between the first atid second elernents 20, 22, but allows relative pivotal niovenicnt therebetween. Ilius, when iniplanted, as shown in Figure 4, the articulation means 24 resists axial cotnpression between first and second vertebra 12, 14 along a support axis 44 extending generally along the spinal colunin, as shown, for example, in Figure 4, but permits pivotal movement between vertebrae. The tertn "pivotal," is intended to comprehend cither or both of a rotational or hvisting niotion about the support axis 44 (for example, rotation between cervical vertebrae by tuniing the head to the right or left), and/or a tilting motion angularly inclined in any direction relative to the support axis 44 (for cxantple, nodding the head forward or backward atid/or tilting the head downward to the riglit or left).

Axial conipressioti, as well as lateral translation normal to thc support axis 44, is t-esisted between the first and second vertcbra 12, 14, by providing the first internal articulatioti surface 40 with a void, such as a concave surface 46, which receives a protuberance, such as a convex surface 48, projecting from the secotid internal articulation surface 42.
'I'his "ball-and-socket"
arrangenient allows relative rotation about the support axis 44 between the first and second vertebra 12, 14. The articulation means 24 can be provided with one or more stops to liniit the range of rotational movemcnt allowecl.
In addition to the "ball-and socket" arrangetnent for the articulating means 24 other configurations are possible. In an alternative embodiment, as shown in l-igures 8 and 10, the articulating means comprises a rocker 100 and channel 101. The second articulation surface 42 can coniprise a substantially U-shaped channel 101 extending along the length of the second element 22. The first articulation surface 40 comprises a correspondingly-shaped rocker 100 which can be, for example, hemielliptical in shape along the length of the first element 20.
Such an arrangement petniits a tilting motion in one plane. In an alternative to this embodiment, as shown in Figure 9, a second range of motion can be added to the articulating mcans 24 by modifying the shape of the channel 102. The niodified cliannel 102 can be, for exaniple, substantially hour-glass in shape through the depth of the channel 102. Ilic channel width at the channel's base 103 and mouth 104 are greater then the channel widtli at the channel's niidpoint 105. The hour-glass shaped channel 102 permits a tilting tnotioti along two petpendicular linear planes.

In an second alternative to this embodiment, as shoxvn in Figure 11, an alteniative second range of motion can be added to the articulating means 24 by niodifying the shape of the g channel 106. The rnodified channel 106 can be, for example substantially liour-glass in shape tlirough the lengtli of the second element 22. 7'he channel width tit tlie cliannel's longitudinal niidpoint 107 is less the channel width at the channel leading end 108 and tail end 109. 1'hose skilled in the art, having the benefit of tthe instant disclosure, will appreciate that the "hour-glass" shape as described herein includes various curves or straiglit edges so long as the width at, or near, the end points of the channel (or the top and bottoni of the channel) is wider than the width at sonie point between the end points. The hour-glass shaped channel 106 pennits two ranges of motion, a tilting motion and a pivoting motion about the central axis. 'I'hese motions may be desirable for some patients.

The articulation nieans 24 preferably further comprises one or tnore angularly offset bevels 50 formed in the first internal articulation surface 40 and/or the second internal articulation surface 42, to allow relative tilting movement between the first and second vertebra 12, 14 in one or more directions. According to the embodiment shown in the figures, the first and second internal articulation surfaces 40,42 are each provided with an angularly offset bevel 50, in a generally pyraniidal configuration, as seen best in Figure 9, thereby enabling tilting niovenient in all directions (360 ). A generally conical configuration is also possible and, likewise, would perniit botli rotational niovement and 360 tilting movenient.
Additionally, as shown in I7igures 10 and 11, the first anci second articulating surfaces 40, 42 can each be provided with a general arc conGguration, which provide a greater range of motion.
T'he natural range of motion of the spine may be approximated by pt-oviding bevels 50 of approximately 5 around the periphery of each of the first and second articulation surfaces 40,42, thereby allowing approximately 100 of tilt in all directions between adjacent vertebrae.
As depicted in the figures, the pivot point or axis of the articulation nieans 24 is generally centrally located on the first and second articulation surfaces 40, 42, and will be aligned with the spine's normal axis of rotation when implanted as shown in Figure 4. This location, however, can be selectively varied to position the center of rotation of the articulation means 24 centrally, anteriorly, posteriorly, to the left, to the right, or eccentrically (off-center in both the anterior/posterior direction and the left/right direction) of the spine's normal axis of rotation, in order to achieve proper alignment of the spine, thereby restoring.optimal sagittal and coronal spinal balance and alignment.

In one embodimettt as shown best by Figure 1, the first and second elements 20, 22 of the implant 10 of the present invention preferably comprise generally hemicylindrical outer walls 60, 70 adjoining to form a genet-ally cylindrical body. When in their assernbled configuration, the first element 20 and the second elemetit 22 abut one another with their respective first and second articulating surfaces 40,42 adjacent and cngaging one another, as describcd abovc. The lirst elcmcnt 20 prcfcrably furtlicr comprises a first radiuscd outcr wal160.
The one or more openings 32 for facilitating bonc ingrowth are provided in this first radiuscd outer wall 60, and corntnunicate with a first fusion charnber 62 tornied between the fit-st radiused outer wall 60 and ttie first articulating surface 40. Similarly, the second element 22 preferably comprises a second radiused outer wall 70, defining one or inore'openings 36 for facilitating bone ingrowth. The openings 36 conimunicate with a secotid fusion chamber 72 fot-tned between the second radiused outer wall 70 and the second articulating surface 34. 7'he first and second radiused outer walls 60,70 can be provideci with threads 80 to facilitate advancing the implant 10 into the intervertebral space during implantation and to hclp secure the implant 10 in position once implanted. The threads 80 on eacir of the first and second radiused outer walls 60, 70 at-e preferably aligned to fortn continuous threads when the first and second elenients 20, 22 are engaged. ln some instances, it may be desirable to provide self-tapping threads 80, arid/or to configure the threads 80 to direct bone fragments generated bv implantation into the openings 32, as taught by U.S. I'atent No. 5,489,308 to Kuslich el al. In other less prefer-rcd ernboditnents, the threads 80 can be replaced witli a contoured outer surface cornprising smooth, splined, flanged, spiked or beaded surface fcatures. 73re implant 10 can ftirthcr comprise one or niorc support flanges 85 in the first and/or second elements 20, 22, for additional strength.
In a second embodinient as shown best by Figures 6a, 6b and 12, the first and second elements 20,22 of the implattt 10 of the present invcntion preferably comprise generally liernielliptical outer walls 97, 99 adjoining to form a generally elliptical body. When in their assembled configuration, the first element 20 and the second element 22 abut one anottier witli their respective first and second articulating surfaces 40,42 adjacent and engabing one another, as described above. The first elenient 20 preferably further comprises a first radiused outer wall 97. The one or more openings 32 for facilitating bone ingrowth are provided in this first radiused outer wall 97, and communicate with a first fusioti chamber 62 fonned between the first radiused outer wall 97 and the first articulating surface 40. Similarly, the second elenient 22 preferably comprises a second radiused outer wall 99, defiining one or niore openings 36 for facilitating bone ingrowth. The openings 36 comtnunicate with a second fusion chaniber 72 formed between the second radiused outer wall 99 and the second articulating surface 42. In alternative enibodiments the contoured outer surfaces of the first 20 and 22 second elements can comprise smooth, splined, flanged, spiked or beaded surface features to secure the element in position once implanted. The itnplant 10 can further comprise one or nlore support flanges 85 in the first and/or second elements 20, 22, for additional strengtli.

In a another emboditnent, as shown in Figures 7 and 12, the element 10 may be tapered along the liorizontal axis. T'he tailing end 92 liaving a vei-tical raditts greater then the vertical radius of the leading end 93. The tapered shape decreases the arnount of material required to be renioved and increases the case of insertion of the implant 10 in between the first and second 5 vertebra.

In a furtlier preferrecl embodimetit, the present invention niay fitrtlier comprise the provision of one or more stabilizing means for temporarily rigidly coupling the ftrst elenient 20 to the second element 22 to prevent relative movement therebetween. For example, it is preferred that the first and second eletnents 20, 22 be held rigidly in place during installation of 10 the implant 10 into the intervertebral space. In addition, the first=and second eletnents 20, 22 shouid remain rigidly coupled for a sufficient length of time after implantation to permit sufficient bone ingrowth into the fusion chanibers to prevent. rclative motion between the implant 10 and the vertebrae 12, 14 during nornial activities of the patient.
'I'ypically, approximately eight to twenty weeks of bone ingrowth will be sufficient, before the first and second elements 20, 22 are uncoupled and perTnitteci to articulate relative to one another. "I7iis temporary stabilization of the first and second elements is accomplished by the present invention, witliotrt the requirenient of a second surgical procedure, through the use of niedium-tenn stabilizing means formed from bioreabsot-bable material. l:xamples of bioreabsorbable tnaterials include polyglycolate polymers or analogues, lactides, polydioxanone, polyglyconate, lactide/glycolide copolymers. By appropriate selection of the niaterial(s) of construction, the length of time required to biodegrade the stabilizing means can be effectively controlled. After the stabilizittg means are dissolved and absorbed by the body, the first and second elenietits of the iniplant 10 are uncoupled, allowing articulation. In otie exaniple emboditnent, depicted in Figure 3, the stabilizing nieans can contprise one or more biodegradable shinls 82 wedged between the first element 20 and the second elenient 22, to prevent relative motion therebetween.
In another exatnple embodiment, the first and second elements 20, 22 are placed in thcir coupled configuration, as shown in Figs. 2-3, with the spaces between the articulating surfaces 40, 42 then being injected or filled with a biodegradable polymer, which provides the medium term temporary stabilizing nicans to couple the elements in position. Care will be taken to avoid filling the fusion chambers 30, 34 and the openings 32, 36 to the fttsion chanibers with the polymer, which could inhibit bone ingrowth. The threads 82 will also remain exposed to assist in implantatiot- of the device. In another exatnple embodiment, depicted in Figure 2, the stabilizing means compr-ise a removable and/or bioreabsorbable endcap 90, which releasably engages the tailing cnd 92 of the implant 10 to couple the first and second elements 20, 22. Ttie WO 99/53871 f'C'T/US99/08898 ll endcap can comprise one or rnore clips 94 for engaging the implant 10, and one or niore keyways 96 for engaging a wrench, driver or othcr actuation dcvicc uscd to advancc the implant into the intervertebral space. A second removable and/or absorbable endcap can be installed on the leading end 93 of the implant 10. The endcaps may additionally function to retain the 5 bone fragments within the chambers 62,72 of the fusion cliatnbers 30, 34, as will be described in greater detail below, until sufficient bone ingrowtlt and fusion has occurred.
Atiothcr etnbodiment of the present invention is depicted by Figure 5, which shows an itnplant 10, generally comprising first and second elentents 20, 22, substantially as described above, and further coniprising an inter-rnediate articulation element, which in the depicted 10 embodiment comprises a generally hemispherical bowl-shaped cap 90 interposed betwcen the concave surface 46 of the first elenient 20 and the convex surface 48 of the second elenient 22.
Ilie cap 90 is preferably fabricated from a wear-resistant, low fr-iction material of construction, which may be soniewhat resilient to absorb impact loading. The provision of the cap 90 allows atticulation at the interface betweeti the top surface of thc cap and the concavc surlace 46 of the first element 20, and between the bottoni surface of the cap atid the convex surface 48 of the second element 22, resultitig in a bipolar articulation. This arrangement recluces frictiortal wear on the articulation surfaces by distributing wear over two articulation interfaces. The engagement of the concave lower surface of the cap 90 witli tiie convex surface 48 of the second element 22, and the etigagement of the eonvex upper surface of the cap 90 with the concave surface 46 of the first elernent 20, prevents the cap 90 frorii becoming dislodged when the iniplant 10 is installed.

The present invention further comprises a method of niaintaining a desired intervertebral space between a first vertebra 12 and a second vertebra 14. The method preferably comprises retnoving a section of the first vertebra to form a cavity therein, niounting a first element of an articulating spinal implant into ttie cavity, and connecting a second element of the implant to the second vertebra. The articulating spinal implant used to carry out this method is preferably substantially siniilar to ttie exarnple enibodiment described above, liaving first and second internal articulation surfaces which adjoin to forrn a joint allowing relative pivotal movement between-the ftrst and second clements, but preventing relative axial compression thcrebetween.
At least one of the elements preferably further comprises a fusion chaniber, including a chaniber and at least one opening cornmunicating with the chamber, for facilitating bone ingrowth into, through and around the fusion chamber from the respective vertebra. In a preferred form, the method of the present invention comprises attachment of both the first arid second elenients of the implant to the respective vertebra using fusion chatnbers for bone irigrowth. In this embodiment, a section of the second vertebra is preferably reinoved to fonn a cavity therein for receiving the second element of the implant. The metliod of the present invention can further coniprise the insertion of bone fi-agnients, which may be the fragments formed in the above-described removal of vertebral sections, into the fusion chaniber(s) of the implant. The presence of these bone fragrnents has been shown to stimulate and enhance bone ingrowth into the fusion chamber. In another einbodiment, the method of the present invention anticipates the application of means for stimulating bone growth into, through, and/or around the fusion chamber(s). The nieans for stiniulating bone growth can coniprise, for exaniple, electrical or magnetic bone gi-owth stimulators, bone niorphogenetic protein (13MP), hydroxyl apatite compounds, demineralized bone conipound, and/or other bone growth stiniulating devices or compounds. It is also anticipated that the introduction of a cyanoacrylate rnaterial, commonly referred to as surgical glue, onto the outer surface of the fusion charnber(s) may be used to fix the implant in optimal position awaiting bone ingrowth.

Implantation of the articulating spinal iniplant according to the present invention may be carried out in a manner generally similar to previously-known inethods for the implantation of non-articulating, rigid-fusion iniplants, with exceptions as set out herein. For example, the niethod of the present invention may utilize standard surgical approaches to the spine fronl either an anterior approacii for tiie cervical and thoracic spinal seg-nents, or from an anterior or posterior approach to the lunibar spinal segments. 'I7ie re-noval of vertebral sections may be accomplished by drilling or chipping a generally circular bore having a diameter and depth adapted to generally inatch the inlplant to be utilized, bridging the first and second vertebra.
Additionally, the circular bore may be tapered witli the leading end diameter being snialler then the tail end diaineter. The bore is preferably centered over the intervertebral space, approximately niidway between the first and second vertebra. 'T'hreads may tlien be tapped into the bore to facilitate insertion of the iniplant.

In an alternative method, the removal of vertebral sections may be accomplished by using a unique surgical instrunient, as shown in Figure 14, for drilling an elliptical bore having a major and niinor diameter and depth adapted to generally niatch the implant to be utilized, bridging the first and second vertebra. Preferably, the surgical instrument is affixed to a drill to provide rotational power to the cutting portion. The cutting portion of the surgical instrunient consists of a circular flute drill bit sheathed within cutting blades forined in a elliptical shape.
The flute drill bit extends out beyond cutting blades to cut a circular section between the first and second vertebra. As the drill bit cuts into the vertebra the cutting blades then reinove the remaining matcrial to form a elliptical bore ltaving a major and minor diatneter and depth adapted to generally match the implant to bc utilized, bridging the tirst and second vertebra.
Alternatively, the iniplant cati be provided with self-tapping threads. 'l'hc implant is assembled with the first and sccond articulating surfaces engaged, and the first anci second elements of the implant are rigidly coupled by stabilizing means substantially as described above. The stabilized implant is advanced into the bore to the desired depth.
Preferably, the intplant is advanced until the tailing end 92 is flush or slightly recessed relative to the outer surface of the vertebrae, thereby eliminating the possibility that outwardly projecting portions of the implant may interfere with or injure adjacent or regional*vascular, ncural or visceral stt-tictures.
In the lunibar area, where greater load bearing is required, two at-ticulating implants cati be placed in parallel positions with the lengthwise axis of eacli acijacent one to tlie other, in a generally parallel arrangement, allowing tlexion/extension niovement alone.
'I'his arrangement will typically require renioval of vertebral niaterial to form two openings, or an extended opening to accornmodate both implants. Alternatively, a singie, appropriately sized implant cottld be placed in the interspace utilizing the transabdominal open surgical approach, the transabdoniinal laparoscopic approach, or the retroperitoneal open anterior approach allowing pivotal motion around the single point of articulation as described above for use in cervical and thoracic intervertebral disc spaces.
Post-operatively, bone ingrowth will occur, fusing the first and/or second elements of the implant to the respective vertebra. After sufficient passage of time, the stabilizing nieans is dissolved and absorbed into the body, uncoupling the articulation means to permit relative motion between the first and secotid elemetits, thus preserving spinal flexibility and rninimizing destructive stress upon adjacent intervertebral joints. The implant resists axial compression between the first and second elements, and thereby prevents relative compression behveen the first and second vertebra, thus maintaining the desired intervertebral space.
Furthet-, the iniplant is recessed into the recipient vertebral site, eliminating inipitigement on tiext adjacent vascular, neural or visceral structures.

While the invention has been disclosed in its preferred foniis, it will be apparent to tose skilled in the art that many tnodificatioiis, additions, and deletions can be made therein without departing from the spirit and scope of the invention and its equivalents as set fortli in the following claims.

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Claims

CLAIMS:

1. A spinal implant comprising:

- a first element comprising a first articulation surface and a first outer surface adapted to engage a first vertebra;

- a second element comprising a second articulation surface and a second outer surface adapted to engage a second vertebra;

characterized in that said first articulation surface comprises a rocker extending along a length of said first element, said second articulation surface comprising a channel extending along a length of said second element, at least a portion of said rocker engaged within said channel to allow relative movement between said first element and said second element, and to resist axial compression along a support axis.

2. The spinal implant of claim 1, wherein said first articulation surface abuts said second articulation surface to form said articulation means.

3. The spinal implant of claim 2, wherein said articulation means comprises a concave surface in said first element and a convex surface from said second element, wherein at least a portion of said convex surface is engaged within said concave surface.

4. The spinal implant of claim 1, wherein said channel has a channel width at a top and bottom of said channel that is greater than a channel width at some point between said top and said bottom.

5. The spinal implant of claim 1, wherein said channel has a channel width at each end thereof that is greater than a channel width at some point between each end.

6. The spinal implant of claim 1, wherein said channel has a channel width at each end thereof that is less than a channel width at some point between each end.

7. The spinal implant of claim 6, wherein said rocker has a rocker width at each end thereof that is less than a rocker width at some point between each end.

8. The spinal implant of claim 1, wherein said first element includes a first fusion chamber located between said first articulation surface and said first outer surface, and said first outer surface defines at least one opening for facilitating bone ingrowth into said first fusion chamber.

9. The spinal implant of claim 1, wherein said second element comprises a second fusion chamber located between said second articulation surface and said second outer surface, and said second outer surface comprises at least one opening for facilitating bone ingrowth into said second fusion chamber.

10. The spinal implant of claim 1, wherein said first outer surface comprises a first radiused outer wall, and said second outer surface comprises a second radiused outer wall.

11. The spinal implant of claim 10, wherein said first radiused outer wall and said second radiused outer wall comprise a securing means for securing said spinal implant within a cavity between said first vertebra and said second vertebra.

12. The spinal implant of claim 11, wherein said securing means comprises a threaded surface defined by each of said first and second radiused outer surfaces.

13. The spinal implant of claim 10, wherein said first radiused outer wall and said second radiused outer wall comprise a hemicylindrical outer surface.

14. The spinal implant of claim 10, wherein said first radiused outer wall and said second radiused outer wall comprise a hemielliptical outer surface.

15. The spinal implant of claim 1, further comprising a tail end and a leading end; and wherein a first radius of said tail end is greater then a second radius of said leading end.

16. The spinal implant of claim 1, further comprising a stabilizing means for temporarily rigidly coupling said first element to said second element.

17. The spinal implant of claim 16, wherein said stabilizing means comprises an endcap adapted to releasably engage a portion of said first element and a portion of said second element.

18. The spinal implant of claim 16, wherein said stabilizing means comprises at least one bioreabsorbable element adapted to be absorbed after implantation.

19. The spinal implant of claim 1, wherein a intermediate articulation element is positioned between said first and second articulation surfaces.

20. The spinal implant of claim 19, wherein said first articulation surface comprises a concave surface, and said second articulation surface comprises a convex surface, and said intermediate articulation element comprises a generally hemispherical cap.

21. Use of the spinal implant as defined in any one of claims 1 to 20 for maintaining an intervertebral space between a first vertebra and a second vertebra, wherein said first and second articulation surfaces adjoin to form a joint allowing relative pivotal movement between said first and second elements but preventing relative compression between said first and second elements.

22. The use of the spinal implant as defined in claim 8 or 9, further comprising use of a means for stimulating bone growth in each of said first and second fusion chambers.

23. The use of claim 21 or 22, further comprising use of at least one bioreabsorbable stabilizing means for temporarily rigidly coupling said first element to said second element to facilitate mounting said first element within a cavity in said first vertebra.