WO2006044649A2 - Implant system, method, and instrument for augmentation or reconstruction of intervertebral disc - Google Patents
Implant system, method, and instrument for augmentation or reconstruction of intervertebral disc Download PDFInfo
- Publication number
- WO2006044649A2 WO2006044649A2 PCT/US2005/037002 US2005037002W WO2006044649A2 WO 2006044649 A2 WO2006044649 A2 WO 2006044649A2 US 2005037002 W US2005037002 W US 2005037002W WO 2006044649 A2 WO2006044649 A2 WO 2006044649A2
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- buttress plate
- blocking
- vertebral
- face
- retaining device
- Prior art date
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/442—Intervertebral or spinal discs, e.g. resilient
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- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1613—Component parts
- A61B17/1631—Special drive shafts, e.g. flexible shafts
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- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
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- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0082—Three-dimensional shapes parallelepipedal
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00017—Iron- or Fe-based alloys, e.g. stainless steel
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00029—Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00161—Carbon; Graphite
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00161—Carbon; Graphite
- A61F2310/00167—Diamond or diamond-like carbon
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00179—Ceramics or ceramic-like structures
- A61F2310/00185—Ceramics or ceramic-like structures based on metal oxides
- A61F2310/00203—Ceramics or ceramic-like structures based on metal oxides containing alumina or aluminium oxide
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00179—Ceramics or ceramic-like structures
- A61F2310/00185—Ceramics or ceramic-like structures based on metal oxides
- A61F2310/00239—Ceramics or ceramic-like structures based on metal oxides containing zirconia or zirconium oxide ZrO2
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00359—Bone or bony tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00365—Proteins; Polypeptides; Degradation products thereof
Definitions
- Intervertebral discs may be displaced or damaged due to trauma or disease resulting in disruption of the annulus fibrosis and the eventual protrusion of the nucleus pulposus into the spinal canal, a condition commonly referred to as a herniated or ruptured disc.
- the extruded nucleus pulposus may press on the spinal nerve, which may cause nerve damage, pain, numbness, muscle weakness and paralysis.
- Intervertebral discs may also deteriorate due to the normal aging process. As a disc dehydrates and hardens, the disc space height may be reduced, leading to instability of the spine, decreased mobility and pain.
- an augmentation instrument for attaching a retaining device to a vertebral endplate comprises a drive housing having a distal end portion, a drive mechanism extending through the drive housing and including a flexible shaft portion, and an attachment mechanism at the distal end portion of the drive housing.
- the attachment mechanism is adapted for coupling to the retaining device.
- a method for preventing migration of a prosthesis from an intervertebral disc space comprises providing a retaining device wherein the retaining device includes a blocking face disposed generally perpendicular to a mounting face. The method further comprises positioning the blocking face within the intervertebral disc space to prevent migration of the prosthesis and securing the mounting face to a vertebral endplate, wherein the retaining device is entirely within the intervertebral disc space.
- FIG. 1 is a sagittal view of vertebral column having a damaged intervertebral disc.
- FIG. 2 shows the intervertebral disc of FIG. 1.
- FIG. 3 a shows an implant system according to one embodiment of the present disclosure.
- FIG. 3b shows an implant according to another embodiment of the present disclosure.
- FIG. 3 c shows an implant according to another embodiment of the present disclosure.
- FIG. 3d shows an implant according to another embodiment of the present disclosure.
- FIG. 3e shows an implant according to another embodiment of the present disclosure.
- FIG. 3f shows an implant according to another embodiment of the present disclosure.
- FIG. 3g shows an implant according to another embodiment of the present disclosure.
- FIG. 3h shows an implant according to another embodiment of the present disclosure.
- FIG. 3i shows an implant according to another embodiment of the present disclosure.
- FIG. 4a shows a cross section view of the implant system of FIG. 3a.
- FIG. 4b shows a cross section view of the implant system of FIG. 3b.
- FIG. 5 shows an augmentation instrument according to one embodiment of the present invention.
- FIGS. 6-10 show a method of using the augmentation instrument.
- FIG. 11 shows an augmentation instrument according to another embodiment of the present invention and a method of using this augmentation instrument.
- the present invention relates generally to intervertebral disc reconstructive devices, and more particularly, to a system for retaining a prosthetic nucleus pulposus.
- the reference numeral 10 refers to a vertebral column with* a damaged intervertebral disc 12 extending between two intact vertebral bodies 14 and 16.
- Vertebral bodies 14, 16 include vertebral endplates 18, 20, respectively, interfacing the intervertebral disc 12.
- the damaged disc 12 may include a nucleus pulposus 22 surrounded by an annulus fibrosus 24. Repairing the damaged disc 12 may involve surgically removing all or portions of the damaged disc 12 and installing an implant system which may include nucleus pulposus replacements, partial or complete intervertebral disc replacements, and other devices for reconstructing or augmenting the intervertebral disc space. These repair procedures may be performed using an anterior, anterolateral, lateral, posterior or other approach known to one skilled in the art.
- an implant system 30 may include a prosthetic nucleus 32 for replacing all or portions of the natural nucleus pulposus
- the implant system 30 may further include one or more retaining devices such as buttress plates 34 attached to the adjacent vertebral body 16 with a fastener 36 and positioned to prevent expulsion or migration of the prosthetic nucleus 32 through an annular defect 38, such as an opening or a weak portion of the annular wall. Additionally, the implant system 30 may include one or more annular plugs 40 located between the prosthetic nucleus 32 and the buttress plates 34.
- retaining devices such as buttress plates 34 attached to the adjacent vertebral body 16 with a fastener 36 and positioned to prevent expulsion or migration of the prosthetic nucleus 32 through an annular defect 38, such as an opening or a weak portion of the annular wall.
- the implant system 30 may include one or more annular plugs 40 located between the prosthetic nucleus 32 and the buttress plates 34.
- the prosthetic nucleus 32 may be of the type described in greater detail in U.S. Patent No. 6,620,196 which is incorporated by reference herein.
- the prosthetic nucleus 32 may generally conform to the created disc space, functioning as a flexible or an articulating spacer to prevent or slow down the collapse of the disc space while maintaining the disc's normal biomechanics. Because th& annulus 24 may be difficult to surgically repair, the prosthetic nucleus 32 may have a tendency toward expulsion from the intervertebral disc space through the annulus defect 38.
- the prosthetic nucleus 32 may be formed of polymers such as polyurethane, copolymers of silicone and polyurethane, silicones, polyolef ⁇ n rubbers, polyvinyl alcohol hydrogels, polyacrylonitrile-based hydrogels, polyacrylic-based hydrogels, or polyurethane-based hydrogels.
- Natural tissues may also be used including collagen-rich or connective tissues such as disc annulus, fascia lata, planar fascia, anterior or posterior cruciate ligaments, Patella tendon, Hamstring tendon, Quadriceps tendon, Achilles tendon, skin, and/or pericardium.
- the prosthetic nucleus may be a more rigid articulating body formed, for example, of polymers such as ultra-high molecular weight polyethylene (UHMWPE), polyetheretherketone, or polymethylmethacrylate; metals such as cobalt-chrome alloys, titanium, titanium alloys, stainless steel, or titanium nickel alloys; or ceramics such as alumina, zirconia, polycrystalline diamond compact, or pyrolitic carbon.
- polymers such as ultra-high molecular weight polyethylene (UHMWPE), polyetheretherketone, or polymethylmethacrylate
- metals such as cobalt-chrome alloys, titanium, titanium alloys, stainless steel, or titanium nickel alloys
- ceramics such as alumina, zirconia, polycrystalline diamond compact, or pyrolitic carbon.
- the buttress plate 34 may provide strong resistance to prosthetic nucleus 32 expulsion even through a large annular defect 38 and may also minimize interference with the kinematics of the involved motion segment, preserving normal disc motion.
- the buttress plate 34 may have a relatively small size and low profile and may be generally subjected to relatively low mechanical demands.
- the buttress plate 34, together with the fastener 36, may fit entirely within the space between vertebral bodies 14, 16 and may be attached to at least one of the endplates 18, 20. Because the buttress plate 34 may be housed entirely within the intervertebral disc space, the damage and scarring of adjacent soft tissues may be minimized.
- the buttress plate 34 may have a height 39 sufficient to block expulsion of the nucleus without impacting the adjacent vertebral endplate during flexion/ extension movement.
- the height 39 may be between 2 and 12 millimeters or greater than half of the height of the intervertebral disc space.
- Buttress plate 34 may be angled or wedge-shaped as shown in FIGS. 3a and 4a, or it may be another shape effective to retain the prosthetic implant member 32 in a desired location when the buttress plate 34 is secured to a vertebral body.
- the buttress plate 34 includes a mounting face 42 for mounting to the endplate 20 and a retaining face 44 extending generally perpendicular to the mounting face 42 and spanning at least a portion of a cephalad-caudal distance 46 between the endplates 18, 20.
- the mounting face 42 may further include an aperture 48 sized to fit the fastener 36.
- the buttress plate 34, particularly mounting face 42 may include surface textures such as serrations, spikes, or ridges to provide better fixation to adjacent bone.
- the fastener 36 may be a screw, a locking screw, a pin, a staple, or another fastening device capable of anchoring the buttress plate 34 in position.
- the fastener 36 may extend as far as necessary into the adjacent vertebral body to securely anchor the buttress plate 34.
- the fastener may be placed at an angle relative to the vertebral endplate.
- the fastener 36 may be coated with hydroxyapetite to improve fixation to the surrounding bone.
- Buttress plate 34 may be made of a rigid, biocompatible material, such as metals, ceramics, polymers, composites, tissue, or other materials.
- suitable metals may include titanium, titanium alloy, nickel titanium alloy, stainless steel, or cobalt chrome alloy.
- Suitable polymers may include polyaryletherketone, polyetheretherketone, polysulfone, polyolefin, polyethylene, tyrosine-based polycarbonate, polyester, polylactide, polyglicolide, polyorthoester, polyphosphazene, polyhydroxylbutyrate, or polyhydroxiylvalerate.
- Suitable composites may include carbon-filled composites, hydroxyl-apetite-filled composites, bioactive-glass-filled composites, and cortical-bone- chip-filled composites.
- Suitable tissues may include cortical bone, cancellous-cortical bone, and bone-ligament structures.
- the bone contacting surfaces of the buttress plate 34 may be coated with hydroxyapetite to enhance fixation.
- the annular plug 40 may be formed of a non-rigid material that generally conforms to the annular defect 38 and may be attached to or placed adjacent the buttress plate 34 to promote original disc mechanics.
- the use of the annular plug 40 in combination with the buttress plate 34 may provide an effective seal to the annular defect 38 and may reduce wear on the prosthetic nucleus 32 by preventing or limiting direct contact between the prosthetic nucleus 32 and the buttress plate 34. Further, the annular plug 40 may promote healing of the annular defect 38.
- the annular plug 40 may be held in place by compression, mechanical fasteners, adhesives, or other suitable means.
- the annular plug 40 may be molded to the buttress plate 34 or attached by a dovetail joint.
- the annular plug 40 may be formed of elastic or otherwise resilient materials.
- suitable materials may include, hydrogels, silicone, polyurethane, polyolefins such as polyisobutylene and polyisoprene, copolymers of silicone and polyurethane, neoprene, nitrile, vulcanized rubber, and/ or other biocompatible elastomeric materials known in the art.
- Fabric or porous scaffold materials made of various synthetic or natural materials may also be suitable for forming annular plug 40.
- These materials may be resorbable or non-resorbable and may include, for example, polyethylene, polyester, polyvinyl alcohol, polyacrylonitrile, polyamide, polytetrafluorethylene, poly- paraphenylene terephthalam ⁇ de, cellulose, silk, elastin, polylactide, polyglycolide, tyrosine-derived polycarbonate, polyanhydride, polyorthoester, polyp hosphazene, polyhydroxybutyrate, and/or polyhydroxyvalerate.
- Natural tissues may also be suitable for forming annular plug 40. For example, autografts, allografts, or xenografts of annulus, ligament, tendon, or other connective tissues may be used.
- the buttress plate may be available in a variety of sizes to provide surgeons with flexibility in repairing annular defects.
- the angle between the mounting and retaining faces may be non-perpendicular.
- the buttress plate may include additional mounting and retaining faces and may attach to both the vertebral endplates 18, 20.
- the annular plug may be omitted, in which case, the retaining face may be smooth or polished to minimize damage to the prosthetic nucleus.
- the retaining face may be lined or coated to reduce wear between the buttress plate and the prosthetic nucleus.
- the liner or coating may be pliable to provide cushioning or relatively rigid to provide wear-resistant properties.
- a UHMWPE liner may be used. The thickness of the UHM WPE liner may, for example, range from 100 microns to 5 millimeters.
- an implant system 50 may be substantially similar to implant system 30 and its components except for the differences described below.
- the implant system 50 may include a prosthetic nucleus 52 for replacing all or portions of the natural nucleus pulposus 22 and/or inner layers of the annulus fibrosus 24.
- the prosthetic nucleus 52 may occupy substantially all of the area vacated by the natural nucleus pulposus 22 and inner layers of the annulus fibrosus 24.
- the implant system 50 may further include one or more retaining devices such as buttress plates 54 attached to the adjacent vertebral body 16 with a fastener 56 and positioned to prevent expulsion or migration of the prosthetic nucleus 52 through an annular defect. Additionally, the implant system 50 may, optionally, omit an annular plug.
- buttress plates may be constructed in a variety of different sizes and configurations to accommodate a variety of different annular defects.
- the buttress plates described below may be substantially similar to buttress plate 34 except for the features described below.
- FIG. 3c depicts a posteriorly located buttress plate 60 that extends between both sides of the adjacent annulus and the prosthetic nucleus 52.
- FIG. 3d depicts a buttress plate 62 that extends between one side of the adjacent annulus and the prosthetic nucleus 52.
- FIG. 3e depicts an elongated buttress plate 64 attached to the endplate 20 with two fasteners 66, both substantially similar to fastener 36.
- This elongated buttress plate 64 may be as wide as the posterior disc space and may, for example, range from 2 to 30 millimeters.
- FIG. 3 F depicts a pair of buttress plates 68 emplaced with a bilateral approach from the posterior.
- FIG. 3g depicts a pair of buttress plates 70 emplaced with a bilateral approach from the posterior and tapered to extend between the remaining annulus and the prosthetic nucleus 52.
- FIG. 3h depicts a pair of buttress plates 72, 74 configured to overlap one another to prevent expulsion of the prosthetic nucleus 52.
- FIG. 3i depicts a pair of buttress plates 76, 78 configured to overlap one another to prevent expulsion of the prosthetic nucleus 52 and also configured to extend between the remaining annulus and the prosthetic nucleus 52.
- an augmentation instrument 150 may be used to install or remove the buttress plate 34.
- the augmentation instrument 150 may include an instrument housing 152 having a bore 54 through which a driver 156 may be inserted.
- the instrument housing 152 may include a distal end 158 having a distal opening 160 thirough which the driver 156 may protrude.
- the distal end 158 and the corresponding portion of the bore 154 may be angled or curved.
- the driver 156 may include a handle portion 162 connected to a shaft 164 lxaving a flexible shaft portion 166 and an engagement end portionl68.
- the engagement end portion 168 may include, for example, a multipurpose driving tool, a drill tip, or a screwdriver tip.
- the engagement end portion 168 may be integral with the shaft 164 or may be separable from the shaft 164.
- a series of drivers may be used to complete an entire procedure.
- the augmentation instrument 150 may further include an actuator system 170 which may be selectively activated to cause further bending of the flexible shaft portion 166.
- An attachment mechanism 172 may be used to selectively couple and decouple a buttress plate 34 to and from the augmentation instrument 150.
- the attachment mechanism 172 may include mechanical, magnetic, or other coupling means known in the art.
- an attachment mechanism may include wire hooks attachable to and releasable from small holes on either side of the buttress plate 34.
- a method for augmenting or reconstructing an intervertebral disc by installing a device, such as a buttress plate 34, to a vertebral endplate 20 will be described.
- a device such as a buttress plate 34
- a discectomy and/or nucleotomy may be performed.
- the procedure may result in the annular defect 38.
- the annular defect may be
- the buttress plate 34 may be located in posterior, anterior, lateral, or other locations of the annular defect.
- the prosthetic nucleus 32 may be inserted through the annular defect 38 and seated between vertebral bodies 14, 16.
- the annular plug 40 may be inserted at the site of the annular defect 38 to promote sealing and to cushion the
- cartilaginous layers of the vertebral endplate 20 at the location of the buttress plate 34 may be removed to promote better bony contact and bonding between the endplate 20 and the buttress plate 34.
- the buttress plate 34 may be installed to promote
- the buttress plate 34 may be loaded to the distal portion 158 of augmentation instrument 150 and held in place with the attachment mechanism 172.
- a driver 156 which may be a drill 180 having a drill tip 182 and a flexible shaft portion 184, may be inserted through the
- the drill tip 182 may protrude from the distal opening 160.
- the angled shape of the distal portion 158 in combination with the actuator system 170 may cause the drill tip 182 to bend at the flexible shaft portion 184.
- the slidable i0 support 186 may be advanced by depressing the trigger 170, placing a force on the flexible shaft portion 184 and causing it to bend. This bending may allow the drill tip 182 to access confined spaces, such as the intervertebral disc space between vertebral bodies 14, 16, with minimal displacement and damage to surrounding tissues.
- the drill tip 182 may penetrate the pre-existing aperture 48 in the buttress plate 34 and may be activated to drill an angled hole 188 (see FIG. 9) into the vertebral endplate 20.
- the drill tip may drill through the mounting face of the buttress plate and into the vertebral endplate 20.
- the drill 180 may be removed and replaced with a driver 156, which may be a screwdriver 190 having a driving tip 192 and a flexible shaft portion 194.
- the fastener 36 which may be a screw, may be coupled to the driving tip 192.
- the fastener 36 and the screwdriver 190 may then be inserted through the bore 154 of the augmentation instrument 150 such that the fastener 36 protrudes through the distal opening 160.
- the screwdriver 190 may be activated to drive the fastener 36 into the angled hole 188. As the screw 36 engages the angled hole 188, the buttress plate 34 may be come secured to the vertebral endplate 20.
- the buttress plate 34 may be positioned such that the retaining face 44 blocks the annular defect 38.
- the secured buttress plate 34 including mounting face 42 and retaining face 44, may be positioned entirely between the vertebral endplates 18, 20 with retaining face 44 projecting in a generally cephalad-caixdal direction. Securing the buttress plate 34 within the intervertebral space may reduce soft tissue damage and interference associated with external fastening mechanisms. With the buttress plate 34 secured, the attachment mechanism 172 may be released, causing the buttress plate 34 to become decoupled from the augmentation instrument 150. If revision becomes necessary, the buttress plate 34 may also be removed using the augmentation instrument 150.
- fastener such and a nail or staple may be used as an alternative to the screw.
- the drilling may take place without the buttress plate 34 attached to the augmentation instrument 150.
- the buttress plate 34 can be attached after the hole 184 is drilled and as the fastener 36 is introduced.
- the augmentation instrument and the method of use described above may also be used to install buttress plates of various sizes, shapes, and configurations, including those described in FIGS. 3b, 3c, 3d, 3e, 3f, 3g, 3h, 3i, and 3j.
- an augmentation instrument 200 may be substantially similar to the augmentation instrument 150 except for the features described below.
- the augmentation instrument 200 may include an distal end 202 having a distal opening 204 through which a driver 206 may protrude.
- the augmentation instrument 200 may further include stabilizers 208, 210 protruding from the distal end 202 to engage the vertebral bodies 14, 16, respectively.
- the distal end 202 of the augmentation instrument 200 may be positioned between vertebral bodies 14 and 16, and the stabilizer 208 may be advanced to engage the vertebral body 14.
- the stabilizer 208 may be selectively extendable. For example, during the initial positioning of the augmentation instrument 200, the stabilizer 208 may be in a retracted position within the instrument. After the instrument 200 is located in a desired position, the stabilizer 208 may be selectively extended and locked to hold the instrument 200 in its desired position.
- the deployed stabilizer 208 may prevent shifting of the distal end 202 during subsequent drilling and buttress plate installation procedures.
- the stabilizer 208 may also maintain precise placement of the distal end 202 while drivers are interchanged.
- the stabilizer 208 may be a sliding pin, but other stabilizing structures such as screws, stables, or clamps may be acceptable alternatives.
- the stabilizer 208 may extend into the vertebral body 14 along an axis defined by the instrument 200 as shown in FIG. 11, but in alternative embodiments the stabilizer may be deployed at an angle. It is understood that stabilizer 210 may be activated in a same or similar manner as stabilizer 208 and thus will not be separately described in detail. Stabilizer 210 may also be deployed together with or independently from, stabilizer 208.
Abstract
Description
Claims
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2007536937A JP2008516688A (en) | 2004-10-14 | 2005-10-14 | Implant system, method and instrument for intervertebral disc replacement or reconstruction |
AU2005295601A AU2005295601A1 (en) | 2004-10-14 | 2005-10-14 | Implant system, method, and instrument for augmentation or reconstruction of intervertebral disc |
EP05812430A EP1827320A2 (en) | 2004-10-14 | 2005-10-14 | Implant system, method, and instrument for augmentation or reconstruction of intervertebral disc |
CA002583347A CA2583347A1 (en) | 2004-10-14 | 2005-10-14 | Implant system, method, and instrument for augmentation or reconstruction of intervertebral disc |
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US10/965,589 | 2004-10-14 | ||
US10/965,589 US7682393B2 (en) | 2004-10-14 | 2004-10-14 | Implant system, method, and instrument for augmentation or reconstruction of intervertebral disc |
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US (1) | US7682393B2 (en) |
EP (1) | EP1827320A2 (en) |
JP (1) | JP2008516688A (en) |
CN (1) | CN101048116A (en) |
AU (1) | AU2005295601A1 (en) |
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Also Published As
Publication number | Publication date |
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WO2006044649A3 (en) | 2006-09-21 |
CA2583347A1 (en) | 2006-04-27 |
AU2005295601A1 (en) | 2006-04-27 |
CN101048116A (en) | 2007-10-03 |
JP2008516688A (en) | 2008-05-22 |
EP1827320A2 (en) | 2007-09-05 |
US7682393B2 (en) | 2010-03-23 |
US20060085002A1 (en) | 2006-04-20 |
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