DE102007007306B3 - Intervertebral implant has two implant parts and joint part; first implant part has two contact elements for contact with vertebrae, second has two joint contact elements; joint part is at least partly in form of textile or knitted fabric - Google Patents

Abstract

The implant has first and second implant parts and a joint part, whereby the first implant part (260 has first and second contact elements for contact with the vertebrae and the second implant part has first and second joint contact elements. The joint part is at least partly in the form of a textile or a knitted fabric. An independent claim is also included for an implant system.

Description

The The present invention relates to a disc implant for insertion in an intervertebral space between adjacent vertebral bodies of two Vertebrae of a human or animal spine, with a first implant part, a second implant part and a Joint part, wherein the first implant part a first and a second on each vertebral body can be applied applying element, wherein the second implant part a first and a second can be applied to a respective vertebral body Articulating element comprises and wherein in an insertion position the first and second implant part detached from each other and in an implantation position are interconnected, with only the second implant part comprises the joint part for forming a articulated connection between the first and the second joint contact element.

Further The present invention relates to an implant system comprising an intervertebral disc implant for insertion into an intervertebral space between adjacent vertebral bodies two vertebrae of a human or animal spine and at least an insertion instrument for holding and inserting the disc implant or a part thereof, wherein the disc implant has a first implant part, a second implant part and a hinge part comprises, wherein the first implant part a first and a second to each one vertebral body can be applied applying element, wherein the second implant part a first and a second can be applied to a respective vertebral body joint system element includes and wherein in an insertion position the first and second implant part detached from each other and in an implantation position are interconnected, with only the second implant part comprises the joint part for forming a articulated connection between the first and the second joint contact element.

Of Further, a method of implanting will be described below an intervertebral disc implant of the type described above or a implant system of the type described above in an intervertebral space between adjacent vertebral bodies two vertebrae of a human or animal spine.

Intervertebral disc implants be in spine surgery used to degenerate, from an intervertebral space between adjacent vertebral bodies two vertebrae of a human or animal spine removed intervertebral discs to replace. Disc implants typically include two plates, each at a vertebral body the adjacent vertebra are created. Furthermore, they include a Joint part, which is typically formed in two parts, wherein one part on one plate and the other part on the other Plate are arranged. The hinge part halves and the plates can in particular also in one piece be educated. Such disc prostheses are already used routinely, over an anterior approach. However, this access has several difficulties. Many surgeons are unfamiliar with the anterior approach. In addition, large vessels must be mobilized become the intervertebral space, which also serves as an intervertebral disc space is called to be able to reach. In particular, injuries to the vessels may occur. Furthermore, revision of the implant is extremely difficult as it is in the range access to scarring comes and the large vessels also grow.

Therefore, disc implants have already been proposed which are suitable for being inserted via a posterior approach. Such an intervertebral disc implant is for example from WO 2005/067824 A1 known. A disadvantage of this known disc implant, however, is that abutting joint surfaces of the joint part are not worked in one piece. Furthermore, from the US 2006/0069440 A1 a multi-part artificial disc replacement implant known, which allows a selective positioning of the joint part. It is therefore an object of the present invention to improve a disc implant and an implant system of the type described above so that they have better functionality.

These Task is in an intervertebral disc implant described above Type according to the invention thereby solved, that. The hinge part at least partially in the form of a fabric or a knitted fabric is formed.

Thus, in the intervertebral disc implant according to the invention, only the second implant part, that is to say the first and the second joint abutment element, supports the joint part. This has compared to in the WO 2005/067824 A1 implant described essential advantages. Thus, the first implant part with the first and second abutment element can be used, for example in conjunction with an insertion instrument, to distract the adjacent vertebral bodies. A distraction facilitates the insertion of the second implant part, which comprises the joint part, because the second implant part typically has a greater height than the first implant part. Since the first implant part does not include the hinge part, the first and the second contact element, in particular during the insertion of the disc Implants, directly come into contact with each other. They can therefore be inserted into a much smaller gap, as the second implant part. Overall, it is thus possible Lich, by introducing a posterior approach the first implant part in the intervertebral space and to distract with this the adjacent to the intervertebral space vertebral body. Once the distance between the adjacent vertebral bodies required for inserting the second implant part has been established, the second implant part can be introduced into the intervertebral space through a second posterior access. Optionally, the first and the second implant part can be firmly connected to one another after insertion into the intervertebral space. A joint part formed at least partially in the form of a fabric or a knitted fabric has outstanding damping properties and also not only allows pivoting movements about one or more pivot axes, but also a shearing motion and axial mobility of the vertebral bodies connected to one another via the intervertebral disc implant, so that overall the properties of a natural disc can be simulated almost perfectly.

Preferably are the fabric and / or the knit of a wire and / or a Fiber formed. In particular, the training of a knitted fabric allows a wire both a stable and a permanently high loadable articulated connection between the adjacent vertebral bodies. Preferably, the a knit wire of titanium or a titanium alloy produced.

In order to the disc implant can at least partially absorb water, for example, an elasticity of the joint part to increase or specifically to reduce, it is advantageous if the hinge part a hydrogel is. Hydrogels are available in numerous variants.

Cheap is it, when the hinge part is formed such that the first and the second joint contact element in the implantation position by at least a hinge axis are pivotable relative to each other. With such a Joint part allows the disc implant according to the invention at least one pivotal movement of the two vertebrae, where the disc implant abuts the at least one hinge axis.

Especially Cheap it is when the hinge part is formed such that the first and the second articulation element in the implantation position pivotable about a hinge point relative to each other ball pivot are. With such a hinge part are practically pivoting movements the over the intervertebral disc implant interconnected vertebral body any number of joint axes possible. It is thus a joint movement with more than one degree of freedom between the first and the second joint system element possible.

Preferably the hinge part is formed in one or two parts. The hinge part So it can be one piece be formed or comprise at least two parts, wherein a Part of the joint part of the first joint attachment element and another Part of the joint part associated with the second joint system element are. The at least two parts of the joint part can be fixed connected to the respective joint system element or integrally with be trained this. A one-piece joint part has in particular the advantage that a permanent and possibly also insoluble connection between the first and second hinge abutment members via the one-piece joint part can be produced.

conveniently, the hinge part is at least partially made of an elastic material produced. So lets Easily move between the first and second Enable hinge system element.

Especially easy to manufacture is the disc implant when the joint part, the first implant part and / or the second implant part at least partly made of a plastic material.

Desired properties of the disc implant can be easily adjusted, if the plastic is a polymer.

In order to characteristics of the disc implant in dependence an environment of the disc implant after implantation can adjust it is advantageous if the plastic is hydrophobic or hydrophilic is. In particular, a hydrophilic plastic allows the disc implant at least partially absorb water, for example, a elasticity of the joint part to increase or deliberately decrease. An example of such a hydrophilic Material is a hydrogel that comes in many variations.

to increase a stability of the disc implant, it is advantageous if the joint part, the first implant part and / or the second implant part at least partially made of a metal. Preferably, the Investment elements and the hinge system elements entirely of a metal produced.

A especially good body tolerance of the Disc implant can be achieved if the metal is titanium, a titanium alloy, a cobalt-based alloy, stainless steel and / or a stainless steel alloy is.

Cheap is it, if the hinge part at least a first and a second, for comprises first correspondingly formed joint element and when in the implantation position, the first joint element on the first Articulating element and the second joint element on the second joint system element is held. Depending on the design of the first and the second joint element can be such a desired Relative movement between the adjacent the disc implant Vertebrae set become.

Especially just lets a ball-joint movement of the adjacent vertebrae relative reach each other, when the first joint element and a hollow dome when the second joint element is formed dome-shaped.

Around a wear, in particular by abrasion, to reduce the joint part, it is cheap, though at least one of the two hinge elements at least partially provided with a coating. The coating can in particular be a friction-reducing coating. As coating materials In particular, plastics, preferably polymers, such as for example, polyetheretherketone (PEEK), with or without fiber reinforcement, for example Carbon fibers can be used.

Preferably the coating is at least partially a ceramic coating. Ceramics are often very common when forming a sliding bearing abriebarm and increase thereby a life of the disc implant.

A stability of the disc implant leaves Easily increase in that the hinge part in the implantation position insoluble with the first and / or second joint contact element is connected. Especially may be the hinge part or, for example, the training him Gelenkele elements, in one piece be formed with the first and second hinge system element.

advantageously, the first and the second contact element are designed such that they are in the release position releasably connectable with an insertion instrument are. Such a design makes it possible with those with the insertion Connected plant elements the intervertebral space by distraction the adjacent vertebral body to enlarge, to an insertion of the second implant part, which the hinge part includes, facilitate.

Cheap is it, when the first and the second contact element in the form of Spreizgliedern a spreader instrument for distracting the adjacent vertebrae formed are and when the spreading members are formed so that they in the release position detachable with the spreading instrument are connectable. The first and the second contact element thus form temporary Parts of the spreader and serve to create adjacent to vertebra of the intervertebral space in which the disc implant is inserted shall be. Thus, virtually a part of the spreader instrument remains, namely its Spreading elements, in the body of the patient, because they form part of the disc implant.

advantageously, the first and / or the second implant part at least one Tool element connecting link for releasable connection with insertion and / or spreading instruments. In particular, if that to Implantation used insertion or spreading with at least a tool element connecting member corresponding links equipped, leaves This is a simple way to create a temporary connection between the respective instrument and the first and / or second implant part produce.

Especially Easy to make is the disc implant, if that at least a tool element connecting member in the form of a tool element holder is trained. In particular, the tool element receptacle in shape be formed a bore or a blind hole, which can also be provided with a threaded portion.

Around the stability of the disc implant to increase overall, it is advantageous if the first contact element and the first joint contact element and the second Investment element and the second joint investment element in the implantation position connected to each other. In this way, the first expands Investment element, so to speak, the first joint investment element and the second Investment element, the second joint investment element. Both the first and second abutment elements as well as the first and second hinge abutment element but are only so big that they can be easily accessed through a posterior access in the body introduced by the patient and in the cleared out Intervertebral space can be used.

In order to optimize a force flow in the spinal column and not to interfere with the intervertebral disc implant, it is advantageous if the joint part in the implantation position is arranged symmetrically or substantially symmetrically with respect to the interconnected first and second implant parts. For example, this can be achieved in that the first implant part is smaller than the second implant part, which comprises the joint part. However, the first implant part can also be as large as the second implant part, namely when these overlap at least partially in the implantation position.

Advantageous it is when a connecting device is provided for connecting the first and second implant part in the implantation position and when the connecting means at least a first, at the first Implant part provided and at least a second, on the second Implant part provided connecting member, which in the Implantation position are engaged with each other. By means of Connecting device can be the first and the second implant part easily connect with each other.

Especially simply the first and the second implant part can be with each other connect when the connecting device in the form of a snap or snap connection is formed and if the at least one first and at least a second link in the form of cooperating Detent or snap members are formed. The first and the second Implant part can be with the snap or snap connection in particular connect without further connecting means. Screws or the like are therefore optionally optionally providable to the first and the second implant part to connect with each other.

Cheap is it, if that at least a first and that at least a second one Connecting member in the implantation position non-positively and / or positively with each other engage. So can easily secure connection of the first and the second implant part are achieved with each other.

Especially The first and the second implant are easy and safe connect part together when the at least one first link is formed in the form of a connecting recess and when the at least one second connecting member in the form of a connection to the recess corresponding connecting projection is formed.

On the first and the second implant part can be easily adjusted bring relative to each other in the implantation position, if the Connecting recess in the form of a groove or a recess is formed and when the connection projection in the form of a to the groove or to the return is formed corresponding tongue. That's the way it is possible, the parts to be joined together in a direction transverse to a longitudinal direction defined by the groove or parallel to this longitudinal direction assemble, for example, collapse.

Preferably The disc implant comprises at least one on or in one Vertebral body can be anchored Anchoring element. By anchoring element can be prevented be that the disc implant moves relative to the vertebral body, in particular, such a relative displacement is prevented. The anchoring element is preferably in the form of a projecting towards the vertebral body Projection formed. Preference, he is on one of the investment elements and / or arranged one of the hinge abutment elements and has from the outer surface perpendicular or substantially perpendicular away. A protruding thorn is suitable Great as an anchoring element.

Advantageous However, it is when the anchoring element in the insertion position is separated from the first and / or second implant part. That's how it works Anchoring element as the first part of the disc implant in introduced the intervertebral space and after in insertion of the first and / or second implant part connected to one of them become.

Preferably is the anchoring element in the form of a bone pin, a bone screw or a clamp formed. Leave such anchoring elements easy and safe with or without appropriate instruments in a vertebral body anchor.

According to one preferred embodiment of Invention may be provided that the first and / or the second Implant part comprise at least a first guide element, that the disc implant at least a second, with the first guide element cooperating guide element and that the at least one first and the at least one second guide element in the insertion position relative to each other are so movable and cooperate, that the first and / or second implant part from the insertion position in the implantation position can be transferred. For example, you can the first and second guide elements serve to the first and / or the second implant part in a desired To bring position into the intervertebral space. So, for example the first guide element along the second guide element guided be to the first and / or the second implant part in the desired implantation position into the intervertebral space.

In order to optimize a guide of the first and / or second implant part, it is advantageous if the at least one second guide element is arranged on the anchoring element or can be arranged thereon. For example, first of all, the anchoring element can be attached to one of the two vertebral bodies adjoining the intervertebral space be anchored by. If the second guide element is arranged on the anchoring element, for example connected thereto, the first guide element, which is arranged on the first and / or second implant part, can be guided into the intervertebral space along the second guide element.

One Particularly simple construction of the disc implant results in that the at least one second guide element in the form of a Thread or a wire is formed. For example, let so the first and / or the second implant part to simple Pull the way into the intervertebral space.

Cheap is it, if the at least one first guide element in the form of a Aperture or recess is formed, in which the at least a second guide element in the introductory and / or implantation position is stored. For example, can the second guide element, if it is in the form of a thread or wire in which Opening or recess are made, respectively the implant part, which has the opening or recess, along the thread or wire. Breakthroughs have the advantage that the first and the second guide element not except Intervention can get. The second guide element can remain in the body after implantation of an intervertebral disc implant or removed. Cheap is it when the second guide element made of a resorbable material. It can be so after Implantation remain in the body of the patient for a certain time and a holding or Exercise attachment function, wherein after a certain time the second guide element is absorbed and then stops exercising a function.

Around simply and safely attach the disc implant to a vertebral body to be able to is it cheap if the disc implant is at least one plane or substantially planar vertebral contact surface comprises.

Advantageous it is when the first and the second implant part at least one have first and at least one second planar Implantteilwirbelkörperanlagefläche and if the at least one flat vertebral contact surface the comprises at least a first and the at least one second planar Implantteilwirbelkörperanlagefläche. The Vertebral abutment surface can so at least two areas together be, namely in that the first implant part and the second implant part be joined together and take the implantation position.

advantageously, comprise at least the first and / or the second implant part a trained for insertion into the bone anchoring element. Such an anchoring element prevents the first and / or the second implant part can be moved relative to the vertebral body when the disc implant is inserted into the disc space.

Preferably is the at least one anchoring element in the form of one of Vertebral contact surface protruding Projection formed. A derar tiger projection can easily in a vertebral body penetrate and prevent a relative movement of the vertebral body relative to the vertebral body contact surface. The projection may be formed, for example, like a spike.

The The object initially posed is further in an implant system The type described above solved according to the invention, that the hinge part at least partially in the form of a fabric or a Knitted fabric is formed.

Thereby, that only the second implant part comprises the joint part, not However, the first implant part, the first implant part with inserting the insertion instrument into the intervertebral space, taking, for example, a particularly compact design of the first To achieve implant part, the first and the second contact element while touching each other. After insertion of the first implant part in the intervertebral space can the first and the second contact element are used, the adjacent vertebral bodies to distract to insertion the second implant part, which carries the joint part, facilitate. An at least partially in the form of a fabric or a knit trained joint part has excellent damping properties and also does not allow only pivoting movements about one or more pivot axes, but also a shearing motion and axial mobility of the over Intervertebral disc implant interconnected vertebrae relative to each other, so that overall the characteristics of a natural Intervertebral disc can be simulated almost perfectly.

In order to the disc implant can at least partially absorb water, for example, an elasticity of the joint part to increase or specifically to reduce, it is advantageous if the hinge part a hydrogel is. Hydrogels are available in numerous variants.

Preferably The implanted disc implant is one of the above described disc implants. It then also has the in conjunction with the disc implants described above mentioned advantages.

Around adjacent vertebral bodies in a simple way to be able to distract, it is advantageous if the Implant system includes a spreader tool for spreading the first and / or second implant part in the insertion and / or implantation position.

In order to preferably few instruments need to be provided, it is advantageous if the spreader instrument that forms at least one insertion instrument. The spreader instrument can thus be used to insert and hold the first and / or second implant part and optionally for distracting the adjacent vertebral bodies be used.

Around to prevent the first and / or second implant part from the insertion tool, is it cheap when the insertion instrument has at least one tool member for detachable connection with the first and / or second implant part in the insertion position.

In order to Preferably, a non-positive and / or positive connection between the Insertion instrument and the first and / or second implant part can be produced, it is advantageous if the at least a tool member corresponding to the at least one tool element connecting member is trained.

Especially when the tool element connecting member in the form of a recess, for example a bore or a blind hole is formed, it is advantageous if the at least one tool member is formed in the form of a projection is.

• – der erste Implantatteil in den Zwischenwirbelraum eingesetzt wird,
• – das erste und das zweite Anlageelement distrahiert werden zum Distrahieren der benachbarten Wirbelkörper,
• – das zweite Implantatteil in den Zwischenwirbelraum eingesetzt und mit dem ersten Implantatteil verbunden wird und
• – eine Distraktion der distrahierten Anlageelemente vor oder nach dem Verbinden des ersten und zweiten Implantatteils miteinander wieder zurückgenommen wird.

Furthermore, a method of the type described above for implanting one of the above-described disc implants or one of the implant systems described above in an intervertebral space between adjacent vertebrae of two vertebrae of a human or animal spine is proposed, in which

• The first implant part is inserted into the intervertebral space,
• The first and second abutment members are distracted to distract the adjacent vertebral bodies,
• - The second implant part is inserted into the intervertebral space and connected to the first implant part and
• A distraction of the distracted abutment elements is withdrawn before or after joining the first and second implant parts together.

With In this procedure, an intervertebral disc implant can be simple and secure be used. In particular, it is not required two Instruments in succession with the first and second implant part to connect to introduce them into the intervertebral space, but it can at the same time the first and / or the second implant part in the intervertebral space be used and interconnected in this. Especially good for this Method the intervertebral disc implants described above or the implant systems described above.

Around Surgery trauma for To minimize a patient, it is beneficial if the first one Implant part through a first minimally invasive posterior. Access and if the second implant part by a second minimally invasive introduced posterior access become.

The following description of preferred embodiments of the invention used in conjunction with the drawings for further explanation. Show it:

1 : a schematic representation of the insertion of a first implant part with an insertion instrument in an intervertebral space;

2 : a schematic representation of the insertion of a second implant part with an insertion instrument into an intervertebral space;

3 a schematic representation of the positioning of the first and second implant part relative to each other in the intervertebral space;

4 a partial side view of a spine with inserted disc implant in the intervertebral space;

5 : an exploded view of the in 4 shown disc implant;

6 a perspective view of a second embodiment of an intervertebral disc implant;

7 : a plan view of the hinge part of the in 6 shown disc implant; and

8th : an enlarged detail view of the joint part 7 ,

In the 1 and 2 is a total with the reference numeral 10 provided implant system shown. It includes an intervertebral disc implant 12 for insertion into an intervertebral space 14 between adjacent vertebral bodies 16 and 18 two whirls 20 and 22 a human or animal spine 24 , The disc implant 12 includes a first implant part 26 , a second implant part 28 and a joint part 30 ,

The first implant part 26 comprises a first, plate-shaped contact element 32 and a second, also plate-shaped contact element 34 , The second implant part 28 comprises a first plate-shaped joint contact element 36 and a second, also plate-shaped joint attachment element 38 , The first investment element 32 and the first joint attachment element 36 are by means of a first connection device 40 connectable with each other. The second investment element 34 and the second joint attachment element 38 are by means of a second connection device 42 connectable with each other. The first investment element 32 and the second contact element 34 are formed substantially symmetrically to a plane of symmetry, which parallel to Implantteilwirbelkörperanlageflächen 44 and 46 runs, pointing in opposite directions. Analog are the plate-shaped joint system elements 36 and 38 formed substantially symmetrically to the same plane of symmetry, which also parallel to Implantteilwirbelkörperanlageflächen 48 and 50 the joint system elements 36 and 38 runs, wherein the Implantteilwirbelkörperanlageflächen 48 and 50 in opposite directions. The first and the second implant part 26 and 28 are formed such that the Implantteilwirbelkörperanlageflächen 44 and 48 of the first contact element 32 and the first joint attachment element 36 a common planar vertebral contact surface 52 form the implant partial vertebral body abutment surfaces 46 and 50 of the second contact element 34 and the second joint system element 38 a common, also flat vertebral body contact surface 54 ,

The investment elements 32 and 34 as well as the joint system elements 36 and 38 are substantially kidney-shaped in a plan view. The first connection device 40 includes two first, on the first investment element 32 arranged connecting members, in the form of a recess-like, oval recess 56 which on a bottom 58 in a front end region of the first abutment element 32 is trained. A second first connecting member is formed by a wedge-shaped in cross-section groove 60 , which from the first investment element 32 pointing away and in a plane parallel to the vertebral abutment surface 52 slightly concave curved. From a free end of the first joint system element 36 sticking out is a tongue 62 provided in the form of an approximately semicircular disc, which is slightly smaller than the recess 56 is trained. The tongue 62 forms as well as a corresponding to the groove 60 trained lead 64 at an end edge of the first joint contact element 36 , a second link of the first connection means 40 , In a connection position in which the projection 64 in the groove 60 and the tongue 62 into the recess 56 intervene, take the first investment element 32 and the first joint attachment element 36 the so-called implantation position.

The second connection device 42 also includes two first links on the second abutment 34 and a recess like recess 66 as well as a groove 68 , which is also wedge-shaped in cross-section. The second joint system element 38 carries as well as the first joint attachment element 36 , at a free end a tongue 70 in the form of a roughly semicircular disc and below this one projection 72 which corresponds to the groove 68 is trained. In the implantation position, in which the second contact element 34 and the second joint attachment element 38 connected, the projection emerges 72 positively in the groove 68 one and the tongue 70 fills the slightly larger recess 66 at least partially. Because of the recesses 56 and 66 a little bigger than the tongues 62 and 70 , can be the first investment element 32 and the first joint attachment element 36 or the second contact element 34 and the second joint attachment element 38 along one of the grooves 60 respectively 68 defined path are shifted relative to each other.

The second implant part 28 carries the joint part 30 , This one is in the in the 1 to 5 illustrated embodiment in two parts and includes a first hinge element 74 and a second hinge element 76 , The first joint element 74 is on a bottom 78 the first joint system element 36 formed, in the form of a substantially disc-shaped projection, which on its from the bottom 78 wegweisenden side a hollow dome-shaped recess 80 having. The second joint element 76 is in the form of a recess 80 shaped corresponding Kalottenabschnitts. The first joint element 74 is integral with the first joint attachment element 36 formed, the second hinge element 76 with the second joint system element 38 ,

The hinge part 30 of the disc implant 12 allows a pivoting movement of the first joint system element 36 and the second joint system element 38 relative to one another about a hinge point which is defined by a center of one of the second hinge element 76 defined dome-shaped surface.

The first connection device 40 and the second connection means 42 can optionally also be designed in the form of a latching or snap connection, which have cooperating detent or snap members, which partially the contact elements 32 and 34 or the joint system elements 36 and 38 assigned. For producing a durable and stable Ver Bond between the investment elements 32 and 34 and the articulation elements 36 and 38 may be the first and second links of the connecting devices 40 and 42 non-positively and / or positively engaged with each other.

On the implant partial vertebral body abutment surfaces 44 . 46 . 48 and 50 are several conical spines 82 formed, which serve as anchoring elements in the articular surfaces of the vertebral body 16 and 18 can penetrate to a relative movement between the disc implant 12 and the vertebral bodies 16 and 18 to prevent after implantation.

Each investment element 32 and 34 as well as each articulation element 36 and 38 indicates at one of the connecting devices 40 and 42 opposite end two parallel with their longitudinal axes aligned blind holes 84 on, the tool element connecting members form in the form of Werkzeugelementaufnah men. Furthermore, on the investment elements 32 and 34 three holes each 86 provided, the longitudinal axes parallel to the vertebral body contact surfaces 52 and 54 run. Two of the holes 86 ends adjacent to the blind holes 84 , one of them in the area of the grooves 60 and 68 ends. The other of the two holes mentioned 86 ends on a convexly curved outer edge of the respective contact element 32 respectively 34 , Adjacent to the mouth of the latter bore is another mouth of the third bore 86 also provided in the area of the grooves 60 respectively 68 ends.

The hinge system elements 36 and 38 have two holes 88 on, with one of the holes adjacent to the blind holes 84 ends and obliquely through the respective joint system element 36 respectively 38 opens in a convex outward facing outer edge. Adjacent to this mouth extends the further bore 88 , and up to the respective projection 64 respectively 72 , The longitudinal axes of the holes 88 also run parallel to the vertebral body contact surfaces 52 respectively 54 , The holes 86 and 88 form first guide elements whose function is described in more detail below.

The disc implant 12 also includes two anchoring elements 90 in the form of bone pins, on which a thread 92 , which forms a second guide element, is attached.

The implant system 10 also includes a spreading instrument 94 for holding and inserting the first implant part. For this purpose are on Spreizinstrument 94 two tool members provided in the form of parallel projecting pins which are to the blind holes 84 are formed correspondingly. The investment elements 32 and 34 , the quasi-spreader instrument 94 form releasable expansion members, so can with the spreading instrument 94 get connected. This is also designed so that the investment elements 32 and 34 parallel to each other away from each other and can be moved towards each other. The insertion instrument 96 is preferably formed as a shaft-like holding instrument, which at a distal end also two pairs of to the blind holes 84 having corresponding pin, so that the joint system elements 36 and 38 can be held together when the second hinge element 76 in the first joint element 74 intervenes.

The first and second implant parts 26 and 28 are preferably made of a biocompatible material, such as a metal or a plastic. The anchoring elements 90 are preferably made of a metal, the thread 92 can optionally be made of a resorbable material.

Hereinafter, a preferred method for implantation of the disc implant 12 in the intervertebral space 14 described.

First, the degenerated disc of the patient, not shown in the figures, must be removed. For this purpose, at least one posterior access into the body of the patient is initially opened. The annulus of the disc is opened translaminar or transforaminal. Thereafter, a conventional partial dissectectomy of the intervertebral disc is made so as to maximize the position of the anchoring element 90 to reach. For this purpose, a channel is preferably created, for example by drilling or by resection by means of a rongeur. Preferably, the optimal position of the anchoring element 90 under X-ray control or navigated, that is determined by means of a navigation system. For this a test instrument is inserted into the prepared canal. The trial instrument provides the necessary dimensions of an applicator for the anchoring element 90 represents.

Next, the applicator of the anchoring element 90 under X-ray control or navigated introduced. In particular, the applicator can be designed such that at the same time two anchoring elements 90 in mutually facing articular surfaces of the vertebral bodies 16 and 18 can be introduced. Now the anchoring elements 90 according to the specified optimum position in the vertebral bodies 16 and 18 anchored. Thereafter, the applicator is removed. Using the on the anchoring element 90 fixed thread 92 becomes a resection instrument to the anchoring element 90 used and the degenerated disc resected, with the anchoring element 90 as a reference point.

Optionally, after resection, a measuring instrument with the anchoring element 90 positioned as a reference point and a resection surface to be checked.

In a next step, the first implant part 26 with spreader tool coupled to it 94 with the help of the thread 92 in the intervertebral space 14 inserted. For this purpose, the thread through holes 98 in the implant partial vertebral body abutment surfaces 44 and 46 that in conjunction with one of the holes 86 stand, threaded through, so that the thread 92 starting from the anchoring element 90 through two holes 86 until the end, at which the blind holes 84 are arranged, from the respective investment element 32 and 34 is led out. Is the first implant part 26 positioned in the desired manner, be by means of spreader 94 the vertebral bodies 16 and 18 distracts, that is the intervertebral space 14 is widened.

The string 92 is passed around the medullary canal and out of the patient's body through a second, minimally invasive approach. It is further noted that the thread 92 through all three holes 86 the first investment elements 32 respectively 34 is performed so that he is in the area of the grooves 60 respectively 68 from the respective investment element 32 respectively 34 exit. He will then drill outside the patient's body through the holes 88 the joint system elements 36 and 38 threaded so that he finally out of the mouth of the hole 88 exit, which is adjacent to the blind holes 84 is arranged. The second implant part 28 then with the insertion tool 96 connected by its pin in the blind holes 84 be inserted. The second implant part 28 can then with the insertion instrument 96 in the intervertebral space 14 introduced and with the thread 92 to the first implant part 26 be introduced. Will the thread 92 curious, so the joint part 30 in its final position, that is in the implantation position about an axis perpendicular to the vertebral body abutment surfaces 52 respectively 54 turned. A connection of the implant parts 26 and 28 takes place via the connecting devices 40 and 42 , Finally, the thread 92 secured and the insertion instrument 96 from the second implant part 28 separated. Finally, the distraction of the vertebral bodies 16 and 18 withdrawn and the spreader instrument 94 also from the first implant part 26 away. In some cases, the distraction may need to be withdrawn to the implant parts 26 and 28 by means of the connecting devices 40 and 42 connect to.

Through the two minimally invasive approaches to the intervertebral space 14 from both sides this can be better achieved for resection and implantation than just from one side and more easily than via an anterior approach.

Instead of the disc implant 12 Alternatively, a in the 6 to 8th illustrated disc implant 100 be used. It is different from the disc implant 12 only by the design of the joint part 102 , Incidentally, the parts of the disc implant 100 identical to those of the disc implant 12 trained so that in the 6 to 8th the same reference numerals have been used for identification.

The hinge part 102 is a total of one piece and has a parallel to the vertebral body contact surfaces 52 respectively 54 in approximately kidney-shaped cross section. It is formed from a compressed knitted fabric, ie a woven or knitted fabric made of a wire 104 or a fiber. Preferably, a wire 104 used, the stability of the joint part 102 elevated. A suitable material is in particular titanium or a titanium alloy. The knitwear is made in the form of a tube, for example, knitted on a circular knitting machine, and then pressed into the desired shape. In this way, a compressed, compact, but elastic hinge part 102 educated. This is partially compressible and may be on the second implant part 28 fitting surfaces of the joint part 102 be moved in parallel relative to each other. This means that with the implant 100 Shear forces can also be absorbed. The hinge part 102 is preferably fixed to the hinge system elements 36 and 38 connected.

The implantation of the disc implant 100 takes place analogously to the implantation of the disc implant described above 10 that is, bilaterally posteriorly between the laminae, that is via an interlaminar approach or transforaminal, as exemplified in US Pat 1 and 2 to see. The first implant part 26 again forms a distraction part and is optionally used for distraction of the vertebral bodies 16 and 18 ,

Claims (47)

Disc implant ( 12 ; 100 ) for insertion into an intervertebral space ( 14 ) between adjacent vertebral bodies ( 16 . 18 ) of two vortices ( 20 . 22 ) of a human or animal spine ( 24 ), with a first implant part ( 26 ), a second implant part ( 28 ) and a joint part ( 30 ; 102 ), wherein the first implant part ( 26 ) a first and a second to a respective vertebral body ( 16 . 18 ) bare investment element ( 32 . 34 ), wherein the second implant part ( 28 ) a first and a second to a respective vertebral body ( 16 . 18 ) engageable articulation element ( 36 . 38 ) and wherein in an insertion position the first and second implant part ( 26 . 28 ) are detached from one another and connected to one another in an implantation position, wherein only the second implant part ( 28 ) the joint part ( 30 ; 102 ) for forming an articulated connection between the first and the second joint installation element ( 36 . 38 ), characterized in that the joint part ( 102 ) is formed at least partially in the form of a fabric or a knitted fabric. An intervertebral disc implant according to claim 1, characterized in that the tissue and / or the knitted fabric consists of a wire ( 104 ) and / or a fiber are formed. Disc implant according to the preamble of claim 1, characterized in that the joint part ( 30 ; 102 ) is a hydrogel. Disc implant according to one of the preceding claims, characterized in that the joint part ( 30 ; 102 ) is formed such that the first and the second joint contact element ( 36 . 38 ) in the implantation position are pivotable relative to each other about at least one hinge axis. Disc implant according to one of the preceding claims, characterized in that the joint part ( 30 ; 102 ) is formed such that the first and the second joint contact element ( 36 . 38 ) in the implantation position about a hinge point relative to each other are pivotable ball joint. Disc implant according to one of the preceding claims, characterized in that the joint part ( 30 ; 102 ) is formed in one or two parts. Disc implant according to one of the preceding claims, characterized in that the joint part ( 102 ) is at least partially made of an elastic material. Disc implant according to one of the preceding claims, characterized in that the joint part ( 30 ; 102 ), the first implant part ( 26 ) and / or the second implant part ( 28 ) are at least partially made of a plastic. An intervertebral disc implant according to claim 8, characterized in that that the plastic is a polymer. An intervertebral disc implant according to claim 8 or 9, characterized characterized in that the plastic is hydrophobic or hydrophilic. Disc implant according to one of the preceding claims, characterized in that the joint part ( 30 ; 102 ), the first implant part ( 26 ) and / or the second implant part ( 28 ) are at least partially made of a metal. An intervertebral disc implant according to claim 11, characterized characterized in that the metal is titanium, a titanium alloy, a Cobalt base alloy, stainless steel and / or a stainless steel alloy is. Disc implant according to one of claims 6 to 12, characterized in that the joint part ( 30 ) at least a first and a second, to the first correspondingly formed hinge element ( 74 . 76 ) and that in the implantation position, the first joint element ( 74 ) on the first joint element ( 36 ) and the second joint element ( 76 ) on the second articulation element ( 38 ) is held. An intervertebral disc implant according to claim 13, characterized in that the first joint element ( 74 ) hollow-calotte-shaped and that the second joint element ( 76 ) is formed dome-shaped. An intervertebral disc implant according to claim 13 or 14, characterized in that at least one of the two joint elements ( 74 . 76 ) is at least partially provided with a coating. An intervertebral disc implant according to claim 15, characterized characterized in that the coating at least partially a ceramic coating is. Disc implant according to one of the preceding claims, characterized in that the joint part ( 30 ; 102 ) in the implantation position inseparably with the first and / or the second joint contact element ( 36 . 38 ) connected is. An intervertebral disc implant according to one of the preceding claims, characterized in that the first and the second abutment element ( 32 . 34 ) are designed such that they are in the release position with an insertion instrument ( 94 ) are releasably connectable. An intervertebral disc implant according to one of the preceding claims, characterized in that the first and the second abutment element ( 32 . 34 ) in the form of spreading members ( 32 . 34 ) of a spreader instrument ( 94 ) for distracting the adjacent vertebral bodies ( 16 . 18 ) are formed and that the spreading members ( 32 . 34 ) are designed such that they in the release position with the Spreizinstru ment ( 94 ) are releasably connectable. An intervertebral disc implant according to claim 18 or 19, characterized in that the first and / or the second implant part ( 26 . 28 ) at least one tool element connecting member ( 84 ) for detachable connection with insertion and / or spreading instruments ( 94 . 96 ) exhibit. An intervertebral disc implant according to claim 20, characterized in that the at least one tool element connecting member ( 84 ) in the form of a tool element receptacle ( 84 ) is trained. An intervertebral disc implant according to one of the preceding claims, characterized in that the first abutment element ( 32 ) and the first articulation element ( 36 ) and the second contact element ( 34 ) and the second joint contact element ( 38 ) are interconnected in the implantation position. Disc implant according to one of the preceding claims, characterized in that the joint part ( 30 ; 102 ) in the implantation position relative to the interconnected first and second implant parts ( 26 . 28 ) is arranged symmetrically or substantially symmetrically. An intervertebral disc implant according to one of the preceding claims, characterized in that a connecting device ( 40 . 42 ) is provided for connecting the first and second implant part ( 26 . 28 ) in the implantation position and that the connection device ( 40 . 42 ) at least a first, on the first implant part ( 26 ) provided and at least a second, on the second implant part ( 28 ) provided link ( 56 . 60 . 62 . 64 . 66 . 68 . 70 . 72 ) which are engaged with each other in the implantation position. An intervertebral disc implant according to claim 24, characterized in that the connecting device ( 40 . 42 ) is designed in the form of a latching or snap connection and that the at least one first and the at least one second connecting member ( 56 . 60 . 62 . 64 . 66 . 68 . 70 . 72 ) in the form of interacting detent or snap members ( 56 . 60 . 62 . 64 . 66 . 68 . 70 . 72 ) are formed. An intervertebral disc implant according to 24 or 25, characterized in that the at least one first and the at least one second connecting member ( 60 . 64 . 68 . 72 ) in the implantation position positively and / or positively engage with each other. An intervertebral disc implant according to any one of claims 24 to 26, characterized in that the at least one first link ( 56 . 60 . 66 . 68 ) in the form of a connection recess ( 56 . 60 . 66 . 68 ) is formed and that the at least one second connecting member ( 62 . 64 . 70 . 72 ) in the form of a connection recess ( 56 . 60 . 66 . 68 ) corresponding connection projection ( 62 . 64 . 70 . 72 ) is trained. An intervertebral disc implant according to claim 27, characterized in that the connecting recess ( 56 . 60 . 66 . 68 ) in the form of a groove ( 60 . 68 ) or a return ( 56 . 66 ) and that the connection projection ( 62 . 64 . 70 . 72 ) in the form of a groove ( 60 . 68 ) or to return ( 56 . 66 ) corresponding tongue ( 62 . 64 . 70 . 72 ) is trained. An intervertebral disc implant according to one of the preceding claims, characterized in that the intervertebral disc implant ( 12 ; 100 ) at least one on a vertebral body ( 16 . 18 ) anchorable anchoring element ( 90 ). An intervertebral disc implant according to claim 29, characterized in that the anchoring element ( 90 ) in the insertion position of the first and / or second implant part ( 26 . 28 ) is disconnected. An intervertebral disc implant according to claim 29 or 30, characterized in that the anchoring element ( 90 ) in the form of a bone pin ( 90 ), a bone screw or a clamp is formed. Disc implant according to one of the preceding claims, characterized in that the first and / or the second implant part ( 26 . 28 ) at least one first guide element ( 86 . 88 ) include that the disc implant ( 12 ; 110 ) at least a second, with the first guide element ( 86 . 88 ) cooperating guide element ( 92 ) and that the at least one first and the at least one second guide element ( 86 . 88 . 92 ) are so movable in the insertion position relative to each other and cooperate, that the first and / or second implant part ( 26 . 28 ) can be transferred from the insertion position into the implantation position. An intervertebral disc implant according to claim 32, characterized in that the at least one second guide element ( 92 ) on the anchoring element ( 90 ) is arranged or can be arranged on this. An intervertebral disc implant according to claim 32 or 33, characterized in that the at least one second guide element ( 92 ) in the form of a thread ( 92 ) or a wire is formed. Disc implant after one of the An Claims 32 to 34, characterized in that the at least one first guide element ( 86 . 88 ) in the form of an opening ( 86 . 88 ) or recess is formed, in which the at least one second guide element ( 92 ) is stored in the insertion and / or implantation position. An intervertebral disc implant according to one of the preceding claims, characterized in that the intervertebral disc implant ( 12 ; 100 ) at least one planar or substantially planar vertebral body abutment surface ( 52 . 54 ). An intervertebral disc implant according to claim 36, characterized in that the first and the second implant part ( 26 . 28 ) at least a first and at least one second planar Implantteilwirbelkörperanlagefläche ( 44 . 46 . 48 . 50 ) and that the at least one planar vertebral body abutment surface ( 52 . 54 ) the at least one first and the at least one second planar Implantteilwirbelkörperanlagefläche ( 44 . 46 . 48 . 50 ). Disc implant according to one of the preceding claims, characterized in that the first and / or the second implant part ( 26 . 28 ) at least one for introduction into bone ( 16 . 18 ) formed anchoring element ( 82 ). An intervertebral disc implant according to claim 38, characterized in that the at least one anchoring element ( 82 ) in the form of one of the vertebral abutment surface ( 52 . 54 ) protruding projection ( 82 ) is trained. Implant system ( 10 ) comprising an intervertebral disc implant ( 12 ; 100 ) for insertion into an intervertebral space ( 14 ) between adjacent vertebral bodies ( 16 . 18 ) of two vortices ( 20 . 22 ) of a human or animal spine ( 24 ) and at least one insertion instrument ( 94 . 96 ) for holding and inserting the disc implant ( 12 ; 100 ) or part ( 26 . 28 ), wherein the disc implant ( 12 ; 100 ) a first implant part ( 26 ), a second implant part ( 28 ) and a joint part ( 30 ; 102 ), wherein the first implant part ( 26 ) a first and a second to a respective vertebral body ( 16 . 18 ) abutment element ( 32 . 34 ), wherein the second implant part ( 28 ) a first and a second to a respective vertebral body ( 16 . 18 ) engageable articulation element ( 36 . 38 ) and wherein in an insertion position the first and second implant part ( 26 . 28 ) are detached from one another and connected to one another in an implantation position, wherein only the second implant part ( 28 ) the joint part ( 30 ; 102 ) for forming an articulated connection between the first and the second joint installation element ( 36 . 38 ), characterized in that the joint part ( 102 ) is formed at least partially in the form of a fabric or a knitted fabric. Implant system according to the preamble of claim 40, characterized in that the joint part ( 30 ; 102 ) is a hydrogel. Implant system according to claim 40 or claim 41, characterized in that the disc implant ( 12 ; 100 ) an intervertebral disc implant ( 12 ; 100 ) according to any one of claims 2, 4 to 39. Implant system according to one of claims 40 to 42, characterized in that the implant system ( 10 ) a spreader instrument ( 94 ) comprises for spreading the first and / or second implant part ( 26 . 28 ) in the insertion and / or implantation position. Implant system according to claim 43, characterized in that the spreader instrument ( 94 ) the at least one insertion instrument ( 94 ). Implant system according to one of claims 40 to 44, characterized in that the insertion instrument ( 94 . 96 ) at least one tool member for releasable connection to the first and / or second implant part ( 26 . 28 ) in the insertion position. Implant system according to claim 45, characterized in that the at least one tool member corresponding to the at least one tool element connecting member ( 84 ) is trained. Implant system according to claim 46, characterized in that that the at least one tool member in the form of a projection is trained.