CA2505850C - Articular facet interference screw - Google Patents
Articular facet interference screw Download PDFInfo
- Publication number
- CA2505850C CA2505850C CA2505850A CA2505850A CA2505850C CA 2505850 C CA2505850 C CA 2505850C CA 2505850 A CA2505850 A CA 2505850A CA 2505850 A CA2505850 A CA 2505850A CA 2505850 C CA2505850 C CA 2505850C
- Authority
- CA
- Canada
- Prior art keywords
- bone screw
- superior
- screw
- inferior
- facet
- 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.)
- Expired - Fee Related
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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
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
-
- 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
- A61B17/56—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
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/8605—Heads, i.e. proximal ends projecting from bone
- A61B17/861—Heads, i.e. proximal ends projecting from bone specially shaped for gripping driver
- A61B17/8615—Heads, i.e. proximal ends projecting from bone specially shaped for gripping driver at the central region of the screw head
-
- 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
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/8625—Shanks, i.e. parts contacting bone tissue
-
- 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
- A61B17/685—Elements to be fitted on the end of screws or wires, e.g. protective caps
-
- 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
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/8625—Shanks, i.e. parts contacting bone tissue
- A61B17/8635—Tips of screws
-
- 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
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B17/864—Pins or screws or threaded wires; nuts therefor hollow, e.g. with socket or cannulated
-
- 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
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8875—Screwdrivers, spanners or wrenches
-
- 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
- A61B17/84—Fasteners therefor or fasteners being internal fixation devices
- A61B17/86—Pins or screws or threaded wires; nuts therefor
- A61B2017/8655—Pins or screws or threaded wires; nuts therefor with special features for locking in the bone
Abstract
The bone screw (1) is used for locking an articular facet between the superior and inferior articular processes of two vertebral bodies and is provided with a threaded shaft (2), a screw head (3) and a central axis (4). The screw head (3) is further provided with a number of grooves (5) on the periphery of the screw head (3) which run essentially parallel to said central axis (4).
Description
z ~ 4 ~ 't~ d ~ z '~ .~ a ~.. , tY
Punted 0308 2004: D~SCf'PMD~ C C~0200608y v o ,~~ ,. .n.,.w . . ., ". ~ . , , . 5. as X"' .. ", ~ . ~' <.~.H .,.."<. , >, ,;r .. , z~.: a,.
23.7.2004 , Articular Facet Interference Screw This invention concerns a bone screw, in particular for locking an articular facet between the superior- and inferior articular processes of two vertebral bodies, in accordance with the pre-characterising portion of Claim 1.
To achieve a circumferential arthrodesis (fusion) the anterior and the posterior columns must be treated. The goal of the treatment is the restoration of the lordotic curve and the anatomically correct disc space. Anteriorly, i.e. in the intervertebral space, implants like cages are inserted' after disc removal. The posterior vertebral column, where the articular facet is located, should be locked as well. State-of-the-art techniques consider translaminar screws or transpedical instrumentation which, however, are not satisfactory.
Translaminar screws have certain disadvantages, like a) the screw insertion point is difficult to localize; the localization is done under full view, i.e. a separate posterior incision is performed medially whereas muscles must be separated from spinal and laminar processes. Most morbidity results from medial incision;
b) the surgeon's view is two-dimensional due to the small incision which may result in interference of the second screw with the first one; and c) aiming devices or navigation toots did not improve insertion technique or precision of screw placement.
CA 02505850 2005-05-11 AMENDED SHEET 26 07 2004:
tS r. r k .,. Z , t x . t d _ S
Fi~nted .,Q~ Q8 2004-' D~SCPAMDC C~-1020Q508 ,, . ... .. .. . ,..n ... ..... .~a ~ ..~. h.:..;~~. .. : ... . , .F _YC.. ,.
....
>s . ., From US-A 20011007074 A1 STROBEL a bone screw is known according the preamble of claim 7.
From US 4,754,749 TSOU another bone screw is known which has two closed canals in the screw head at an angle with the screw axis. A guide pin is insertable in one of these_closed canals, so that upon insertion of the guide pin it projects radially over the shaft and axially over the head of the screw which renders it complicated and rather unstable.
The invention as claimed aims at solving the above described problems.
The present invention provides a bone screw as defined in Claim 1 and a method for locking an articular facet of a vertebral body as defined in Claim 24 The advantages of said method and the use of said bone screw are the following:
- percutaneous approach which results in reduced morbidity;
- low implant cost due to simple design, in particular in comparison to transpedicular fixation;
- lower risk with regard to screw positioning compared to translami~aar screws; and - easy removal of the screws.
The interference screw according to the invention allows a new surgical technique to lock the articular facets of vertebral bodies.
Punted 0308 2004: D~SCf'PMD~ C C~0200608y v o ,~~ ,. .n.,.w . . ., ". ~ . , , . 5. as X"' .. ", ~ . ~' <.~.H .,.."<. , >, ,;r .. , z~.: a,.
23.7.2004 , Articular Facet Interference Screw This invention concerns a bone screw, in particular for locking an articular facet between the superior- and inferior articular processes of two vertebral bodies, in accordance with the pre-characterising portion of Claim 1.
To achieve a circumferential arthrodesis (fusion) the anterior and the posterior columns must be treated. The goal of the treatment is the restoration of the lordotic curve and the anatomically correct disc space. Anteriorly, i.e. in the intervertebral space, implants like cages are inserted' after disc removal. The posterior vertebral column, where the articular facet is located, should be locked as well. State-of-the-art techniques consider translaminar screws or transpedical instrumentation which, however, are not satisfactory.
Translaminar screws have certain disadvantages, like a) the screw insertion point is difficult to localize; the localization is done under full view, i.e. a separate posterior incision is performed medially whereas muscles must be separated from spinal and laminar processes. Most morbidity results from medial incision;
b) the surgeon's view is two-dimensional due to the small incision which may result in interference of the second screw with the first one; and c) aiming devices or navigation toots did not improve insertion technique or precision of screw placement.
CA 02505850 2005-05-11 AMENDED SHEET 26 07 2004:
tS r. r k .,. Z , t x . t d _ S
Fi~nted .,Q~ Q8 2004-' D~SCPAMDC C~-1020Q508 ,, . ... .. .. . ,..n ... ..... .~a ~ ..~. h.:..;~~. .. : ... . , .F _YC.. ,.
....
>s . ., From US-A 20011007074 A1 STROBEL a bone screw is known according the preamble of claim 7.
From US 4,754,749 TSOU another bone screw is known which has two closed canals in the screw head at an angle with the screw axis. A guide pin is insertable in one of these_closed canals, so that upon insertion of the guide pin it projects radially over the shaft and axially over the head of the screw which renders it complicated and rather unstable.
The invention as claimed aims at solving the above described problems.
The present invention provides a bone screw as defined in Claim 1 and a method for locking an articular facet of a vertebral body as defined in Claim 24 The advantages of said method and the use of said bone screw are the following:
- percutaneous approach which results in reduced morbidity;
- low implant cost due to simple design, in particular in comparison to transpedicular fixation;
- lower risk with regard to screw positioning compared to translami~aar screws; and - easy removal of the screws.
The interference screw according to the invention allows a new surgical technique to lock the articular facets of vertebral bodies.
2' CA 02505850 2005-05-11 AMENDED SHEET 2,6 07 2004 The natural functional spine unit (FSU) contains two articular facets. The function of the screw according to the invention is the interference in the sense of obstruction or fixation of said articular facets. Since the core diameter of the screw is significantly larger than the gap in the articular facet, the device is hindering the natural articulation. The function of the screw thread is the insertion by rotation. After insertion the screw thread protects the screw from axial migration and the anti-rotation device protects the screw from migration by rotation.
According to the new surgical method the locking screws are inserted through two percutaneous approaches in the trajectories parallel to the articular surface of the articular facet.
Aiming wires guarantee the correct positioning. An anti-rotation element keeps the bone screw in position and hinders the screws from turning out if micro-motion is applied to the screws. This technique is applicable if the anterior vertebral column (i.e.
the intervertebral space of the related segment) is stabilised with a spacer such as an intervertebral cage.
According to a special embodiment the grooves on the periphery of the screw head are running essentially parallel to the central axis. This shall be interpreted in such a way that minor angulation with regard to the central axis either towards radially the latter or tangentially to it would still be functional. Such an angulation in a.radial plane and measured relative to the central axis might be in the order of up to 60°, but preferably less than 20°. The possible angulation in a tangential plane and measured relative to the central axis might be in the order of maximum 20 °, preferably less than ~.0°.
In a particular embodiment the bone screw is provided with at least one pair of diametrally opposed grooves on the periphery of said screw head which enhances stability of the implant.
The screw head may be provided with a central cavity coaxially arranged with respect to said central axis, e.g. with a polygonal profile, preferably a hexagonal profile for receiving a screw-driver having a corresponding profile.
The grooves on the periphery of the screw head may be juxtaposed to the polygonal planes of said central cavity. By this measure a higher mechanical strength can be achieved.
In a further embodiment an anti-rotation element is insertable in said groove or said pair of grooves on the periphery of said screw head, whereby said anti-rotation element in its inserted position projects radially out of the periphery of said screw head. The anti-rotation element is preferably a U-shaped staple with two legs and a central portion bridging said two legs and designed for insertion into said groove or said pair of grooves of said screw head. The anti-rotation element has preferably a diameter which is larger than said screw head. The anti-rotation element in form of a U-shaped staple may be provided with a guiding element attached to said central portion and running essentially parallel to said legs. The guiding element may be in the form of a plate, a circular cylinder or a prism designed for insertion into said central cavity of said screw head. The cylindrical shape of the guiding element has the advantage of a more accurate gliding.
The central portion of the anti-rotation element may be provided with at least one perforation for removal of the screw.
The threaded shaft of the bone screw has preferably a thread with a high angle of pressure, e.g. in the range of 4° to 70°.
The flank of said thread can be symmetrically or asymmetrically oriented. The asymmetrically oriented thread is compressing particularly cancellous bone. This increases initial fixation stability.
The bone screw may be self-tapping, preferably by means of a cutting edge. "
The core of the screw shaft may be either cylindrical or tapering away from the screw head.
In the case of cylindrical core of the screw shaft various advantages can be achieved, namely:
- a continuous bending strength along the screw shaft;
- the application of a constant insertion torque while turning the screw in the articular facet; and - due to the constant shaft diameter the screw does not become loose if the device is turned back slightly after insertion.
This could appear if the surgeon brings the grooves for the anti-rotation element in congruent direction like the articular facet gap.
In the case of a conical shape of the core the shaft is compressing the surrounding bone. This increases the initial stability of the implant.
The envelope of the threaded shaft may be cylindrical allowing also a constant insertion torque. However, the envelope of the threaded shaft preferably tapers away from the screw head so that the purchase of the thread in the bone is increasing by turning the screw in.
The bone screw may be self-drilling, preferably by means of a chucking groove.
The new method for locking an articular facet between the superior and inferior articular processes of two vertebral bodies consists in the insertion of the threaded shaft of a bone screw in the gap of said articular facet. To that purpose the bone screw is preferably cannulated and insertion is performed by means of an aiming wire. The bone screw has preferably a screw head with a larger diameter than said threaded shaft and said threaded shaft is inserted in said gap of said articular facet until said screw head touches the bone. Upon insertion of said bone screw an anti-rotation element may be applied to said screw head such that rotation of said bone screw is prevented.
The various features of novelty which characterize the invention are pointed out with particularity in the claims annexed to and forming part of this disclosure. For the better understanding of the invention, its operating advantages and specific objects attained by its use, reference should be had to the accompanying drawings, examples and descriptive matter in which are illustrated and described preferred emb~diments of the invention.
In the drawings:
Fig. 1 is a perspective view of the bone screw according to the invention together with an anti-rotation element to be used with the screw;
Fig. 2a is a longitudinal section through the central axis of the screw and the anti-rotation element according to Fig. 1;
Fig. 2b is a top view of the bone screw according to Fig. 1 with the anti-rotation element inserted into the screw head;
Fig. 3 is a perspective view of a trocar for bringing an aiming wire into the gap between the articular facet;
Fig. 4. is a perspective view of a drill bit, the aiming wires being temporarily fixed in the gaps of the articular facets;
Fig. 5 is a perspective view of the bone screw being inserted by means of a screw-driver into the gap of the articular facet by using the temporarily fixed guiding wire;
Fig. 6 is a perspective view of the anti-rotation element being put over the screw head into its grooves closest to the joint gap; and Fig. 7 is a perspective view of the inserted bone screw to which the anti-rotation element has been attached.
The bone screw 1 as represented in Figs. 1, 2a and 2b is used in particular for locking an articular facet between the superior and inferior articular processes of two vertebral bodies. It has a threaded shaft 2, a screw head 3 and a central axis 4. The screw head 3 is provided with six grooves 5 regularly disposed on the periphery of the screw head 3 running essentially parallel to the central axis 4. The screw head 3 is further provided with a central cavity 6 coaxially arranged with respect to the central axis 4 and having a hexagonal shape.
The anti-rotation element 10 is provided with a U-shaped staple having two legs 11 and a central portion 13 bridging said two legs 11. The U-shaped staple is provided with a guiding element 12 - having the shape of a circular cylinder - attached to the central portion 13 and running essentially parallel to the legs 11. As can be seen in Figs. 1 and 2a the anti-rotation element may be connected to the bone screw 1 by moving it along the central axis 4 whereby its central portion 13 enters the central cavity 6 of 'the screw head 3 and the two legs 11 are inserted into one of the three pairs of grooves 5 of the screw head 3 as shown in Fig. 2b.
The free ends of the two legs 11 are provided with an protrusion oriented radially inwards to the central axis 4 so that when the legs 11 are gliding along the grooves 5 the protrusions 15 will click under the lower edge 16 of the screw head 3 thereby securing the anti-rotation element 10 against withdrawal in the opposite axial direction.
The central portion 13 of the U-shaped staple is further provided with at a perforation 14 facilitating removal of the bone screw 1.
Useful materials for the bone screw 1 as well as for the anti-rotation element 10 are titanium, titanium alloys or fibre-reinforced plastic materials. They may be coated with ceramic.
A detailed method of operation follows for the better under-standing of the invention:
1. Both positions in extension of the articulating planes of the articular facet concerned are identified and marked accordingly on the skin. To this purpose an image intensifier is used to control position and direction.
2. Bilateral skin incisions are performed in the direction of the articular facets.
3. Depending on the surgeon's preference, a trocar 17 or similar instrument is used to bring an aiming wire 18 into the .y gap" 19 between the articular facets (Fig. 3). Positional control is indicated using an image intensifier.
4. As shown in Fig. 4 the aiming wires 18 are temporarily fixed in the gaps 19 of the articular facets by means of the drill bit ("screw head reamer" or "counter sink").
According to the new surgical method the locking screws are inserted through two percutaneous approaches in the trajectories parallel to the articular surface of the articular facet.
Aiming wires guarantee the correct positioning. An anti-rotation element keeps the bone screw in position and hinders the screws from turning out if micro-motion is applied to the screws. This technique is applicable if the anterior vertebral column (i.e.
the intervertebral space of the related segment) is stabilised with a spacer such as an intervertebral cage.
According to a special embodiment the grooves on the periphery of the screw head are running essentially parallel to the central axis. This shall be interpreted in such a way that minor angulation with regard to the central axis either towards radially the latter or tangentially to it would still be functional. Such an angulation in a.radial plane and measured relative to the central axis might be in the order of up to 60°, but preferably less than 20°. The possible angulation in a tangential plane and measured relative to the central axis might be in the order of maximum 20 °, preferably less than ~.0°.
In a particular embodiment the bone screw is provided with at least one pair of diametrally opposed grooves on the periphery of said screw head which enhances stability of the implant.
The screw head may be provided with a central cavity coaxially arranged with respect to said central axis, e.g. with a polygonal profile, preferably a hexagonal profile for receiving a screw-driver having a corresponding profile.
The grooves on the periphery of the screw head may be juxtaposed to the polygonal planes of said central cavity. By this measure a higher mechanical strength can be achieved.
In a further embodiment an anti-rotation element is insertable in said groove or said pair of grooves on the periphery of said screw head, whereby said anti-rotation element in its inserted position projects radially out of the periphery of said screw head. The anti-rotation element is preferably a U-shaped staple with two legs and a central portion bridging said two legs and designed for insertion into said groove or said pair of grooves of said screw head. The anti-rotation element has preferably a diameter which is larger than said screw head. The anti-rotation element in form of a U-shaped staple may be provided with a guiding element attached to said central portion and running essentially parallel to said legs. The guiding element may be in the form of a plate, a circular cylinder or a prism designed for insertion into said central cavity of said screw head. The cylindrical shape of the guiding element has the advantage of a more accurate gliding.
The central portion of the anti-rotation element may be provided with at least one perforation for removal of the screw.
The threaded shaft of the bone screw has preferably a thread with a high angle of pressure, e.g. in the range of 4° to 70°.
The flank of said thread can be symmetrically or asymmetrically oriented. The asymmetrically oriented thread is compressing particularly cancellous bone. This increases initial fixation stability.
The bone screw may be self-tapping, preferably by means of a cutting edge. "
The core of the screw shaft may be either cylindrical or tapering away from the screw head.
In the case of cylindrical core of the screw shaft various advantages can be achieved, namely:
- a continuous bending strength along the screw shaft;
- the application of a constant insertion torque while turning the screw in the articular facet; and - due to the constant shaft diameter the screw does not become loose if the device is turned back slightly after insertion.
This could appear if the surgeon brings the grooves for the anti-rotation element in congruent direction like the articular facet gap.
In the case of a conical shape of the core the shaft is compressing the surrounding bone. This increases the initial stability of the implant.
The envelope of the threaded shaft may be cylindrical allowing also a constant insertion torque. However, the envelope of the threaded shaft preferably tapers away from the screw head so that the purchase of the thread in the bone is increasing by turning the screw in.
The bone screw may be self-drilling, preferably by means of a chucking groove.
The new method for locking an articular facet between the superior and inferior articular processes of two vertebral bodies consists in the insertion of the threaded shaft of a bone screw in the gap of said articular facet. To that purpose the bone screw is preferably cannulated and insertion is performed by means of an aiming wire. The bone screw has preferably a screw head with a larger diameter than said threaded shaft and said threaded shaft is inserted in said gap of said articular facet until said screw head touches the bone. Upon insertion of said bone screw an anti-rotation element may be applied to said screw head such that rotation of said bone screw is prevented.
The various features of novelty which characterize the invention are pointed out with particularity in the claims annexed to and forming part of this disclosure. For the better understanding of the invention, its operating advantages and specific objects attained by its use, reference should be had to the accompanying drawings, examples and descriptive matter in which are illustrated and described preferred emb~diments of the invention.
In the drawings:
Fig. 1 is a perspective view of the bone screw according to the invention together with an anti-rotation element to be used with the screw;
Fig. 2a is a longitudinal section through the central axis of the screw and the anti-rotation element according to Fig. 1;
Fig. 2b is a top view of the bone screw according to Fig. 1 with the anti-rotation element inserted into the screw head;
Fig. 3 is a perspective view of a trocar for bringing an aiming wire into the gap between the articular facet;
Fig. 4. is a perspective view of a drill bit, the aiming wires being temporarily fixed in the gaps of the articular facets;
Fig. 5 is a perspective view of the bone screw being inserted by means of a screw-driver into the gap of the articular facet by using the temporarily fixed guiding wire;
Fig. 6 is a perspective view of the anti-rotation element being put over the screw head into its grooves closest to the joint gap; and Fig. 7 is a perspective view of the inserted bone screw to which the anti-rotation element has been attached.
The bone screw 1 as represented in Figs. 1, 2a and 2b is used in particular for locking an articular facet between the superior and inferior articular processes of two vertebral bodies. It has a threaded shaft 2, a screw head 3 and a central axis 4. The screw head 3 is provided with six grooves 5 regularly disposed on the periphery of the screw head 3 running essentially parallel to the central axis 4. The screw head 3 is further provided with a central cavity 6 coaxially arranged with respect to the central axis 4 and having a hexagonal shape.
The anti-rotation element 10 is provided with a U-shaped staple having two legs 11 and a central portion 13 bridging said two legs 11. The U-shaped staple is provided with a guiding element 12 - having the shape of a circular cylinder - attached to the central portion 13 and running essentially parallel to the legs 11. As can be seen in Figs. 1 and 2a the anti-rotation element may be connected to the bone screw 1 by moving it along the central axis 4 whereby its central portion 13 enters the central cavity 6 of 'the screw head 3 and the two legs 11 are inserted into one of the three pairs of grooves 5 of the screw head 3 as shown in Fig. 2b.
The free ends of the two legs 11 are provided with an protrusion oriented radially inwards to the central axis 4 so that when the legs 11 are gliding along the grooves 5 the protrusions 15 will click under the lower edge 16 of the screw head 3 thereby securing the anti-rotation element 10 against withdrawal in the opposite axial direction.
The central portion 13 of the U-shaped staple is further provided with at a perforation 14 facilitating removal of the bone screw 1.
Useful materials for the bone screw 1 as well as for the anti-rotation element 10 are titanium, titanium alloys or fibre-reinforced plastic materials. They may be coated with ceramic.
A detailed method of operation follows for the better under-standing of the invention:
1. Both positions in extension of the articulating planes of the articular facet concerned are identified and marked accordingly on the skin. To this purpose an image intensifier is used to control position and direction.
2. Bilateral skin incisions are performed in the direction of the articular facets.
3. Depending on the surgeon's preference, a trocar 17 or similar instrument is used to bring an aiming wire 18 into the .y gap" 19 between the articular facets (Fig. 3). Positional control is indicated using an image intensifier.
4. As shown in Fig. 4 the aiming wires 18 are temporarily fixed in the gaps 19 of the articular facets by means of the drill bit ("screw head reamer" or "counter sink").
5. As shown in Fig. 5 a cannulated and self-tapping bone screw 1 is inserted by means of a screw-driver 21 into the gap 19 by using the temporarily fixed guiding wires 18 until the screw heads 3 of the bone screws 1 are touching the bone.
6. As shown in Fig. 6 an anti-rotations element 10 is put over the screw head 3 in the grooves 5 (notches) closest to the joint gap 19. Eventually the bone screw 1 must be turned back by some degrees in order to match the grooves 5 (notches) in the screw head 3 with the joint gap 19 (Fig. 7).
7. All instruments are removed.
8. The placement of the bone screws 1 is verified by using an image identifier and the wound is closed.
The method of operation as described can be performed on one side of the vertebral column only but is preferably performed simultaneously on the right and left side, as shown in Figs. 3 to 7, which has biomechanical advantages.
The method of operation as described can be performed on one side of the vertebral column only but is preferably performed simultaneously on the right and left side, as shown in Figs. 3 to 7, which has biomechanical advantages.
Claims (46)
1. A bone screw for locking an articular facet between the superior and inferior articular processes of two vertebral bodies, said bone screw comprising:
a threaded shaft;
a central longitudinal axis;
a screw head having at least one axial groove on its periphery; and an anti-rotation element insertable in said at least one groove, said anti-rotation element projecting radially outward from said periphery of said screw head when inserted in said at least one groove.
a threaded shaft;
a central longitudinal axis;
a screw head having at least one axial groove on its periphery; and an anti-rotation element insertable in said at least one groove, said anti-rotation element projecting radially outward from said periphery of said screw head when inserted in said at least one groove.
2. The bone screw of claim 1 wherein said at least one axial groove runs substantially parallel to said central axis.
3. The bone screw of claim 1 wherein said at least one axial groove has an angulation in a radial plane and measured relatively to said central axis in the order of less than 600°.
4. The bone screw of claim 1 wherein said at least one axial groove has an angulation in a tangential plane and measured relatively to said central axis in the order of less than 20°.
5. The bone screw of claim 1 wherein said at least one axial groove has an angulation in a tangential plane and measured relatively to said central axis in the order of less than 10°.
6. The bone screw of claim 1 further comprising a second groove on the periphery of said screw head, said second groove diametrically opposed to said at least one groove.
7. The bone screw of claim 1 wherein said screw head has a central cavity coaxial with said central axis.
8. The bone screw of claim 1 wherein said anti-rotation element has a diameter larger than the diameter of said screw head.
9. The bone screw of claim 1 wherein said anti-rotation element is generally U-shaped having two legs and a central portion bridging said two legs.
10. The bone screw of claim 9 wherein said anti-rotation element comprises a guiding element attached to said central portion that runs substantially parallel to said legs.
11. The bone screw of claim 10 wherein:
said screw head has a central cavity; and said guiding element comprises either a plate, a circular cylinder, or a prism insertable into said central cavity of said screw head.
said screw head has a central cavity; and said guiding element comprises either a plate, a circular cylinder, or a prism insertable into said central cavity of said screw head.
12. The bone screw of claim 9 wherein said central portion has at least one perforation.
13. The bone screw of claim 1 wherein said threaded shaft has a thread with a high angle of pressure ranging from 4° to 70°.
14. The bone screw of claim 13 wherein said thread has a flank that is symmetrically oriented.
15. The bone screw of claim 13 wherein said thread has a flank that is asymmetrically oriented.
16. The bone screw of claim 1 wherein said bone screw is self-tapping.
17. The bone screw of claim 1 wherein said screw head has a central cavity having a polygonal profile.
18. The bone screw of claim 17 wherein said at least one groove on the periphery of said screw head is juxtaposed with a polygonal plane of said central cavity.
19. The bone screw of claim 1 wherein said threaded shaft has a cylindrical core.
20. The bone screw of claim 1 wherein said threaded shaft has a core that tapers away from said screw head.
21. The bone screw of claim 1 wherein said threaded shaft has a cylindrical envelope.
22. The bone screw of claim 1 wherein said threaded shaft has an envelope that tapers away from said screw head.
23. The bone screw of claim 1 wherein said bone screw is self-drilling via a chucking groove.
24. Use of an intra-facet bone screw for insertion into a facet joint between a superior articular surface of an inferior vertebral body and an inferior articular surface of a superior vertebral body said intra-facet bone screw suitable for insertion into the facet joint between the superior articular surface of the inferior vertebral body and the inferior articular surface of the superior vertebra so that the threaded shaft of the bone screw partially engages the superior and inferior articular surfaces, a longitudinal axis of the bone screw being substantially aligned with and located between the superior articular surface of the inferior vertebral body and the inferior articular surface of the superior vertebral body; and comprising an anti-rotation element suitable for attachment on said bone screw such that a portion of said anti-rotation element projects radially outward from the periphery of said bone screw to prevent rotation of said bone screw.
25. The use of claim 24 wherein:
said bone screw is cannulated; and an aiming wire is suitable for insertion of said threaded shaft of said bone screw into the facet joint.
said bone screw is cannulated; and an aiming wire is suitable for insertion of said threaded shaft of said bone screw into the facet joint.
26. The use of claim 24 wherein:
said bone screw has a screw head with a larger diameter than said threaded shaft and is suitable for insertion of said threaded shaft of said bone screw into the facet joint until said screw head touches bone.
said bone screw has a screw head with a larger diameter than said threaded shaft and is suitable for insertion of said threaded shaft of said bone screw into the facet joint until said screw head touches bone.
27. The use of claim 24 wherein:
said bone screw has a screw head having at least one groove; and the anti-rotation element on said bone screw is such that a portion of said anti-rotation element is suitable for insertion in said groove and projects radially outward from the periphery of said bone screw to prevent rotation of said bone screw.
said bone screw has a screw head having at least one groove; and the anti-rotation element on said bone screw is such that a portion of said anti-rotation element is suitable for insertion in said groove and projects radially outward from the periphery of said bone screw to prevent rotation of said bone screw.
28. The use of claim 24 wherein said insertion and said attachment is on right and left sides of a vertebral column.
29. Use of first and second intra-facet bone screws suitable for insertion into first and second articular facet joint gaps between superior and inferior articular processes of two vertebral bodies of a patient's spine comprising:
a) a first aiming wire suitable for insertion of a portion of the first aiming wire into the first articular facet joint gap and a second aiming wire suitable for insertion of a portion of the second aiming wire into the second articular facet joint gap;
b) the first intra-facet bone screw suitable for simultaneous insertion into the first facet joint gap and the second intra-facet bone screw suitable for simultaneous insertion into the second facet joint gap, the first bone screw being suitable for insertion into the first facet joint gap between the superior articular process of an inferior vertebra and the inferior articular process of a superior vertebra such that an externally threaded shaft of the first bone screw is suitable for partial engagement of the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra, a longitudinal axis of the first bone screw being substantially aligned with and located between the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra, the second bone screw being suitable for insertion into the second facet joint gap between the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra such that an externally threaded shaft of the second bone screw is suitable for partial engagement of the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra, a longitudinal axis of the second bone screw being substantially aligned with and located between the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra;
and c) the first and second aiming wires are suitable for removal from the first and second facet joint gaps.
a) a first aiming wire suitable for insertion of a portion of the first aiming wire into the first articular facet joint gap and a second aiming wire suitable for insertion of a portion of the second aiming wire into the second articular facet joint gap;
b) the first intra-facet bone screw suitable for simultaneous insertion into the first facet joint gap and the second intra-facet bone screw suitable for simultaneous insertion into the second facet joint gap, the first bone screw being suitable for insertion into the first facet joint gap between the superior articular process of an inferior vertebra and the inferior articular process of a superior vertebra such that an externally threaded shaft of the first bone screw is suitable for partial engagement of the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra, a longitudinal axis of the first bone screw being substantially aligned with and located between the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra, the second bone screw being suitable for insertion into the second facet joint gap between the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra such that an externally threaded shaft of the second bone screw is suitable for partial engagement of the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra, a longitudinal axis of the second bone screw being substantially aligned with and located between the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra;
and c) the first and second aiming wires are suitable for removal from the first and second facet joint gaps.
30. The use of claim 29, wherein the first and second bone screws are suitable for percutaneous insertion into the first and second facet joint gaps.
31. The use of claim 29, further comprising:
d) identification of first and second articulating planes of the first and second facet joint gaps on the patient's skin; and e) a device suitable for forming bilateral skin incisions at the first and second articulating planes.
d) identification of first and second articulating planes of the first and second facet joint gaps on the patient's skin; and e) a device suitable for forming bilateral skin incisions at the first and second articulating planes.
32. The use of claim 29 comprising:
d) a first trocar suitable for insertion at least partially into the first facet joint gap and a second trocar suitable for insertion into the second facet joint gap prior to a).
d) a first trocar suitable for insertion at least partially into the first facet joint gap and a second trocar suitable for insertion into the second facet joint gap prior to a).
33. The use of claim 29 wherein the first and second facet joint gaps are suitable for preparation with a drill bit prior to a).
34. The use of claim 29 wherein the first and second bone screws are suitable for insertion in b) until heads of the first and second bone screws touch bone adjacent the first and second facet joint gaps.
35. The use of claim 34 comprising:
d) first and second anti-rotation elements suitable for placement over the heads of the first and second bone screws.
d) first and second anti-rotation elements suitable for placement over the heads of the first and second bone screws.
36. The use of claim 29 wherein an image identifier is suitable for verification of d) placement of the first and second bone screws prior to c).
37. Use of an intra-facet bone screw and an anti-rotation element suitable for insertion into a facet joint gap between superior and inferior articular processes of adjacent vertebrae following formation of an incision in a patient in need thereof, the bone screw including a longitudinal axis, an externally threaded shaft, a head and a cannulated bore and the anti-rotation element including two legs and a central portion, comprising:
a) an aiming wire suitable for insertion at least partially into the facet joint gap;
b) the intra-facet bone screw suitable for percutaneous insertion at least partially into the facet joint gap with the aiming wire, and insertion between the superior articular process of an inferior vertebra and the inferior articular process of a superior vertebra;
c) the bone screw suitable for insertion into the facet joint gap such that the externally threaded shaft of the bone screw is suitable for partial engagement with the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra, the longitudinal axis of the intra-facet bone screw being substantially aligned with and located between the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra and the head touches bone adjacent the facet joint gap;
d) the aiming wire suitable for removal; and e) the anti-rotation element suitable for placement over the head such that the two legs are positioned in the facet joint gap, respectively, and the central portion of the anti-rotation element is positioned in the cannulated bore.
a) an aiming wire suitable for insertion at least partially into the facet joint gap;
b) the intra-facet bone screw suitable for percutaneous insertion at least partially into the facet joint gap with the aiming wire, and insertion between the superior articular process of an inferior vertebra and the inferior articular process of a superior vertebra;
c) the bone screw suitable for insertion into the facet joint gap such that the externally threaded shaft of the bone screw is suitable for partial engagement with the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra, the longitudinal axis of the intra-facet bone screw being substantially aligned with and located between the superior articular process of the inferior vertebra and the inferior articular process of the superior vertebra and the head touches bone adjacent the facet joint gap;
d) the aiming wire suitable for removal; and e) the anti-rotation element suitable for placement over the head such that the two legs are positioned in the facet joint gap, respectively, and the central portion of the anti-rotation element is positioned in the cannulated bore.
38. The use of claim 37, wherein the bone screw is suitable for insertion in c) by movement of the bone screw down the aiming wire such that the aiming wire is positioned within the cannulated bore.
39. The use of claim 37 wherein the bone screw is suitable for turning back following d) to match grooves in the head of the bone screw with the joint gap such that the two legs are positioned in the facet joint gap.
40. A bone screw for locking an articular facet between the superior and inferior articular processes of two vertebral bodies, said bone screw comprising a threaded shaft suitable for insertion in a gap of said articular facet, and an anti-rotation element suitable for attachment onto said bone screw such that a portion of said anti-rotation element projects radially outward from the periphery of said bone screw to prevent rotation of said bone screw.
41. An intra-facet bone screw for insertion into a facet joint between a superior articular surface of an inferior vertebral body and an inferior articular surface of a superior vertebral body comprising:
a threaded shaft for insertion into the facet joint between the superior articular surface of the inferior vertebral body and the inferior articular surface of the superior vertebra so that the threaded shaft of the bone screw partially engages the superior and inferior articular surfaces, a longitudinal axis of the bone screw being substantially aligned with and located between the superior articular surface of the inferior vertebral body and the inferior articular surface of the superior vertebral body; and an anti-rotation element for attachment on said bone screw such that a portion of said anti-rotation element projects radially outward from the periphery of said bone screw to prevent rotation of said bone screw.
a threaded shaft for insertion into the facet joint between the superior articular surface of the inferior vertebral body and the inferior articular surface of the superior vertebra so that the threaded shaft of the bone screw partially engages the superior and inferior articular surfaces, a longitudinal axis of the bone screw being substantially aligned with and located between the superior articular surface of the inferior vertebral body and the inferior articular surface of the superior vertebral body; and an anti-rotation element for attachment on said bone screw such that a portion of said anti-rotation element projects radially outward from the periphery of said bone screw to prevent rotation of said bone screw.
42. The intra-facet bone screw of claim 41 wherein:
said bone screw is cannulated.
said bone screw is cannulated.
43. The intra-facet bone screw of claim 41 wherein:
said bone screw has a screw head with a larger diameter than said threaded shaft.
said bone screw has a screw head with a larger diameter than said threaded shaft.
44. The intra-facet bone screw of claim 41 wherein:
said bone screw has a screw head having at least one groove.
said bone screw has a screw head having at least one groove.
45. An intra-facet bone screw and an anti-rotation element for insertion into a facet joint gap between superior and inferior articular processes of adjacent vertebrae, the bone screw including a longitudinal axis, an externally threaded shaft, a head and a cannulated bore and the anti-rotation element including two legs and a central portion.
46. The bone screw of claim 1 wherein said at least one axial groove has an angulation in a radial plane and measured relatively to said axis in the order of less than 20°.
Applications Claiming Priority (1)
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PCT/CH2002/000608 WO2004043278A1 (en) | 2002-11-13 | 2002-11-13 | Articular facet interference screw |
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CA2505850A1 CA2505850A1 (en) | 2004-05-27 |
CA2505850C true CA2505850C (en) | 2011-01-04 |
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CA2505850A Expired - Fee Related CA2505850C (en) | 2002-11-13 | 2002-11-13 | Articular facet interference screw |
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US (3) | US7699878B2 (en) |
EP (1) | EP1585449B8 (en) |
JP (1) | JP4307387B2 (en) |
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2002
- 2002-11-13 JP JP2004550592A patent/JP4307387B2/en not_active Expired - Lifetime
- 2002-11-13 DE DE60214908T patent/DE60214908T2/en not_active Expired - Lifetime
- 2002-11-13 ES ES02774232T patent/ES2274099T3/en not_active Expired - Lifetime
- 2002-11-13 EP EP02774232A patent/EP1585449B8/en not_active Expired - Lifetime
- 2002-11-13 AU AU2002340694A patent/AU2002340694B2/en not_active Ceased
- 2002-11-13 BR BRPI0215923-6A patent/BR0215923B1/en not_active IP Right Cessation
- 2002-11-13 WO PCT/CH2002/000608 patent/WO2004043278A1/en active IP Right Grant
- 2002-11-13 CA CA2505850A patent/CA2505850C/en not_active Expired - Fee Related
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WO2004043278A1 (en) | 2004-05-27 |
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JP2006506113A (en) | 2006-02-23 |
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US7699878B2 (en) | 2010-04-20 |
TWI296194B (en) | 2008-05-01 |
TW200414890A (en) | 2004-08-16 |
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