WO2016144150A1 - Expandable system for intersomatic fusion and method for the use thereof - Google Patents

Expandable system for intersomatic fusion and method for the use thereof Download PDF

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Publication number
WO2016144150A1
WO2016144150A1 PCT/MX2015/000037 MX2015000037W WO2016144150A1 WO 2016144150 A1 WO2016144150 A1 WO 2016144150A1 MX 2015000037 W MX2015000037 W MX 2015000037W WO 2016144150 A1 WO2016144150 A1 WO 2016144150A1
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WO
WIPO (PCT)
Prior art keywords
box
platform
clamp
lateral
gates
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Application number
PCT/MX2015/000037
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Spanish (es)
French (fr)
Inventor
Salvador José MARIN
Original Assignee
Marin Salvador José
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Publication date
Application filed by Marin Salvador José filed Critical Marin Salvador José
Priority to PCT/MX2015/000037 priority Critical patent/WO2016144150A1/en
Publication of WO2016144150A1 publication Critical patent/WO2016144150A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor

Definitions

  • the present invention relates in general to an expandable system for intersomatic fusion and more specifically to a system consisting of an expandable box, a positioning device and a forceps for expansion that allow to locate within the intervertebral space, easily and with ease. a minimum invasion, the expandable box, said box being able to be later expanded to immobilize the adjacent vertebrae.
  • Surgical fusion of the spine is a method widely used for the treatment of painful segmental instability associated or not, to root compression; Its objective is to eliminate this instability and, in this way, reduce the pain and disability that this causes. It can be done through different surgical techniques, within them, those that include the use of internal fixation (instrumentation) have improved the fusion rates and clinical results, and that is, they have avoided the need to use a rigid external support after Surgery.
  • FPL posterolateral fusion
  • the circumferential fusion was developed to provide a solid fixation of the segments to be fused, maintaining at the same time, the capacity to support weight and the height of the intervertebral space.
  • Xa FPL the placement of the graft in the vertebral body, subjecting the graft to compressive forces, improving bone fusion by the law of olf; the vertebral body receives greater vascular supplementation than the posterior elements and this will further enhance the potential fusion; by restoring the height of the disc space improves the sagittal alignment and achieves an indirect foraminal decompression, decreasing the pain caused by the preexisting lesion; more disc is dried, facilitating the formation of bone healing tissue, thus favoring intervertebral fusion ⁇
  • Among its disadvantages is the higher requirement - technique, the higher initial cost and the higher rate of complications, such as dural damage, neurogenic damage and device migration.
  • intersomatic fusion ⁇ FI ⁇ provides the surgeon with multiple options regarding the approach, the graft used and the internal fixation devices.
  • the intersomatic device titanium, carbon fiber, PEEK, or iliac crest structural graft can be used; of these, the iliac crest structural graft has poor support capacity and is associated with high rates of postoperative displacement or collapse.
  • the first of these groups is formed by the rigid boxes, which have pre-established dimensions so, to be implanted, they require means that separate the space between vertebrae to allow their correct placement, being its greater disadvantage the increase of the risk of damages caused by an excessive application of force in order to introduce the device and / or an excessive opening of the intersomatic space;
  • the second group consists of the expandable boxes, whose common characteristic is that they can vary their height dimensions, thus allowing them to be admitted into the intersynceric space without the need to apply large forces nor being required to perform a preliminary separation between the vertebrae .
  • US Patent 8308804 B2 discloses a spinal fusion device comprising a first end plate configured to fit within a disc space and engage a first vertebra and a second end plate configured to fit within the disc space and engage with a second vertebra, the two plates being separated by a single spacer that is located between the first end plate and the second end plate and maintains a predetermined distance between the first and second plate.
  • the disadvantage of the device described is that the elevation is not made uniformly when introducing the spacer, since said element is wedge-shaped and first raises the portion closest to the entry site, making it difficult to place it correctly.
  • great care must be taken when entering the separator since it is an independent piece of the device, if it is not entered in the correct angle, it avoids the firm fixation of the device.
  • OS 6159244 A discloses an expandable intervertebral fusion implant that includes a pair of semi-cylindrical shells having coupling surfaces that resist change when the parts are assembled.
  • the shells have pillars provided with teeth that allow to ratchet between the shells after they have been placed between the vertebral elements.
  • the pillars are curved and extend from their shells at a non-perpendicular angle, so that the resulting implant narrows to accommodate between non-parallel medullary end plates, maintaining the curvature of the spine.
  • This implant has the disadvantage of requiring the previous piercing of a channel on the surface of the vertebrae to avoid lateral movements thereof and also, by having multiple teeth on the pillars, it can be the case that if not carried out correctly the elevation of the device, this one is uneven because the teeth of the four pillars do not align correctly.
  • Patent US 6332895 Bl protects an expandable intervertebral implant that includes two separate shells having corrugated collecting surfaces that resist compression and displacement when the parts are distended with a special installation tool.
  • the shells include two flat wings that provide a large support area against the adjacent vertebral endplates to prevent the implant from sinking into the cancellous bone.
  • the disadvantage of this implant is that it is necessary to carry out a groove through the walls of the two vertebrae adjacent to the implant in order to accommodate the central arched part of both housings.
  • the implant also has the problem that there are no mechanisms to prevent horizontal movement between the two housings, so if this occurs, the device would be misplaced and the load of the vertebrae would not be distributed evenly.
  • US patent 7828849 B2 protects an intervertebrai spacer device consisting of three members forming a closed box, with two perations at one of its ends and a third bore at the tip of the opposite end.
  • the operation of said device is based on the sliding of the central member by a laterally applied force, which causes the angled sections of the first and third member to be separated from each other, necessitating a securing bolt to keep the device in an extended position.
  • the previous configuration of elements allows the device to be removed, since when pressing the bolt the mechanism is released, collapsing the members; however, the presence of a controlling race resort bolt Xa increases complexity of the device and if it loses its rigidity, the device collapses uncontrollably causing serious spinal injuries.
  • the present invention has for its object to provide a compact and easy placement that can be located within small spaces
  • a particular objective of the present invention is to provide a system for intersoratal fusion that has an expanding box with means to prevent horizontal sliding between the components of the same.
  • Another objective of the present invention is to provide an intersoratal box with elements that ensure the elevation thereof and that at the same time prevent the collapse of the height achieved.
  • Another objective of the present invention is to provide a positioning system for the intersomatic box, which is easy to operate and has a small number of elements.
  • Figure 1 is a perspective view of the lower platform of the expander box.
  • Figure 2 is a perspective view of the upper platform of the expanding box.
  • Figure 3 is a perspective view of the lower platform ⁇ e and the expanding box showing the location of the gates or windows in an oblique position.
  • Figure 4 is a perspective view of the lower platform of the expanding box showing the location of the doors or windows in vertical position.
  • Figure 5 is a perspective view of the ventral region of the expanding box showing the use of the threaded hole and the bolts or screws.
  • Figure 6 is a perspective view of the holding pin 2 without the guide rod and the threaded handle.
  • Figure 7 is a perspective view of the holding part with the guide rod and the threaded handle.
  • Figure 8 is a perspective view of the clamp for expansion in the closed position.
  • Figure 9 is a perspective view of the clamp for expansion in the open position.
  • Figure 10 is a perspective view of the expandable box with the guide rod engaged.
  • Figure 11 is a perspective view of the expanding box with the clamping piece engaged on the guide rod without the threaded handle.
  • Figure 12 is a perspective view of the expandable box coupled to the clamping piece secured with the threaded handle.
  • Figure 13 shows the placement of the system for intersomatic fusion in the intervertebral space using the clamping piece.
  • Figure 14 shows the collapsed expandable box attached to the guide rod located in the intervertebral space
  • Figure 15 shows the insertion of the clamp for expansion in the space between the platforms of the box S expandable.
  • Figure 16 shows the expansion of the expandable box through the thrust caused by the blades of the expansion clamp
  • Figure 17 shows the expandable box with the gates raised and fixed in the intervertebral space still coupled to the guide rod.
  • Figure 18 shows the expandable box placed correctly in the intervertebral space
  • Figure 19 is a perspective view of the lower platform of the mode with four gates, with the gates in an oblique position.
  • Figure 20 is a perspective view of the lower platform of the four-gauge mode, with the gates in vertical position.
  • Figure 21 shows a section of the expandable box of the four-gauge mode, with the gates in an oblique position.
  • Figure 22 shows a section d expandable box of the mode with four gates, with the gates in verticai position,
  • Figure 23 is a perspective view of the central piece in the form of "double ⁇ " of the expandable box in its modality that increases both in height and width,
  • Figure 24 is a top view of the lower platform of the expandable box showing the modality increasing both in height and width.
  • Figure 25 is a perspective view of the clamp for lateral expansion in the closed position.
  • Figure 26 is a perspective view of the clamp for side panel in open position.
  • Figure 28 shows the box expanded in width of the modality that increases both in height and width.
  • the objective technological development of the present invention consists of a system for intersomatic fusion comprising an expandable box of reduced height in its folded mode, with means preventing lateral displacements between its contact surfaces. Also, the present invention relates to a series of devices for facilitating the placement and elevation of the expandable box within the intersomatic space.
  • the system for intersomatic fusion of the present invention comprises an expandable intersomatic box ⁇ A ⁇ , a clamping piece (B) and a clamp for expansion (C).
  • the box AS in turn comprises a lower platform 1 which is a piece of shape substantially adapted to adapt to the contours of the vertebrae ⁇ such as rectangular, oval, kidney-shaped, etc.), compact and with a window or orifice central (2), with the lower surface of said platform ⁇ 15 being rough, to come into contact with the cartilaginous terminal plate of the lower vertebra of the intervertebral space, the upper surface of the platform ⁇ 1 ⁇ is smooth and from it four are raised hollow cylinders ⁇ 3) perpendicular, one in each corner, arranged to receive four cylinders of smaller diameter protruding from an upper platform (5) and, slots ⁇ 4 ⁇ adjacent to said cylinders.
  • the upper platform (5) is a piece substantially the same as that of the lower platform (1), compact and with a central window or hole ⁇ 6 ⁇ , with a rough upper surface, to come into contact with the terminal plate cartilaginous of the superior vertebra of the intervertebral space and, a smooth lower surface from which protrude four cylinders (7) perpendicular to it, one at each corner, arranged to disengage within the four hollow cylinders (3) of greater diameter that rise of the lower platform (i), to allow the gearing of both platforms (upper and lower) avoiding the horizontal displacements between them, said cylinders (?), slots (8) adjacent to them and; gates or windows (9) having they are compact rectangular structures, with a central hole also rectangular, arranged horizontally opposite each other and perpendicular to the greater diameter of the lower platform, said components being located at the oblique ends of two lateral projections ⁇ 10 ⁇ of the upper surface of the lower platform (1) in the direction of its major axis, so that the box (A) to be in contracted position, has windows
  • the box ⁇ &) on its ventral face (which is the face that will correspond to the ventral side of the spine, once placed), has aligned in its central part a hole with thread ⁇ 11 ⁇ located on the platform top ⁇ 5) and two bolts or screws ⁇ 12 ⁇ located on the lower platform (1).
  • the clamping piece ⁇ 8 ⁇ comprises a hollow upper rod (13) through which a rod or guide (14) runs, two lower rods ⁇ 15 ⁇ , two parallel frame pieces (16) through which the rod runs ( 13) as the two rods (15) and, a threaded handle (17) which is placed in one of the distal ends of the guide (14), in such a way that the rod (14) when being threaded in the hole (11) ⁇ of the box (A), serves as a guide for the insertion of the hollow rod (13), allowing to align the lower rods (155 with each of the bolts ⁇ 12 ⁇ of the lower platform (15 of the box (A)) .
  • the clamp for expansion ⁇ C ⁇ comprises a hollow rod ⁇ 18 ⁇ supported by a piece with two rings (19) located on the upper surface of an axis (20), which serves as a pivot point of two arms ⁇ 21 ⁇ That they continue at their distal end, towards the hollow rod (18), with two blades (22) that open in response to the approach of the arms (21).
  • Said clamp (C) also has an insurance system (23) in the form of a crosshead that limits the opening of the blades (22).
  • both the lower and upper platform of the box (A) are oval in shape, said box having at least 4 windows, two on each side of the box, which in each case One of its upper ends has lateral grooves to receive a double V- shaped structure "(25) that allows to coordinate the displacement of each two windows in order to expand the box in a controlled and uniform manner. Increase the effective area of the expanded box and resist higher compression forces such as those that occur when the box is placed in the lumbar region.
  • each of the platforms of the expandable ca is manufactured in two lateral segments joined by a central segment in the form of "double T" (26) that has a pair of slides through which the two lateral segments slide ( right and left), said segments travel equivalent distances until they face each other in the middle line or center of each of the center-segments (26).
  • the lateral projection (10) of the ventral face is also divided into two sections, each of which has a bolt or screw (12) associated with it.
  • the expansion clamp (C) is inserted through the same channel used for the insertion of the box on the guide (14), in this way it is allowed to introduce correctly the two blades (22) in the space that is between the lower platform (!) and the upper (5) of the box.
  • the expansion clamp ⁇ C ⁇ is correctly positioned, it is applied to the two arms ⁇ 21 ⁇ bringing them closer to each other, this moves the two blades away ⁇ 22 ⁇ by raising the gates, so that the box expands in height and sits firmly between the surfaces of the adjacent vertebrae.
  • the box In the modality in which the box also increases its width, before carrying out the lifting of the gates it is necessary to introduce a prism or the modified clamp for lateral expansion ⁇ D ⁇ .
  • the two hollow tubular pieces ⁇ 24 ⁇ are applied or coupled on the two bolts ⁇ 12 ⁇ of each of the sections of the lateral projection ⁇ 10 ⁇ ⁇ as shown in figure 27 ⁇ , once placed the clamp in the correct position, force is applied to the arms (215) in order to bring them closer together, thereby causing the separation of the two tubular pieces ⁇ 24 ⁇ and the lateral segments (left and right) of the platforms.
  • the box (A) thereby increasing the total width of the intersomatic box (Figure 285 ⁇

Abstract

The invention relates to a system for intersomatic fusion with mechanisms for preventing unwanted lateral movements between the components thereof, comprising an expandable cage containing two platforms between which there are windows that are elevated by means of a clip for expansion at altitude, said cage being placed in the intervertebral space by means of a fastening part comprising a threaded guide and a series of hollow rods that allow the complete control of movements of the cage.

Description

SISTEMA EXPANDISTE RARA FUSION IH SRSOMATICA X METODO DE  SYSTEM EXPANDISTE RARA FUSION IH SRSOMATICA X METHOD OF
USO  USE
Campo de la Invención Field of the Invention
La presente invención se refiere en general a un sistema expandible para fusión intersomática y más específ camente a un sistema que consta de una caja expandible, un dispositivo de colocación y una pinza para expansión que permiten ubicar dentro del espacio intervertebral, de manera fácil y con una mínima invasión, la caja expandible, pudiendo dicha caja ser expandida posteriormente para inmoviliaar las vértebras adyacentes. The present invention relates in general to an expandable system for intersomatic fusion and more specifically to a system consisting of an expandable box, a positioning device and a forceps for expansion that allow to locate within the intervertebral space, easily and with ease. a minimum invasion, the expandable box, said box being able to be later expanded to immobilize the adjacent vertebrae.
Antecedentes de la Invención Background of the Invention
La fusión quirúrgica de la columna vertebral es un método muy utilizado para el tratamiento de la inestabilidad segmentaria dolorosa asociada o no, a compresión radicular; su objetivo es eliminar dicha inestabilidad y, de este modo, reducir el dolor y la incapacidad que ésta provoca. Se puede realizar mediante diferentes técnicas quirúrgicas, dentro de ellas, las que comprenden el empleo de fijación interna {instrumentación} han mejorado las tasas de fusión y ios resultados clínicos, y a su es, han evitado la necesidad de utilizar un soporte externo rígido luego de la cirugía. Surgical fusion of the spine is a method widely used for the treatment of painful segmental instability associated or not, to root compression; Its objective is to eliminate this instability and, in this way, reduce the pain and disability that this causes. It can be done through different surgical techniques, within them, those that include the use of internal fixation (instrumentation) have improved the fusion rates and clinical results, and that is, they have avoided the need to use a rigid external support after Surgery.
Actualmente, las dos técnicas de fusión instrumentada más utilizadas son la fusión posterolateral ( FPL) mediante instrumentación posterior pedicuiar aislada y la fusión circunferencial mediante instrumentación posterior pedicular asociada a caja intersomática anterior. La fusión circunferencial fue desarrollada para proporcionar una fijación sólida de los segmentos por fusionar, manteniendo al mismo tiempo, la capacidad de soportar peso y la altura del espacio intervertebral. Asimismo, presenta las siguientes ventajas con respecto a Xa FPL: la colocación del injerto en el cuerpo vertebral, somete al injerto a fuerzas compresivas, mejorando la fusión ósea por la ley de olf; el cuerpo vertebral recibe mayor suplemento vascular que ios elementos posteriores y esto mejorarla aún más la potencial fusión; al restaurar la altura del espacio discai mejora el alineamiento sagital y logra una descompresión foraminal indirecta, disminuyendo el dolor causado por la lesión preexistente; se reseca mayor cantidad de disco, facilitando la formación de tejido oseo cicatrizante, favoreciéndose asi la fusión intervertebral ^ Entre sus desventajas figura la mayor exigencia - técnica, el mayor costo inicial y la tasa más alta de complicaciones, como daño dural, daño neuroiógico y migración del dispositivo. Currently, the two most commonly used instrumented fusion techniques are posterolateral fusion (FPL) using isolated posterior pedicure instrumentation and fusion circumferential by posterior pedicular instrumentation associated with anterior intersomatic box. The circumferential fusion was developed to provide a solid fixation of the segments to be fused, maintaining at the same time, the capacity to support weight and the height of the intervertebral space. It also has the following advantages with respect to Xa FPL: the placement of the graft in the vertebral body, subjecting the graft to compressive forces, improving bone fusion by the law of olf; the vertebral body receives greater vascular supplementation than the posterior elements and this will further enhance the potential fusion; by restoring the height of the disc space improves the sagittal alignment and achieves an indirect foraminal decompression, decreasing the pain caused by the preexisting lesion; more disc is dried, facilitating the formation of bone healing tissue, thus favoring intervertebral fusion ^ Among its disadvantages is the higher requirement - technique, the higher initial cost and the higher rate of complications, such as dural damage, neurogenic damage and device migration.
La evolución de la fusión intersomática {FI} provee al cirujano de múltiples opciones con respecto ai abordaje, el injerto utilizado y los dispositivos de fijación interna. En cuanto ai dispositivo intersomático, se pueden utilizar cajas de titanio, de fibra de carbono, de PEEK, o injerto estructural de cresta iliaca; de éstos, el injerto estructural de cresta iliaca tiene poca capacidad de soporte y se asocia a altas tasas de desplazamiento o colapso posquirúrgJfco. Dentro de las cajas para fusión, existen dos grandes grupos, el primero de dichos grupos está conformado por las cajas rígidas, las cuales, tienen dimensiones preestablecidas por lo que, para ser implantadas, requieren de medios que separen el espacio entre vertebras para permitir su correcta colocación, siendo su mayor desventaja el incrementar el riesgo de daños causados por una aplicación excesiva de fuerza con el fin de introducir el dispositivo y/o una apertura excesiva del espacio intersomático; el segundo grupo io conforman las cajas expandióles, que tiene como característica común el poder variar sus dimensiones de altura, permitiendo de esta forma, poder ser ingresadas en el espacio íntersornético sin necesidad de aplicar grandes fuerzas ni siendo requerido realizar una separación previa entre las vértebras . The evolution of the intersomatic fusion {FI} provides the surgeon with multiple options regarding the approach, the graft used and the internal fixation devices. As for the intersomatic device, titanium, carbon fiber, PEEK, or iliac crest structural graft can be used; of these, the iliac crest structural graft has poor support capacity and is associated with high rates of postoperative displacement or collapse. Within the boxes for fusion, there are two large groups, the first of these groups is formed by the rigid boxes, which have pre-established dimensions so, to be implanted, they require means that separate the space between vertebrae to allow their correct placement, being its greater disadvantage the increase of the risk of damages caused by an excessive application of force in order to introduce the device and / or an excessive opening of the intersomatic space; The second group consists of the expandable boxes, whose common characteristic is that they can vary their height dimensions, thus allowing them to be admitted into the intersynceric space without the need to apply large forces nor being required to perform a preliminary separation between the vertebrae .
Un ejemplo de caja intersomática expandible está descrito en la Patente US 8308804 B2, la cual describe un dispositivo de fusión espinal que comprende una primera placa terminal configurada para encajar dentro de un espacio de disco y comprometerse con una primera vértebra y una segunda placa terminal configurada para encajar dentro del espacio discal y compromete se con una segunda vértebra, estando las dos placas separadas por un único espaciador que está situado entre la primera placa terminal y la segunda placa terminal y mantiene una distancia predeterminada entre la primera y la segunda placa. La desventaja del dispositivo descrito radica en que la elevación no se realiza de manera uniforme al introducir el espaciador, toda vez que dicho elemento tiene forma de cuña y eleva primero la porción más cercana al sitio de ingreso, dificultando la correcta colocación del mismo. Además, se debe tener mucho cuidado ai momento de ingresar el separador ya que ai ser una pieza independiente del dispositivo, si no se ingresa en el ángulo correcto, evita la fijación firme del dispositivo. An example of an expandable interbody box is described in US Patent 8308804 B2, which discloses a spinal fusion device comprising a first end plate configured to fit within a disc space and engage a first vertebra and a second end plate configured to fit within the disc space and engage with a second vertebra, the two plates being separated by a single spacer that is located between the first end plate and the second end plate and maintains a predetermined distance between the first and second plate. The disadvantage of the device described is that the elevation is not made uniformly when introducing the spacer, since said element is wedge-shaped and first raises the portion closest to the entry site, making it difficult to place it correctly. In addition, great care must be taken when entering the separator since it is an independent piece of the device, if it is not entered in the correct angle, it avoids the firm fixation of the device.
La Patente OS 6159244 A, describe un implante de fusión intervertebral expandíble que incluye un par de conchas semi™ cilindricas que tienen superficies de acoplamiento que resisten el cambio cuando las partes son ensambladas. Las conchas tienen pilares provistos de dientes que permiten hacer trinquete entre las conchas después de que se han colocado entre ios elementos vertebrales. Los pilares están curvados y se extienden desde sus conchas en un ángulo no perpendicular, de modo que se estrecha el implante resultante, para acomodarse entre placas extremas de médula no paralelas, manteniendo la curvatura de la columna. Dicho implante tiene la desventaja de requerir la horadación previa de un canal sobre la superficie de las vértebras para evitar los movimientos laterales del mismo y además, al tener múltiples dientes sobre ios pilares, se puede dar el caso de que ai no llevarse a cabo correctamente la elevación del dispositivo, éste quede desnivelado por no alinearse correctamente los dientes de los cuatro pilares.  OS 6159244 A discloses an expandable intervertebral fusion implant that includes a pair of semi-cylindrical shells having coupling surfaces that resist change when the parts are assembled. The shells have pillars provided with teeth that allow to ratchet between the shells after they have been placed between the vertebral elements. The pillars are curved and extend from their shells at a non-perpendicular angle, so that the resulting implant narrows to accommodate between non-parallel medullary end plates, maintaining the curvature of the spine. This implant has the disadvantage of requiring the previous piercing of a channel on the surface of the vertebrae to avoid lateral movements thereof and also, by having multiple teeth on the pillars, it can be the case that if not carried out correctly the elevation of the device, this one is uneven because the teeth of the four pillars do not align correctly.
La Patent US 6332895 Bl protege un implante intervertebral expandible que incluye dos carcasas separadas que tienen superficies de acopiamiento corrugadas que resisten la compresión y desplazamiento cuando las partes se distienden con una herramienta especial, de instalación. Las carcasas incluyen dos alas planas que proporcionan una gran área de soporte contra las placas terminales vertebrales adyacentes para evitar que el implante se hunda en el hueso esponjoso. La desventaja de dicho implante radica en que es necesario llevar a cabo un surco a través de las paredes de las dos vértebras adyacentes al implante con el fin de dar cabida a la parte central arqueada de ambas carcasas. Por otra parte, el implante también presenta el problema de que no existen mecanismos que eviten el desplazamiento horizontal entre las dos carcasas, por lo que de darse éste, ei dispositivo quedaría mal colocado y la carga de las vértebras no se repartiría de manera uniforme. Patent US 6332895 Bl protects an expandable intervertebral implant that includes two separate shells having corrugated collecting surfaces that resist compression and displacement when the parts are distended with a special installation tool. The shells include two flat wings that provide a large support area against the adjacent vertebral endplates to prevent the implant from sinking into the cancellous bone. The disadvantage of this implant is that it is necessary to carry out a groove through the walls of the two vertebrae adjacent to the implant in order to accommodate the central arched part of both housings. On the other hand, the implant also has the problem that there are no mechanisms to prevent horizontal movement between the two housings, so if this occurs, the device would be misplaced and the load of the vertebrae would not be distributed evenly.
La patente US 7828849 B2, protege un dispositivo espaciador intervertebrai que consta de tres miembros que forman una caja cerrada, con dos pe foraciones en uno de sus extremos y una tercer perforación en la punta del extremo opuesto. Ei funcionamiento de dicho dispositivo se basa en el deslizamiento del miembro central mediante una fuerza aplicada lateralmente, que hace que las secciones en ángulo del primer y tercer miembro se separen entre si, necesitando un perno de aseguramiento para mantener el dispositivo en posición extendida. La anterior configuración de elementos le permite que ei dispositivo pueda ser removido, ya que al presionar el perno se libera el mecanismo, colapsando ios miembros; sin embargo, la presencia de un resort que controla la carrera del perno incrementa Xa complejidad del dispositivo y sí éste pierde la rigidez, el dispositivo colapsa, de manera incontrolada generando lesiones graves en la columna. US patent 7828849 B2, protects an intervertebrai spacer device consisting of three members forming a closed box, with two perations at one of its ends and a third bore at the tip of the opposite end. The operation of said device is based on the sliding of the central member by a laterally applied force, which causes the angled sections of the first and third member to be separated from each other, necessitating a securing bolt to keep the device in an extended position. The previous configuration of elements allows the device to be removed, since when pressing the bolt the mechanism is released, collapsing the members; however, the presence of a controlling race resort bolt Xa increases complexity of the device and if it loses its rigidity, the device collapses uncontrollably causing serious spinal injuries.
Las patentes US 8105382 {B2} y US 8435298 (B2), protegen implantes intervertábrales que comprenden un dispositivo tipo "gato mecánico de manivela", qu permiten regular la elevación del mismo mediante un tornillo que acerca entre sí dos cuñas, que entran en contacto con las superficies inclinadas de las porciones de contacto superior e inferior 8 del dispositivo:, permitiendo de esta forma variar a voluntad la altura del mismo; sin embargo si el tornillo no se bloquea, el dispositivo tiende a comprimirse por las fuerzas aplicadas a él. The patents US 8105382 {B2} and US 8435298 (B2), protect intervertábrales implants that comprise a device "crank mechanical jack", which allow to regulate the elevation thereof by a screw that brings two wedges together, which come into contact with the inclined surfaces of the upper and lower contact portions 8 of the device:, thus allowing the height of the device to be varied at will; however, if the screw is not blocked, the device tends to be compressed by the forces applied to it.
En ninguno de los documentos antes citados, se describe que los sistemas de fusión intersomática, tengan cajas expandibies con elementos que controlen los desplazamientos transversales indeseados entre los componentes de la misma y mucho menos que ai mismo tiempo cuenten con seguros que garanticen que los elementos mantengan la distancia entre las superficies en contacto con las vértebras evitando de esta forma su detracción. Aunado a lo anterior, ios dispositivos antes mencionados en muchos casos requieren de la horadación de canales sobre las superficies de la vertebra a fin de mantenerlos fijos en su lugar y los equipos que permiten su inserción y elevación son muy complejos, aumentando el riesgo de averías y generando complicaciones en la manipulación y colocación de las cajas intersomáticas.  In none of the aforementioned documents, it is described that the systems of intersomatic fusion, have boxes expanibies with elements that control the undesirable transverse displacements between the components of the same and much less that at the same time have insurances that guarantee that the elements maintain the distance between the surfaces in contact with the vertebrae thus preventing their detraction. In addition to the above, the aforementioned devices in many cases require the piercing of channels on the surfaces of the vertebra in order to keep them fixed in place and the equipment that allows their insertion and elevation are very complex, increasing the risk of breakdowns and generating complications in the manipulation and placement of the intersomatic boxes.
En vista de la problemática anterior, e¾iste la necesidad de proporcionar un sistema para la fusión intersomática, que permita la colocación de la caja expandífoie de roañera segura y fácil y que además, cuente con medios de aseguramiento qtse eviten el deslizamiento horizontal entre los componentes de la caj a expandible .  In view of the previous problem, you have the need to provide a system for intersomatic fusion, which allows the placement of the safe and easy expanding box of roañera and that also has means of assurance that avoid the horizontal sliding between the components of the expandable box.
Stwaario d© la Invención Stwaario of the Invention
Con el fin de superar las desventajas de los sistemas para fusión intersomática existentes, la presente invención tiene por objeto el proporcionar un sistema compacto y de fácil colocación que pueda ser ubicado dentro de espacios reducidos , In order to overcome the disadvantages of existing intersomatic fusion systems, the present invention has for its object to provide a compact and easy placement that can be located within small spaces,
Un objetivo particular de la presente invención, es el proporcionar un sistema para fusión intersoraática que cuente con una caja expandibie con medios que eviten el deslizamiento horizontal entre los cbíitponentes de la mism .  A particular objective of the present invention is to provide a system for intersoratal fusion that has an expanding box with means to prevent horizontal sliding between the components of the same.
Otro objetivo de ia presente invención, es proporcionar una caja intersoraática con elementos que aseguren la elevación de la misma y que al mismo tiempo eviten el colapso de ia altura lograda.  Another objective of the present invention is to provide an intersoratal box with elements that ensure the elevation thereof and that at the same time prevent the collapse of the height achieved.
Un . objetivo adicional de ia presente invención, es proveer un sistema de colocación para la caja intersomática, de fácil operación y reducido número de elementos.  A . Another objective of the present invention is to provide a positioning system for the intersomatic box, which is easy to operate and has a small number of elements.
También es un objetivo de la presente invención, el proveer un sistema para la fusión ínter-somática que pueda ser utilizado en cualquier región de la columna vertebral (cervical; torácica y/o lumbar) .  It is also an objective of the present invention to provide a system for inter-somatic fusion that can be used in any region of the spine (cervical, thoracic and / or lumbar).
Los objetivos antes citados, asi co o otros y las ventajas de la presente invención, vendrán a ser aparentes de la siguiente descripción detallada de la misma.  The aforementioned objects, as well as others and the advantages of the present invention, will become apparent from the following detailed description thereof.
Descripción de las Figuras de la Invención Description of the Figures of the Invention
La Figura 1 es una vista en perspectiva de la plataforma inferior de la caja expandibie. Figure 1 is a perspective view of the lower platform of the expander box.
La figura 2 es una vista en perspectiva de ia plataforma superior de la caja expandibie.  Figure 2 is a perspective view of the upper platform of the expanding box.
La figura 3 es una vista en perspectiva de la plataforma inferior <$ey la caja expandibie mostrando ia ubicación de las compuertas o ventanas en posición oblicua. S Figure 3 is a perspective view of the lower platform <e and the expanding box showing the location of the gates or windows in an oblique position. S
La figura 4 es una vista en perspectiva de ia plataforma inferior de la caja expandibie mostrando ia ubicación de las compuertas o ventanas en posición vertical. Figure 4 is a perspective view of the lower platform of the expanding box showing the location of the doors or windows in vertical position.
La figura 5, es una vista en perspectiva de la región ventral de la caja expandibie mostrando la u icación del orificio roscado y los pernos o tornillos.  Figure 5 is a perspective view of the ventral region of the expanding box showing the use of the threaded hole and the bolts or screws.
La figura 6, es una vista en perspectiva de la pi 2 sujetadora sin la varilla guía y ia manija roscada.  Figure 6 is a perspective view of the holding pin 2 without the guide rod and the threaded handle.
La figura 7, es una vista en perspectiva de la piez sujetadora con la varilla guia y la manija roscada.  Figure 7 is a perspective view of the holding part with the guide rod and the threaded handle.
La figura 8, es una vista en perspectiva de ia pinza para expansión en posición cerrada .  Figure 8 is a perspective view of the clamp for expansion in the closed position.
La figura 9, es una vista en perspectiva de ia pinza para expansión en posición abierta .  Figure 9 is a perspective view of the clamp for expansion in the open position.
La figura 10, es una vista en perspectiva ia caja expandibie con la varilla guía acoplada.  Figure 10 is a perspective view of the expandable box with the guide rod engaged.
La figura 11, es una vista en perspectiva de la caja expandibie con la pieza sujetadora acoplada sobre la varilla guía sin ia manija roscada.  Figure 11 is a perspective view of the expanding box with the clamping piece engaged on the guide rod without the threaded handle.
La figura 12, es una vista en perspectiva de la caja expandibie acoplada a la pieza sujetadora asegurada con la manija roscada.  Figure 12 is a perspective view of the expandable box coupled to the clamping piece secured with the threaded handle.
La figura 13, muestra la colocación del sistema para fusión intersomática en el espacio intervertebral usando ia pieza sujetadora.  Figure 13 shows the placement of the system for intersomatic fusion in the intervertebral space using the clamping piece.
La figura 14, muestra la caja expandibie colapsada acopiada a ia varilla guia ubicada en el espacio intervertebral ,  Figure 14 shows the collapsed expandable box attached to the guide rod located in the intervertebral space,
La figura 15, muestra ia inserción de la pinza para expansión en el espacio entre las plataformas de ia caja S expandible . Figure 15 shows the insertion of the clamp for expansion in the space between the platforms of the box S expandable.
La figura 16, muestra la expansión de la caja expandible medíante el empuje causado por las palas de la pinza para expansión ,  Figure 16 shows the expansion of the expandable box through the thrust caused by the blades of the expansion clamp,
La figura 17, muestra la caja expandible con las compuertas elevadas y fijada en el espacio intervertebral todavía acoplada a la varilla guia.  Figure 17 shows the expandable box with the gates raised and fixed in the intervertebral space still coupled to the guide rod.
La figura 18, muestra la caja expandible colocada correctamente en el espacio intervertebral,  Figure 18 shows the expandable box placed correctly in the intervertebral space,
La figura 19, es una vista en perspectiva de la plataforma inferior de la modalidad con cuatro compuertas, co las compuertas en posición oblicua.  Figure 19 is a perspective view of the lower platform of the mode with four gates, with the gates in an oblique position.
La figura 20, es una vista en perspectiva de la plataforma inferior de la modalidad con cuatro compuertas, con las compuertas en posición vertical.  Figure 20 is a perspective view of the lower platform of the four-gauge mode, with the gates in vertical position.
La figura 21, muestra un corte de la caja expandible de la modalidad con cuatro compuertas, con las compuertas en posición oblicua.  Figure 21 shows a section of the expandable box of the four-gauge mode, with the gates in an oblique position.
La figura 22, muestra un corte d la caja expandible de la modalidad con cuatro compuertas, con las compuertas en posíción verticai ,  Figure 22 shows a section d expandable box of the mode with four gates, with the gates in verticai position,
La figura 23, es una vista en perspectiva de la pieza central en forma de "doble Ί" de la caja expandible en su modalidad que aumenta tanto en altura como en ancho,  Figure 23 is a perspective view of the central piece in the form of "double Ί" of the expandable box in its modality that increases both in height and width,
La figura 24, es una vista superior de la plataforma inferior de la caja expandible mostrando la modalidad que aumenta tanto en altura como en ancho.  Figure 24 is a top view of the lower platform of the expandable box showing the modality increasing both in height and width.
La figura 25, es una vista en perspectiva de la pinza para expansión lateral en posición cerrada.  Figure 25 is a perspective view of the clamp for lateral expansion in the closed position.
La figura 26, es una vista en perspectiva de la pinza para eKpansxón lateral en posición abierta. Figure 26 is a perspective view of the clamp for side panel in open position.
La figura 27, muestra la inserción de la pinza para expansión lateral sobre los pernos de la modalidad que aumenta tanto en altura como en ancho.  Figure 27 shows the insertion of the clamp for lateral expansion on the bolts of the modality that increases both in height and width.
La figura 28, muestra la caja expandida en ancho de la modalidad que aumenta tanto en altura como en ancho.  Figure 28 shows the box expanded in width of the modality that increases both in height and width.
Descripción Detallada de la Invención El desarrollo tecnológico objetivo de la presente invención consiste en un sistema para fusión intersomática que comprende de una caja expandible de altura reducida en su modo plegado, con medios que evitan los desplazamientos laterales entre sus superficies de contacto. Asimismo, la presente invención se refiere a una serie de dispositivos para facilitar la colocación y elevación de la caja expandible dentro del espacio intersomático. Detailed Description of the Invention The objective technological development of the present invention consists of a system for intersomatic fusion comprising an expandable box of reduced height in its folded mode, with means preventing lateral displacements between its contact surfaces. Also, the present invention relates to a series of devices for facilitating the placement and elevation of the expandable box within the intersomatic space.
El sistema para fusión intersomática de la presente invención comprende una caja intersomática expandible {A} , una pieza sujetadora (B) y una pinza para expansión (C) .  The system for intersomatic fusion of the present invention comprises an expandable intersomatic box {A}, a clamping piece (B) and a clamp for expansion (C).
La caja {AS a su vez comprende una plataforma inferior (1) que es una pieza de forma sustancialmente apropiada para adaptarse a los contornos de las vértebras {tales como rectangular, ovalada, arriñonada, etc.), compacta y con una ventana u orificio central (2), siendo rugosa la superficie inferior de dicha plataforma {15, para entrar en contacto con la placa terminal cartilaginosa de la vértebra inferior del espacio intervertebral, la superficie superior de la plataforma {1} es lisa y de ella se elevan cuatro cilindros huecos {3) perpendiculares, uno en cada esquina, dispuestos para recibir a cuatro cilindros de menor diámetro que sobresalen de una plataforma superior (5) y, unas ranuras {4} adyacentes a dichos cilindros. La plataforma superior (5) es una pieza de forma sustancialmente igual a la de ia plataforma inferior (1), compacta y con una ventana u orificio central {6} , con una superficie superior, rugosa, para entrar en contacto con la placa terminal cartilaginosa de la vértebra superior del espacio intervertebral y, una superficie inferior lisa de la que sobresalen cuatro cilindros (7} perpendiculares a ella, uno en cada esquina, dispuestos para desligarse dentro de los cuatro cilindros huecos (3) de mayor diámetro que se elevan de ia plataforma inferior (i), para permitir el engranaje de ambas plataformas (superior e inferior} evitando los desplazamientos horizontales entre ellas, teniendo dichos cilindros (?) , ranuras (8) adyacentes a ellos y; compuertas o ventanas (9} que son estructuras rectangulares compactas, con un orificio central también rectangular, dispuestas horizon almente unas frente otras y perpendiculares al diámetro mayor de ia plataforma inferior, estando dichas compuestas ubicadas en ios extremos oblicuos de dos salientes laterales {10} de la superficie superior de ia plataforma inferior (1) en el sentido de su eje mayor, de tai manera que la caja (A) al encontrarse en posición contraída, tiene las ventanas o compuertas (9) apoyadas oblicuas con respecto a la plataforma inferior (1) descansando sobre los salientes laterales (10) y, en la posición expandida, las ventanas o compuertas (9) pasan de la posición de reposo u oblicuas con respecto a la plataforma inferior íl) a la posición vertical, encajando en las ranuras (4 8) dispuestas para ello tanto en la plataforma inferior como en la plataforma superior. La presencia de las múltiples ventanas u orificios ubicados tanto en las plataforma inferior (1) como en la plataforma superior (5); así como en las compuertas (9), permite una mejor aplicación del injerto óseo dentro de la caja (A ) en su posición expandida y un mayor contacto del injerto con las superficies de las placas termínales cartilaginosas de las vértebras, mejorando con ello la tasa de fusión intervertebral. The box AS in turn comprises a lower platform 1 which is a piece of shape substantially adapted to adapt to the contours of the vertebrae {such as rectangular, oval, kidney-shaped, etc.), compact and with a window or orifice central (2), with the lower surface of said platform {15 being rough, to come into contact with the cartilaginous terminal plate of the lower vertebra of the intervertebral space, the upper surface of the platform {1} is smooth and from it four are raised hollow cylinders {3) perpendicular, one in each corner, arranged to receive four cylinders of smaller diameter protruding from an upper platform (5) and, slots {4} adjacent to said cylinders. The upper platform (5) is a piece substantially the same as that of the lower platform (1), compact and with a central window or hole {6}, with a rough upper surface, to come into contact with the terminal plate cartilaginous of the superior vertebra of the intervertebral space and, a smooth lower surface from which protrude four cylinders (7) perpendicular to it, one at each corner, arranged to disengage within the four hollow cylinders (3) of greater diameter that rise of the lower platform (i), to allow the gearing of both platforms (upper and lower) avoiding the horizontal displacements between them, said cylinders (?), slots (8) adjacent to them and; gates or windows (9) having they are compact rectangular structures, with a central hole also rectangular, arranged horizontally opposite each other and perpendicular to the greater diameter of the lower platform, said components being located at the oblique ends of two lateral projections {10} of the upper surface of the lower platform (1) in the direction of its major axis, so that the box (A) to be in contracted position, has windows or gates (9) supported obliquely with respect to the lower platform (1) resting on the lateral projections (10) and, in the expanded position, the windows or gates (9) pass from the rest or oblique position with respect to the lower platform (I)) to the vertical position, fitting into the slots (4 8) arranged for it both in the lower platform as on the upper platform. The presence of the multiple windows or orifices located both on the lower platform (1) and on the upper platform (5); as well as in the gates (9), it allows a better application of the bone graft inside the box (A) in its expanded position and a greater contact of the graft with the surfaces of the cartilaginous end plates of the vertebrae, thereby improving the rate of intervertebral fusion.
Por otra parte la caja {&) en su cara ventral {que es la cara que corresponderá con la cara ventral de la columna vertebral, una vez colocada) , tiene alineados en su parte central un orificio con rosca {11} ubicado en la plataforma superior {5) y dos pernos o tornillos {12} ubicados en la plataforma inferior (1) .  On the other hand, the box {&) on its ventral face (which is the face that will correspond to the ventral side of the spine, once placed), has aligned in its central part a hole with thread {11} located on the platform top {5) and two bolts or screws {12} located on the lower platform (1).
La pieza sujetadora {8} comprende una varilla superior hueca (13) por donde discurre una varilla o guía (14), dos varillas inferiores {15} , dos piezas de marco paralelas (16} a través de las cuales discurren tanto la varilla {13} como las dos varillas (15) y, una manija roscada (17) que se coloca en uno de ios extremos distaies de la guía (14) , de tal manera que la varilla (14} al ser roscada en el orificio {11} de la caja (A) , sirve como guía para la inserción de la varilla hueca (13) , permitiendo alinear las varillas inferiores (155 con cada uno de los pernos {12} de la plataforma inferior (15 de la caja (A) .  The clamping piece {8} comprises a hollow upper rod (13) through which a rod or guide (14) runs, two lower rods {15}, two parallel frame pieces (16) through which the rod runs ( 13) as the two rods (15) and, a threaded handle (17) which is placed in one of the distal ends of the guide (14), in such a way that the rod (14) when being threaded in the hole (11) } of the box (A), serves as a guide for the insertion of the hollow rod (13), allowing to align the lower rods (155 with each of the bolts {12} of the lower platform (15 of the box (A)) .
Finalmente la pinza para expansión {C} , comprende una varilla hueca {18} sostenida por un pieza con dos arillos (19) ubicada sobre la superficie superio de un eje (20}, que sirve como punto de giro de dos brazos {21} que se continúan en su extremo distal, en dirección a la varilla hueca (18), con dos palas (22) que se abren en respuesta al acercamiento de los brazos (21). Dicha pinza (C) , además cuenta con un sistema de seguros (23) en forma de una cruceta que limita la apertura de las palas (22) . Finally the clamp for expansion {C}, comprises a hollow rod {18} supported by a piece with two rings (19) located on the upper surface of an axis (20), which serves as a pivot point of two arms {21} That they continue at their distal end, towards the hollow rod (18), with two blades (22) that open in response to the approach of the arms (21). Said clamp (C) also has an insurance system (23) in the form of a crosshead that limits the opening of the blades (22).
En una modalidad del sistema (Figuras 19 a 22} , tanto la plataforma inferior como la superior de la caja (A), son de forma ovalada, teniendo dicha caja al menos 4 ventanas, dos a cada lado de la caja, que en cada uno de sus extremos superiores presentan ranuras laterales para recibir una estructura en forma de vdoble T" (25) que permite coordinar el desplazamiento de cada dos ventanas con el fin de expandir la caja de manera controlada y uniforme. La conformación antes descrita, permite incrementar el área efectiva de la caja expandióle y resisti fuerzas de compresión mayores tales corno las que se verifican ai colocar la caja en la región lumbar. In one embodiment of the system (Figures 19 to 22), both the lower and upper platform of the box (A) are oval in shape, said box having at least 4 windows, two on each side of the box, which in each case One of its upper ends has lateral grooves to receive a double V- shaped structure "(25) that allows to coordinate the displacement of each two windows in order to expand the box in a controlled and uniform manner. Increase the effective area of the expanded box and resist higher compression forces such as those that occur when the box is placed in the lumbar region.
En otra modalidad de la invención (Figuras 23, 24, 2? y 28) la caja no solo aumenta su altura, sino que permite además variar su ancho. Para ello, cada una de las plataformas de la ca a expandible se manufactura en dos segmentos laterales unidos mediante un segmento central en forma de "doble T" (26) que presenta un par de correderas por las que se deslizan los dos segmentos laterales (derecho e izquierdo) , dichos segmentos recorren distancias equivalentes hasta hacer tope el uno con ei otro en la línea media o centro de cada uno de los segmentos- centrales (26) . En esta modalidad, la saliente lateral (10) de la cara ventral también, se encuentra dividida en dos secciones, cada una de las cuales tiene asociada un perno o tornillo (12) que sirve como sitio de unión para una pinza de expansión lateral {D) que es una modificación de la pinza para expansión de altura con la diferencia de que no lleva la varilla hueca {18} y en vez de las dos palas (22) cuenta con dos piezas tubulares huecas {24} adaptadas para recibir en su interior a ios pernos (12) de cada una de las secciones de la saliente lateral ventral. In another embodiment of the invention (Figures 23, 24, 2? And 28) the box not only increases its height, but also allows it to vary its width. For this, each of the platforms of the expandable ca is manufactured in two lateral segments joined by a central segment in the form of "double T" (26) that has a pair of slides through which the two lateral segments slide ( right and left), said segments travel equivalent distances until they face each other in the middle line or center of each of the center-segments (26). In this embodiment, the lateral projection (10) of the ventral face is also divided into two sections, each of which has a bolt or screw (12) associated with it. which serves as a joining site for a lateral expansion clamp {D) which is a modification of the clamp for height expansion with the difference that it does not carry the hollow rod {18} and instead of the two blades (22) it has with two hollow tubular pieces {24} adapted to receive inside them the bolts (12) of each of the sections of the ventral lateral projection.
La metodología utilizada para colocar el sistema en su ubicación final es la siguiente;  The methodology used to place the system in its final location is as follows;
En primer término, se acopia La guia {14} ai orificio First, the guide {14} ai hole is collected
{11} de la plataforma superior de la caja {A}; posteriormente, la guía (14) se introduce dentro de la varilla superior hueca (13) hasta que el extremo dista! libre de la misma sobresalga, teniendo cuidado de hacer coincidir las varillas inferiores (15) con los pernos {12} de la plataforma inferior; una vez logrado esto, se procede a asegurar todo el conjunto de manera firme mediante la .manija roscada (17) . El conjunto asi formado puede ser manipulado de manera sencilla y permite introducirlo por un orificio de tamaño reducido. {11} of the upper platform of the box {A}; subsequently, the guide (14) is inserted into the upper hollow rod (13) until the end is distal! free of the same protrude, taking care to match the lower rods (15) with the bolts {12} of the lower platform; Once this is achieved, the entire assembly is secured firmly by the threaded handle (17). The assembly thus formed can be manipulated in a simple manner and allows inserting it through a hole of reduced size.
Una v z que la caja (A) y la pieza sujetadora (B) se encuentran unidas firmemente, se guia todo el conjunto hasta el espacio intersomático a través de un canal practicado por métodos convencionales. Una vez ubicada la caja (A) en el espacio Ínt somático, se retira la manija roscada {17} liberando de esta forma la pieza sujetadora (B) que debe ser retirada en la dirección contraria a su inserción. Hecho esto, La caja (A) queda unida solo a la guía (14) ,  Once the box (A) and the clamping piece (B) are firmly connected, the entire assembly is guided to the intersomatic space through a channel practiced by conventional methods. Once the box (A) is located in the Int somatic space, the threaded handle {17} is removed, thus releasing the clamping piece (B) that must be removed in the direction opposite to its insertion. Done this, The box (A) remains attached only to the guide (14),
Usando la varilla hueca (18) se introduce la pinza para expansión (C) por el mismo canal utilizado para la inserción de la caja sobre la guia (14), de esta forma se permite introducir de manera correcta las dos palas (22) en el espacio que queda entre la plataforma inferior (!) y la superior (5) de la caja. Una vez colocada de forma correcta la pinza de expansión {C} , se aplica fue za sobre los dos brazos {21} acercándolos entre sí, esto aleja las dos palas {22} elevando las compuertas, con lo que la caja se expande en altura y se asienta firmemente entre las superficies de las vértebras adyacentes . Using the hollow rod (18) the expansion clamp (C) is inserted through the same channel used for the insertion of the box on the guide (14), in this way it is allowed to introduce correctly the two blades (22) in the space that is between the lower platform (!) and the upper (5) of the box. Once the expansion clamp {C} is correctly positioned, it is applied to the two arms {21} bringing them closer to each other, this moves the two blades away {22} by raising the gates, so that the box expands in height and sits firmly between the surfaces of the adjacent vertebrae.
En la modalidad en la que la caja aumenta también su anchura, antes de llevar acabo el levantamiento de las compuertas es necesario introducir primé o la pinza modificada para expansió lateral {D} . Para ello, se aplican o acoplan las dos piezas tubulares huecas {24} sobre los dos pernos {12} de cada una de las secciones de la saliente lateral {10} {tal y como se observa en la figura 27} , Una vez colocada la pinza en la posición correcta, se procede a aplicar fuerza sobre los brazos (215 a fin de acercarlos entre si, causando con ello la separación de las dos piezas tubulares {24} y ios segmentos laterales (izquierdo y derecho) de las plataformas de la caja (A) , aumentando con ello el ancho total, de la caja intersomática (Figura 285 ·  In the modality in which the box also increases its width, before carrying out the lifting of the gates it is necessary to introduce a prism or the modified clamp for lateral expansion {D}. For this, the two hollow tubular pieces {24} are applied or coupled on the two bolts {12} of each of the sections of the lateral projection {10} {as shown in figure 27}, once placed the clamp in the correct position, force is applied to the arms (215) in order to bring them closer together, thereby causing the separation of the two tubular pieces {24} and the lateral segments (left and right) of the platforms. the box (A), thereby increasing the total width of the intersomatic box (Figure 285 ·

Claims

REXVTNDICACIONES l.~ Un sistema expandible para fusión intersomática, que comprende una caja expandible (A) , una pieza s jetadora (8) y una pinza para expansión {C) , caracterizado porque la caja expandible (A) comprende una plataforma inferior (1) diseñada par adaptarse a los contornos de las vértebras, con una superficie inferior rugosa que entra en contacto con la placa terminal cartilaginosa de la vértebra inferior del espacio intervertebral y una superficie superior lisa; una ventana u orificio central (2), cuatro cilindros huecos (3) dispuestos cada uno perpendicuiarroente en cada esquina de dicha superficie superior lisa; ranuras {4) dispuestas de inane a adyacente a los cilindros huecos {3}, una plataforma superior íS) de la misma co figuración que la plataforma inferior {1} , con una ventana u orificio central (6), siendo su superficie superior rugosa para entra en contacto con la placa terminal cartilaginosa de la vértebra superior del espacio .intervertebral, mientras que su superficie inferior es lisa y alberga cuatro cilindros (7} perpendiculares a dicha superficie, dispuestos uno en cada esquina para insertarse dentro de los cilindros huecos (3) correspondientes de la plataforma inferior (1}; ranuras {8} dispuestas de manera adyacente a dichos cilindros (7) ; dos salientes laterales (10) dispuestas en la superficie superior de la plataforma inferior {!,} en el sentido de su eje mayor; compuertas o ventanas (9) con un orificio central, dispuestas horizontalmente unas frente a otras y perpendiculares al diámetro mayor de la plataforma inferior {15; en extremos oblicuos de las salientes laterales (10); un orificio co rosca {11} practicado en la plataforma superior (5), en la parte media de ia cara ventral de la caja (A); dos pernos o tornillos {12} dispuestos en la saliente lateral de la plataforma inferior {!}; una varilla superior hueca (13) y dos varillas inferiores (15) dispuestas en la pieza sujetadora (B) y soportadas por dos piezas de marco paralelas {16}; una varilla o guia (14) colocada dentro de dicha varilla {13}, configurada para ser recibida por uno de sus extremos en el orificio roscado {11} de ia plataforma superior £5} y por una manija roscada {17} en el otro extremo; una varilla hueca {18} dispuesta en la pinza para expansión (C) , adaptada para recibir la varilla o guia {14} y sostenida por una piez.a con dos arillos {19} conectada a un eje {20}, que sirve co o punto de giro para dos brazos {21} que se continúan en su extremo dista!, en diredción a la varilla hueca {18} , por dos palas {225, teniendo dicha pinza (C) un sistema de seguros (23) en forma de cruceta que controla la apertura de las palas (22}, de tai manera que al engranarse los cilindros {3} y (7}d© las plataformas inferior (1) y. superior (5), las compuertas o ventanas {9} quedan oblicuas con respecto a la plataforma inferior {!), descansando en los salientes laterales £10} y formando la caja (A), mientras que al colocar la guia (14) de la pieza sujetadora (B) en el orificio {11} de .la caja (A), se acopla ia caja (A) a la pieza sujetadora (B) usando la varilla hueca (13) corno guia para hacer coincidir las varillas inferiores (15} con los pernos o tornillos {12}, asegurando el conjunto de manera firme mediante la manija roscada {17} para su colocación y, una ea colocada la caja en su ubicación fina! se retira la manija roscada (i?) para separar ia pieza sujetador» (B) y dicha guia (14) sirve para colocar la pinza para expansión (C) en su lugar entre las plataformas inferior (I) y superior (5) permitiendo elevar las com uertas o ventanas (9) hasta la posición vertical mediante la apertura de palas (22} causada por la fuerza aplicada sobre los brazos (21) / encajando dichas compuertas en las ranuras inferiores {4) y superiores {$) para evitar la retracción de la caja (A), de tal manera que la caja (A) una vez ubicada en su posición final y debido a la presencia de las múltiples ventanas u orificios {2} y {6) ubicados tanto en las plataforma inferior (1) como en la plataforma superior (5), asi como en las compuertas (9), permite una mejor aplicación del injerto óseo dentro de la caja (A) en su posición expandida y un mayor contacto del injerto con las superficies de las placas terminales cartilaginosas de las vértebras, mejorando con ello la tasa de fusión intervertebral. REXVTNDICATIONS 1. An expandable system for intersomatic fusion, comprising an expandable box (A), a sizing piece (8) and an expansion clamp (C), characterized in that the expandable box (A) comprises a lower platform (1). ) designed to adapt to the contours of the vertebrae, with a rough lower surface that comes in contact with the cartilaginous endplate of the inferior vertebra of the intervertebral space and a smooth upper surface; a window or central hole (2), four hollow cylinders (3) each arranged perpendicular in each corner of said smooth top surface; slots {4) disposed inane a adjacent to the hollow cylinders {3}, an upper platform S S) of the same configuration as the lower platform {1}, with a window or central hole (6), its upper surface being rough for it comes into contact with the cartilaginous terminal plate of the upper vertebra of the intervertebral space, while its lower surface is smooth and houses four cylinders (7) perpendicular to said surface, arranged one at each corner to be inserted inside the hollow cylinders ( 3) corresponding to the lower platform (1), grooves {8} arranged adjacent to said cylinders (7), two lateral projections (10) arranged on the upper surface of the lower platform {!,} In the direction of their major axis, gates or windows (9) with a central hole, arranged horizontally facing each other and perpendicular to the greater diameter of the lower platform {15; at oblique ends of the lateral projections s (10); a threaded hole {11} made in the upper platform (5), in the middle part of the ventral side of the box (A); two bolts or screws {12} arranged in the lateral projection of the lower platform {!}; a hollow upper rod (13) and two lower rods (15) arranged on the holding part (B) and supported by two parallel frame parts {16}; a rod or guide (14) placed inside said rod {13}, configured to be received by one of its ends in the threaded hole {11} of the upper platform £ 5 and by a threaded handle {17} in the other extreme; a hollow rod {18} arranged in the expansion clamp (C), adapted to receive the rod or guide {14} and held by a piez.a with two rings {19} connected to an axis {20}, which serves or pivot point for two arms {21} which are continued at their distal end, in the direction of the hollow rod {18}, by two blades {225, said clamp (C) having an insurance system (23) in shape of crosshead that controls the opening of the blades (22), so that when the cylinders {3} and (7} d © the lower platforms (1) and upper (5), the floodgates or windows are engaged {9} they are oblique with respect to the lower platform {!), resting on the lateral projections £ 10} and forming the box (A), while placing the guide (14) of the clamping piece (B) in the hole {11} of the box (A), the box (A) is attached to the clamping piece (B) using the hollow rod (13) as a guide to match the lower rods (15) with the bolts or screws {12}, ensuring the set firmly by means of the threaded handle {17} for its placement and, the box is placed in its fine location! the threaded handle (i?) is removed to separate the piece fastener »(B) and said guide (14) serves to place the expansion clamp (C) in place between the lower (I) and upper (5) platforms, allowing to raise the doors or windows (9) to the vertical position by opening blades (22) caused by the force applied to the arms (21) / fitting said gates in the lower slots {4) and upper slots {$) to avoid retraction of the box (A), in such a way that the box (A) once located in its final position and due to the presence of the multiple windows or holes {2} and {6) located both on the lower platform (1) and on the upper platform (5), as well as in the gates (9), allows a better application of the bone graft inside the box (A) in its expanded position and a greater contact of the graft with the surfaces of the cartilaginous terminal plates of the vertebrae, thereby improving the fusion rate intervertebral
2. - El sistema de acuerdo con la reivindicación X, caracterizado porque cada una de las plataformas de la caja (A) comprenden dos segmentos laterales, uno derecho y otro izquierdo, unidos mediante un segmento central en forma de ^dobie T" {26} que presenta un par de correderas en las que se deslizan dichos segmentos laterales recorriendo distancias equivalentes hasta hacer tope el uno con el otro en la línea medía del segmento central {26} y; la saliente lateral de la cara ventral se encuentra dividida en dos secciones, estando asociada a cada una de ellas un perno o tornillo que sirven como sitio d unión para recibir la pinza de expansión lateral y permitir la extensión de los segmento laterales .  2. - The system according to claim X, characterized in that each of the platforms of the box (A) comprise two side segments, one right and one left, joined by a central segment in the form of ^ dobie T "{26 } which has a pair of slides in which said lateral segments slide along equivalent distances until they stop against each other at the midline of the central segment {26} and the lateral projection of the ventral face is divided into two sections, each of which is associated with a bolt or bolt serving as a joining site for receiving the lateral expansion clamp and allowing the extension of the lateral segments.
3. - El sistema de acuerdo con la reivindicación 1, caracterizado porque además comprende una pinza modificada para expansión lateral {D) que es una modificación de la pinza para expansión (C) , pero sin la varilla hueca {18} y con dos piezas tubulares huecas (24) que substituyen a las S dos palas (22) y están adaptadas para recibir en su interior a los pernos (12} de cada una de las secciones de la saliente lateral ventral. 3. - The system according to claim 1, characterized in that it also comprises a modified clamp for lateral expansion {D) which is a modification of the clamp for expansion (C), but without the hollow rod {18} and with two hollow tubular pieces (24) that replace the two blades S (22) and are adapted to receive inside the bolts (12) of each of the sections of the ventral lateral projection.
4. - El sistema de acuerdo con cualquiera de las reivindicaciones 1 o 2, caracterizado porque la forma de las0 plataformas de la caja (A) se selecciona del grupo consistente en rectangular, ovalada o arríñonada.  4. - The system according to any of claims 1 or 2, characterized in that the shape of the platforms of the box (A) is selected from the group consisting of rectangular, oval or arriñonada.
5. - El sistema de acuerdo con cualquiera de las reivindicaciones 1 o 2, caracterizado porque el número de compuertas o ventanas (9} es 2 y el número de ranuras de5 cada plataforma es .  5. - The system according to any of claims 1 or 2, characterized in that the number of gates or windows (9) is 2 and the number of slots of each platform is 5.
6. - El sistema de acuerdo con cualquiera de las reivindicaciones i o 2, caracterizada porque el número de compuertas o ventanas {9} es 4 y están formando dos grupos teniendo entre cada 2 de dichas compuertas una estructura en0 forma de "doble T" (25) que es recibida por ranuras laterales ubicadas en los extremos superiores de las compuertas (9), para coordinar los movimientos de elevación de la caja (A) yp el número de ranuras de cada plataforma es 8.  6. - The system according to any of claims 1 or 2, characterized in that the number of gates or windows {9} is 4 and are forming two groups having between each 2 of said gates a structure in the form of "double T" ( 25) that is received by lateral grooves located in the upper ends of the gates (9), to coordinate the movements of elevation of the box (A) and p the number of grooves of each platform is 8.
7. ~ Un método para colocar el sistema expandible para5 fusión intersomática de cualquiera de las reivindicaciones anteriores caracterizado porque comprende los pasos de; a} colocar la varilla o guia {14} en el agujero roscado (11) de la plataforma superior (5) ;  7. A method for placing the expandable system for intersomatic fusion of any of the preceding claims characterized in that it comprises the steps of; a} place the rod or guide {14} in the threaded hole (11) of the upper platform (5);
b) introducir la guia (14) dentro de la varilla hueca0 (13) de la pieza sujetadora, haciendo coincidir ios pernos (12) con las varillas huecas {15} y, asegurar el conjunto con la manija roscada (17); b) insert the guide (14) into the hollow rod0 (13) of the clamping piece, making the bolts coincide (12) with the hollow rods {15} and, secure the assembly with the threaded handle (17);
c) introducir el conjunto de caja y pieza sujetadora por un canal hecho por métodos conocidos hasta el espacio intervertebral, de tal manera que Xa superficie inferior de la plataforma inferior íl) quede en contacto con la placa terminal cartilaginosa de la vértebra inferior del espacio intervertebral y la superficie superior de la plataforma superior {5} quede en contacto con la placa cartilaginosa de la vértebra superior del espacio intervertebral;  c) introducing the box and holder assembly through a channel made by known methods to the intervertebral space, such that the lower surface of the lower platform (1) is in contact with the cartilaginous endplate of the lower vertebra of the intervertebral space and the upper surface of the upper platform {5} is in contact with the cartilaginous plate of the superior vertebra of the intervertebral space;
á) retirar la manija roscada (1?) y retraer por el misino canal de inserción la pieza sujetadora (B) dejando atrás la guia { i ) ;  a) remove the threaded handle (1?) and retract the insert (B) leaving the guide {i) behind;
ej insertar la pinza para expansión (CJ a través del canal practicado e introducir la guia (14) dentro de la varilla hueca {18} hasta que las palas {22} se posicionen el espacio que existe entre las plataformas inferior {1} y superior {5};  eg insert the clamp for expansion (CJ through the channel practiced and introduce the guide (14) into the hollow rod {18} until the blades {22} are positioned in the space between the bottom platforms {1} and above {5};
f) aplicar fuerza sobre los brazos (21) de la pinza {C} acercándolos entre si, para causar la apertura de las palas {22}, de tal manera que las compuertas (9) pasen de una posición oblicua con respecto a la píataforina inferior a una posición perpendicular, para expandir la caja (A) , andándola a las superficies cartilaginosas de las vértebras ,  f) applying force on the arms (21) of the clamp {C} bringing them closer to each other, to cause the opening of the blades {22}, in such a way that the gates (9) pass from an oblique position with respect to the ptataphorin lower to a perpendicular position, to expand the box (A), moving it to the cartilaginous surfaces of the vertebrae,
8.- El método de acuerdo con la reivindicación 7, caracterizado porque si cada una de las plataformas de la caja (A) se encuentra dividida en dos secciones antes del paso e}, además comprende los pasos de;  8. The method according to claim 7, characterized in that if each of the platforms of the box (A) is divided into two sections before step e}, it also comprises the steps of;
g) introducir a través del canal practicado la pinza modificada para expansión lateral (D), para hacer coincidir las varillas tubulares (24) con cada uno de los pernos (12) ubicados en cada una de las secciones de la saliente lateral (10) y; g) introduce the clamp through the channel modified for lateral expansion (D), to match the tubular rods (24) with each of the bolts (12) located in each of the sections of the lateral projection (10) and;
h) aplicar fuerza sobre los brazos (21} de la pinza {D} acercándolos entre sí, para causar la apertura de las varillas (24), de tal manera que las porciones izquierda y derecha de cada una de las plataformas se alejen entre sí para aumentar el ancho de la caja (A) .  h) applying force on the arms (21) of the clamp {D} bringing them closer to each other, to cause the rods to open (24), in such a way that the left and right portions of each of the platforms move away from each other to increase the width of the box (A).
PCT/MX2015/000037 2015-03-06 2015-03-06 Expandable system for intersomatic fusion and method for the use thereof WO2016144150A1 (en)

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Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1998014142A1 (en) * 1996-10-01 1998-04-09 Surgical Dynamics, Inc. Spinal fusion implant and method of insertion thereof
WO2009064787A2 (en) * 2007-11-12 2009-05-22 Synthes (U.S.A.) Adjustable height intervertebral implant
WO2009114381A1 (en) * 2008-03-07 2009-09-17 Synthes Usa, Llc Expandable interbody spacer device
US20100016970A1 (en) * 2008-07-17 2010-01-21 John Kapitan Spinal interbody spacers
US20110130835A1 (en) * 2008-12-10 2011-06-02 Innvotec Surgical, Inc. Adjustable Distraction Cage With Linked Locking Mechanisms
WO2013184946A1 (en) * 2012-06-06 2013-12-12 Medivest, Llc Expandable tissue spacer implant and method of use
US20140249629A1 (en) * 2005-04-12 2014-09-04 Ahmnon D. Moskowitz Zero-profile expandable intervertebral spacer devices for distraction and spinal fusion and a universal tool for their placement and expansion

Patent Citations (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO1998014142A1 (en) * 1996-10-01 1998-04-09 Surgical Dynamics, Inc. Spinal fusion implant and method of insertion thereof
US20140249629A1 (en) * 2005-04-12 2014-09-04 Ahmnon D. Moskowitz Zero-profile expandable intervertebral spacer devices for distraction and spinal fusion and a universal tool for their placement and expansion
WO2009064787A2 (en) * 2007-11-12 2009-05-22 Synthes (U.S.A.) Adjustable height intervertebral implant
WO2009114381A1 (en) * 2008-03-07 2009-09-17 Synthes Usa, Llc Expandable interbody spacer device
US20100016970A1 (en) * 2008-07-17 2010-01-21 John Kapitan Spinal interbody spacers
US20110130835A1 (en) * 2008-12-10 2011-06-02 Innvotec Surgical, Inc. Adjustable Distraction Cage With Linked Locking Mechanisms
WO2013184946A1 (en) * 2012-06-06 2013-12-12 Medivest, Llc Expandable tissue spacer implant and method of use

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