CN100574728C - Intervertebral disc replacement device and system - Google Patents

Abstract

The present invention discloses a disc replacement device (10) comprising: a first implantable member (12) having a first anchor plate (16) and a female body (18) detachably couplable with the first anchor plate (16), and a second implantable member (14) having a second anchor plate (20) and a male body (22) detachably couplable with the second anchor plate (20), the male body (22) for movable engagement with the female body (18), wherein the female body is coupled to the first anchor plate using a first coupling member in a manner to permit separation of the female body from the first anchor plate with removal of the first coupling member while leaving the first anchor plate implanted on a vertebra; or wherein the boss is coupled to the second anchor plate using a second coupling member in a manner that, with the second coupling member removed, allows the boss to separate from the second anchor plate while leaving the second anchor plate implanted on a vertebra.

Description

Intervertebral disc replacement device and system

Cross-references to related applications

This application claims priority to U.S. Provisional Patent Applications 60/368,783, filed March 30, 2002, and 60/381,529, filed May 16, 2002, both of which Both applications have Lytton Williams as first inventor, the entire contents of which are hereby incorporated by reference in their entirety as if fully set forth herein.

technical field

The present invention relates to an intervertebral disc replacement device and system for implanting in a patient's spine.

Background technique

The human spine is a flexible structure containing 33 vertebrae separated by intervertebral discs. The intervertebral discs act as shock absorbers lining between adjacent vertebrae and allow flexion between the vertebrae. Typically, a disc consists of a nucleus pulposus, annulus fibrosus, and endplates. The nucleus pulposus comprises an inner gel-like nucleus that occupies 25-40% of the disc's cross-sectional area. The annulus fibrosus is a complex structure of collagen fibers that surrounds the nucleus pulposus and resists hooping, torsion and bending forces on the disc. Endplates of cartilage separate the disc from the vertebrae on each side of the disc.

Currently, back pain is a widespread public health problem, especially among the elderly. Persistent and severe back pain can be debilitating and incapacitating. A common cause of this pain is usually due to abnormalities in the intervertebral discs. For example, trauma, stress, injury, disease, or abuse may result in damage to one or more vertebrae and/or one or more intervertebral discs. More precisely, disorders of the vertebrae and intervertebral discs may include, but are not limited to: (1) rupture of the disc annulus such as annulus; (2) chronic inflammation of the intervertebral disc; (3) localized disc herniation with inclusion or escape extrusion and (4) instability of the vertebrae surrounding the intervertebral disc.

Various methods of treating back pain have been devised. For example, milder back pain can be treated with medication or other noninvasive treatments. However, severe back pain often requires removal of at least a portion of damaged or dysfunctional back tissue. It is also possible for a disc to rupture. A ruptured disc can be surgically removed, and two adjacent vertebrae near the removed disc can be fused together. Alternatively, the endplates of two adjacent vertebrae can be fused from the posterior side by screws or other fusion devices. While these fusion procedures have proven successful in the treatment of some intervertebral dysfunctions, some drawbacks have also been revealed. For example, such post-fusion procedures may produce pseudarthrosis.

As previously stated, there is a need to develop implantable intervertebral devices that mimic the natural motion of the vertebrae.

Contents of the invention

The present application relates to a variety of intervertebral devices that can be implanted in a variety of ways into a patient's spine to treat a variety of conditions.

Disclosed herein are embodiments of an intervertebral disc replacement device comprising a first implantable member having a first anchoring plate implanted on a vertebra and a recess detachably coupled to the first anchoring plate and, a second implantable member having a second anchoring plate implanted on the vertebra and a convex body detachably coupled to the second anchoring plate for movable engagement with the concave body , wherein the recess is coupled to the first anchoring plate using a first coupling in such a manner as to allow the recess to separate from the first anchoring plate as the first coupling is removed , while leaving the first anchoring plate implanted on the vertebrae; or wherein the protrusion is coupled to the second anchoring plate using a second coupling in such a manner that as the second coupling moves removal, allowing the protrusion to detach from the second anchoring plate while leaving the second anchoring plate implanted on the vertebrae.

In another embodiment, an intervertebral device is disclosed and includes a first implantable member having a first anchoring plate implanted on a vertebra and a detachable coupled to the recesses on the first anchoring plate on which a plurality of anchors are placed on the periphery; and a second implantable element having a first implanted on the vertebrae Two anchor plates and protrusions detachably coupled to the second anchor plate, a plurality of anchors disposed on the periphery of said anchor plates, said protrusions for movable engagement with said recesses , wherein the recess is coupled to the first anchoring plate using a first coupling in such a manner as to allow the recess to separate from the first anchoring plate as the first coupling is removed , while leaving the first anchoring plate implanted on the vertebrae; or wherein the protrusion is coupled to the second anchoring plate using a second coupling in such a manner that as the second coupling moves removal, allowing the protrusion to detach from the second anchoring plate while leaving the second anchoring plate implanted on the vertebrae.

In yet another embodiment, a partial disc intervertebral device is described and includes a first partial disc device having a first anchoring plate and a detachable semi-recessed plate coupled to the first anchoring plate. body, a plurality of anchors placed on the outer periphery of the first anchor plate; and a second partial disc device having a second anchor plate and a detachable coupling to the second anchor plate A plurality of anchoring pieces are placed on the outer periphery of the second anchor plate on the semi-convex body, and the semi-convex body is used for movable engagement with the semi-concave body.

Additionally, a method for implanting a disc prosthesis in a patient's spine is described and includes providing a disc space between two adjacent vertebrae, placing at least one disc prosthesis within the disc space, aligning the endplates of the vertebral cartilage with the At least one anchor is engaged on the disc prosthesis.

In another embodiment, a method of implanting an intervertebral disc prosthesis in a patient's vertebrae is disclosed and includes providing a disc space between two adjacent vertebrae in which to place a first disc spacer having a concavity therein. An implant, engaging the endplate of the vertebral cartilage with at least one anchor on the first implantable part, placing a second implantable part with a convex body in the disc space so that the endplate of the vertebral cartilage is in contact with the first implantable part At least one anchor member on the two implantable parts engages and engages the concave body of the first implantable part into the convex body on the second implantable part.

In yet another embodiment, a method of repairing an intervertebral disc device implanted in a patient is disclosed and includes providing a disc space between two adjacent vertebrae, a first one having first implantable members implanted therein a vertebra having a first implant coupled to a concave body coupled thereto, and a second vertebra having a second implant implanted therein coupled to a second implant having a convex body coupled thereto, The coupling that couples the recess to the first implant is removed, the recess is removed from the first implant and the first anchor plate is left implanted in the first vertebra, where the first anchor A replacement recess is placed on the anchor plate, the replacement recess is coupled to the first anchor plate by a coupling member, and the replacement recess of the first implantable member engages the protrusion of the second anchor plate.

In addition, an anterior lateral method of accessing the patient's vertebrae is described here and involves, with the patient placed in lateral decubitus position, the location of the intervertebral discs to be accessed within the spine, passing medial and lateral along the central axis within the patient's skin Make an incision in the disc space that needs to be repaired, cut the subcutaneous tissue and the fascia under it, bluntly dissect the external oblique muscle, bluntly dissect the transverse muscle, bluntly dissect the internal oblique muscle, bluntly dissect the peritoneum behind the vertebrae, and do not damage the waist The psoas muscle is dissected anteriorly or posteriorly bluntly by the plexus or nerve root, the peritoneum is retracted medially and toward the vertebral head, the dissected vessels are ligated, and the ligated vessels are retracted medially and laterally to provide access to the vertebrae. channel.

Other objects, features, and advantages of the present invention will appear in the following detailed description.

Description of drawings

Figure 1 is a perspective view of an embodiment of an intervertebral disc replacement device;

Figure 2 is a longitudinal view of an embodiment of an intervertebral disc replacement device;

3 is a front view of an embodiment of an anchoring plate of an intervertebral disc replacement device;

Figure 4 is a perspective view of the first anchor plate embodiment of the disc replacement device with the dimples removed therefrom;

5 is a side view of the first anchor plate embodiment of the disc replacement device with the recess removed therefrom along line 5-5 shown in FIG. 4;

Figure 6 is a perspective view of the disc replacement device female embodiment removed from the first anchoring plate;

7 is a side view of the disc replacement device concave embodiment removed from the first anchor plate along line 7-7 shown in FIG. 6;

Figure 8 is a perspective view of a first implantable member embodiment of a disc replacement device;

Fig. 9 is a perspective view of another embodiment of the first implantable part of the intervertebral disc replacement device;

Figure 10 is a perspective view of the first implantable member embodiment of the disc replacement device being assembled;

Figure 11 is a perspective view of the first implantable member embodiment of the assembled disc replacement device;

Figure 12 is a perspective view of a second implantable member embodiment of a disc replacement device;

13 is a perspective view of the second anchor plate embodiment of the disc replacement device with the protrusions removed therefrom;

Figure 14 is a side view of a second anchor plate embodiment of the disc replacement device with the protrusions removed along line 14-14 as shown in Figure 13;

15 is a perspective view of the embodiment of the disc replacement device boss removed from the second anchor plate;

Figure 16 is a side view of an embodiment of the protrusion of the intervertebral disc replacement device from the second anchor plate along the line 16-16 shown in Figure 15

Fig. 17 is a perspective view of an embodiment of an arched body of an intervertebral disc replacement device;

Fig. 18 is an embodiment view of the convex body of the intervertebral disc replacement device;

Fig. 19 is a view of another embodiment of the convex body part of the intervertebral disc replacement device;

Figure 20 is a longitudinal view of an embodiment of a disc replacement device with force applied thereto along its midline;

21 is a longitudinal view of an embodiment of a disc replacement device with force applied thereto off-center;

Fig. 22 is another embodiment view of the convex body of the intervertebral disc replacement device;

Figure 23 is a longitudinal view of the embodiment of the intervertebral disc replacement device shown in Figure 22, with force applied thereto along its midline;

Fig. 24 is a longitudinal view of the embodiment of the intervertebral disc replacement device shown in Fig. 22, with force applied thereto deviated from its midline;

Figure 25 is a partial view of an embodiment of the disk replacement device;

Fig. 26 is a view of an embodiment of the first partial disc of the partial disc replacement device;

Fig. 27 is a view of an embodiment of the second partial disc of the partial disc replacement device;

Figure 28 is a perspective view of an intervertebral disc between two adjacent vertebrae;

Figure 29 is a perspective view of an intervertebral disc located between two adjacent vertebrae at a distance D6;

30 is a perspective view of two adjacent vertebrae separated by a distance D6;

Fig. 31 is a perspective view of an embodiment of the second implantable part of the intervertebral disc replacement device located between two adjacent vertebrae;

Fig. 32 is a perspective view of an embodiment of a second implantable part of an intervertebral disc replacement device coupled to a vertebra;

Fig. 33 is a perspective view of an embodiment of the first implantable part of the intervertebral disc replacement device located between two adjacent vertebrae;

Fig. 34 is a perspective view of an embodiment of the first implantable part of the intervertebral disc replacement device coupled to the vertebrae;

35 is a perspective view of an embodiment of a first implantable member coupled to a vertebra engaged with a second implantable member coupled to an adjacent vertebra;

36 is a perspective view of another embodiment of a first implantable member coupled to a vertebra engaged with a second implantable member coupled to an adjacent vertebra;

Figure 37 is a perspective view of a second implantable member coupled to a vertebra prior to boss replacement;

38 is a perspective view of a second implant coupled to a vertebra undergoing boss replacement, in which the boss has been removed;

39 is a perspective view of a second implant coupled to a vertebra undergoing boss replacement, wherein the replacement boss has been placed into the disc space;

40 is a perspective view of an embodiment of a first implantable member coupled to a vertebra engaged with a second implantable member coupled to an adjacent vertebra;

Figure 41 is a perspective view of an embodiment of a first implantable member coupled to a vertebra engaged with a second implantable member coupled to an adjacent vertebra prior to a disc fusion procedure

42 is a perspective view of an embodiment of the first anchoring plate and the second anchoring plate coupled to the vertebrae, respectively, before being coupled to the disc fusion device; and

Figure 43 is a perspective view of an embodiment of a first anchoring plate and a second anchoring plate previously coupled to vertebrae, respectively, coupled with a disc fusion device.

Detailed ways

The disc replacement devices disclosed herein can be implanted in the spinal column of a mammal. Unlike prior intervertebral disc prostheses having an attachment device for the nucleus pulposus or annulus of the fibrous disc, the intervertebral disc prosthesis disclosed herein includes at least one anchoring plate having one or more anchor members thereon , the anchor is used to engage and couple the disc replacement device to the vertebral cartilage endplates of the spine, thereby increasing the stability of the device once implanted. In addition, the disc replacement devices disclosed herein may have replacement components, thereby allowing the surgeon to customize the device to each patient's physiological limitations and changes in physiological conditions. Additionally, disc replacement devices can be made in different sizes, thereby allowing the device to be implanted at different locations in a patient's spine. For example, the intervertebral device is sized for implantation in the lumbar segment of the patient's spine. In another embodiment, the intervertebral device is sized for implantation into the cervical segment of the patient's spine.

Figures 1 and 2 show different views of one embodiment of a disc replacement device. As shown in FIG. 1, the intervertebral device 10 includes a first implantable member 12 and a second implantable member 14 sized to removably engage the first implantable member 12. . Said first implantable part 12 comprises a first anchoring plate 16 on which recesses 18 are formed. Similarly, the second implantable part 14 includes a second anchoring plate 20 on which projections 22 are formed. Optionally, the protrusion 22 can be detachably connected to the second anchor plate 20 using, for example, a coupling member 23 . Although not shown, the recess 18 may be detachably connected to the first anchor plate 16 using a coupling 23 . Couplings 23 may include, by way of example, but are not limited to, screws including set screws, bolts, pins, locks, buttons, locking pins, friction retention devices, magnetic retention devices, and snap locks. Each of the first and second anchor plates 16, 20 may include one or more anchor members 24 extending therefrom. As shown in FIG. 1 , the anchors 24 may be positioned on the periphery of the first and second anchor plates 16 , 20 , thereby allowing the anchors 24 to penetrate and remain in the mounting surface or structure. For example, anchors 24 may penetrate and remain within the cartilaginous endplates of the patient's vertebrae. The first implantable member 12, the second implantable member 14, or both may include a therapeutic or marking agent thereon. For example, the first implantable member 12, the second implantable member 14, or both may be plasma sprayed or include thereon the plasma sprayed or titanium-coated anchor 24.

Figure 3 shows in detail the first anchor plate 16 having a plurality of anchors 24 at its periphery. As shown in FIG. 3 , the anchor 24 includes an anchor body 26 that defines an anchor lumen 28 . The anchor cavity 28 formed in the anchor body 26 allows or promotes the growth of tissue or bone graft material into or through the anchor cavity 28, thereby firmly coupling the first anchor plate 16 to the vertebrae. Anchor 24 may include a sharpened or pointed tip 30 that allows anchor 24 to penetrate adjacent tissue. For example, the sharpened tip 30 of the anchor 24 facilitates entry of the anchor into the endplate of the vertebra while limiting or eliminating vertebral fragmentation during implantation. In another embodiment, the anchors 24 may be replaced with rounded, blunt or atraumatic tips instead of sharp or pointy tips.

As shown in FIG. 3 , the anchor body 26 includes a continuous wall that defines an anchor lumen 28 . Without limitation, at least one anchor body 26, anchor member 24, or anchor plate 16, 20 includes at least one channel, groove, tab, button, perforation, or other on its surface. Interrupt to aid or promote tissue growth within it. For example, the inner surface defining anchoring cavity 28, the outer surface of anchoring cavity 26, or both surfaces of anchoring cavity 26 are porous or rough to promote tissue growth within, or smooth To facilitate the penetration of the anchor 24 into the vertebrae. In another embodiment, the anchor 24, the anchor plates 16, 20, or both may include a coating, such as a titanium-plasma coating, or have grooves thereon and thereby provide a rough surface.

The anchors 24 placed on the anchor plates 16, 20 can be made in different lengths, diameters, or shapes. In one embodiment, anchor 24 comprises a solid post or body. In an alternative embodiment, anchor 24 comprises a hollow or tubular structure. For example, anchor cavity 28 formed within anchor 24 may have a transverse dimension of about 0.5 millimeters to about 0.9 millimeters. In another embodiment, the distal portion 32 of the anchor 24 can be straight, curved, diverging, converging, and/or can include an edge, lip, or notch feature to enhance or enhance tissue movement. Internal growth. In another embodiment, the anchors 24, the anchor plates 16, 20, or both may have a therapeutic agent disposed thereon. Examples of therapeutic agents may include, for example, hydroxyapatite, biologically active proteins (eg, osteogenin protein), or other therapeutic agents that promote tissue growth therein. In another alternative embodiment, the anchor plates 16, 20 and/or the anchors 24 disposed thereon may be plasma sprayed or may include titanium bumps or bumps. Like the first anchor plate 16, the second anchor plate 20 includes anchors 24 similar to those previously described (see FIGS. 1-2).

As shown in FIGS. 1-3 , the anchor members 24 extend perpendicularly from the anchor plates 16 , 20 . In an alternative embodiment, the anchors 24 extend at an angle from the first and second anchor plates 16, 20, respectively, and may be generally straight, curved, tapered, diverging, Conical, or conical. The anchoring piece 24 can be integrally formed with the anchoring plates 16, 20 or connected with the anchoring plates 16, 20 by the prior art in the field, for example, plasma welding. The first and second implantable members 12, 14, respectively, or any portion thereof, may be fabricated from or otherwise incorporate a number of biocompatible materials, including, without limitation, titanium or titanium alloys, stainless steel, Cobalt-chromium alloys, vanadium, ceramic or ceramic materials such as alumina and zinc oxide ceramics, nickel-titanium alloys, memory alloys, plastics, commercially known as "peek" (polyetheretherketone) ( polyetherether ketone) or "Ultrapeek" (polyether ketone, ether ketone, ketone) carbon fiber reinforced polymer, polycarbonate, polypropylene, polyethylene, glass or carbon fiber filled cellulose B (carbon fibers Kevlar), synthetic materials, different metal alloys, elastomers, or other biocompatible, largely chemically inert materials. Additionally, the intervertebral devices of the present invention may comprise echogenic, radiopaque, or radiolucent materials.

4-8 illustrate different compositions of the first implantable member 12 . As shown in FIGS. 4 and 5 , the first anchor plate 16 includes a base plate 40 for receiving and supporting one or more anchor members 24 thereon. The base plate 40 communicates with the first and second holding walls 42A, 42B, respectively. The first retention flange 44A is integral with, connected to, or otherwise in communication with the first retention wall 42A, thereby defining a first retention groove 46A. Similarly, a second retention flange 44B is integral with, attached to, or otherwise in communication with the second retention wall 42B, thereby defining a second retention groove 46B. The inner surface 48 of the base plate 40 further defines first and second retention grooves 46A, 46B, respectively. As a result, the receptacle recess receptacle 50 is formed by the inner surface 48 of the base plate 40, the first and second retention walls 42A, 42B, and the first and second retention flanges 44A, 44B. As shown in FIG. 4, at least one coupling groove 52 may be formed in the first retaining wall 42A, the second retaining wall 42B, or both retaining walls. Alternatively, at least one coupler groove 52 may be formed on any part of the first anchor plate 16 described above.

Figures 6-9 show the recesses 18 removed from the first anchor plate 16 (see Figures 4-5). The recess 18 defines a groove 60 therein. As shown in FIG. 6, the groove 60 defines a longitudinal concave arc A1 juxtaposed to the longitudinal axis L _o , a transverse concave arc A2 juxtaposed to the transverse axis L _a , or both, whereby , when engaged with the first implantable element 12 (see FIG. 2), the second implantable member 14 is free to move along concave arcs A1, A2 or both. In the illustrated embodiment, the recess 18 includes first and second planar flanges 62A, 62B, respectively, adjacent to the groove 60, respectively. As shown in FIG. 9 , the recess 18 may include four planar flanges 62A, 62B, 62C, 62D adjacent to the grooves 60 , respectively. The recess 18 can be formed without a flat flange, or, alternatively, can have any number of flat flanges formed thereon. Still referring to FIGS. 6-9 , the planar flanges 62A, 62B may define a groove 60 . In addition, the planar flanges 62A, 62B can be formed to limit or limit the longitudinal, lateral, rotational, Arching, or lateral movement.

Still referring to FIGS. 6-8 , the recess 18 includes at least a first support wall 64A and a second support wall 64B. A first coupling track 66A is produced on the first support wall 64A. Likewise, a second coupling track 66B is fabricated on the second support wall 64B. The base member 68 is connected to the first and second coupling rails 66A, 66B. The first and second coupling rails 66A, 66B are assembled so as to be received in the receiver recess receiver 50 and engage with the first and second retaining flanges 44A, 44B (see FIGS. 4 and 5 ), whereby The recess 18 is separately coupled to the first anchor plate 16 . A coupling receptacle 70 of the coupling 23 may be accommodated therein, which may be placed in any part of the aforementioned recess 18 .

In the illustrated embodiment, the recess 18 includes coupling tracks 66A, 66B that can engage the first anchor plate 16 to detachably connect the recess 18 to the first anchor plate 16 . In alternative embodiments, the recess 18 may be detachably coupled to the first anchor plate 16 using various coupling means known in the art, including, for example, friction fit means, locking components, magnetic coupling devices, twist locks (twist locks), or snap fit devices.

10 and 11 show the first implantable device 12 at different stages of assembly. As shown, the base 68 of the recess 18 is adjacent the inner surface of the base plate 40 of the first anchor plate 16 . Thereafter, the recess 18 advances along the line L1 shown in FIG. 10 , and finally the recess 18 advances into the receiver recess receiver 50 of the first anchoring plate 16 . The continuous process of the recess 18 into the receiver recess receiver 50 is such that the first and second support walls 64A, 64B and the first and second coupling rails 66A, 66B are in contact with the first and second retaining walls 42A, 42B and the first Engages with the second retaining flanges 44A, 44B, thereby detachably connecting the recess 18 to the first anchor plate 16 . Retractable or detachable coupling 23 may be inserted into coupling groove 52 and coupling receptacle 70 (see FIGS. 4 and 6 ), thereby securing recess 18 to first anchor plate 16 . In the illustrated embodiment, the recess 18 is made to _slideably engage and couple to the first anchor plate 16 along the transverse axis La. In an alternative embodiment, the recess 18 is made to slideably engage and couple to the first anchor plate 16 along the longitudinal axis L _o .

12-19 illustrate a second implantable member 14 embodiment. As shown, the second implantable member 14 includes a second anchor plate 20 having a protrusion 22 releasably attached thereto. One or more anchors 24 are disposed thereon or in communication with the second anchor plate 20 . At least one coupling 23 is used to fix the protrusion 22 to the second anchor plate 20 . As shown in FIG. 12, the protrusion 22 may define a longitudinal convex arc A3, a transverse convex arc A4, or both, so that when engaging the first implantable member 12 (see FIG. 8), the second implantable member 12 is engaged. The convex body 22 of the two implantable parts 14 can move freely in the concave body 18 . The convex arcs A3 and A4 can be symmetrical or asymmetrical.

Referring to Figures 13 and 14, the second anchor plate 20 includes a base member 80 having a raised receptacle 82 formed thereon, receptacle. In one embodiment, the male receptacle 82 may be integral with or attached to the inner surface 84 of the base member 80 . The outer surface 86 of the base member 80 may include one or more anchor members 24 thereon. In the illustrated embodiment, the anchors 24 are positioned on the periphery of the outer surface 86 of the base member 80, thereby enabling the anchors 24 to engage and remain within the endplates of the patient's vertebral cartilage. In the illustrated embodiment, a convex receptacle 82 is located on the inner surface of the base plate 80 . In alternative embodiments, any number of convex receptacles 82 may be located on the inner surface of the base plate 80 . The nose receptacle 82 may include a coupling flange 88 on or in communication with the coupling body 90, thereby forming a coupling groove 92 that engages and retains the nose 22 therein. Coupling flange 88 is grooved as shown in FIG. 13 . However, the coupling flange 88 is not limited to the slot configuration shown, and is fabricated so that the bow 100 is inserted into the lateral, vertical, or vertical engagement into the coupling groove 92, whereby the male receiver 82 Fixedly engaged and coupled to the second anchor plate 20 . In another embodiment, the coupling flange 88 may comprise or otherwise comprise a continuous flange, groove, or other coupling shape. At least one fastener receptacle 94 capable of receiving a coupling 23 (see FIG. 12 ) may be located on any component of said second anchor plate 20 .

15-17 illustrate an embodiment of the protrusion 22 of the intervertebral device 10 . As shown, the male body 22 includes an arcuate body 100 that includes a first surface 102 having at least one male body coupler 104 thereon. First and second support walls 106 , 108 , respectively, are connected to first surface connection 102 . The base 110 is connected to the first and second support walls 106 , 108 . In the illustrated embodiment, the base 110 is connected to the first surface 102 . In alternative embodiments, the bottom 110 may not be in contact with the first surface 102 . At least one fastening groove 112 is located on the first support wall 106 . Optionally, the fastening groove can be located on the second support wall 108 or the bottom 110 . The fastening groove 112 is adapted to receive the coupling 23 therein (see FIG. 2 ), thereby removably connecting the protrusion 22 to the second anchor plate 20 .

The male member 120 includes an engagement surface 122 that is movably engaged to the groove 60 of the first implantable member 21 (see FIG. 6 ). Coupling surface 124 may be positioned adjacent engagement surface 122 and may include at least one coupling fastener 126 thereon. The coupling fastener 126 engages the male coupler 104 of the bow and retains the male coupler therein. In the illustrated embodiment, coupling fasteners 126 removably couple male member 120 to first surface 102 of bow 100 . Optionally, coupling fasteners 126 non-removably couple male member 120 to first surface 102 of bow 100 . Various coupling fasteners 126 known in the art may be used to couple male member 120 to bow 100, including, for example, pins, slip-fit retainers, frictional retainers, snap locks, and twist Lock. In another embodiment, the convex body 120 and the bow 100 may be integrally formed or joined to the bow 100 using methods known in the art including, for example, adhesive coupling, spin welding, sonic welding, surface Over-cast, and casting molded, and may include integral features, such as undercut holes or slots therein.

Referring to FIGS. 16 and 17 , at least the second support wall 108 of the bow 100 includes an attachment mechanism or attachment groove 114 for engaging a male receptacle on the inner surface 84 of the second anchor plate 20 82 , thereby removably coupling the projection 22 to the second anchor plate 20 . The coupling 23 may be placed in the fastening groove 112 of the boss 22 and the fastener receiver 94 of the second anchor plate 20 to secure the boss 22 to the second anchor plate 20 . In the illustrated embodiment, the attachment holes 116 and retaining grooves 118 cooperatively couple the protrusion 22 to the second anchor plate 20 . Alternatively, various coupling mechanisms can be used to couple the projections 22 to the second anchor plate 20, including, for example, magnetic couplings, twist locks, slide fits, friction fits, locking tabs, and the present invention. Other coupling mechanisms known in the art. In the illustrated embodiment, the projection 22 is configured to slidably engage and couple with the second anchor plate 20 along a transverse axis. In an alternative embodiment, the projection 22 is configured to slidably engage and couple with the second anchor plate 20 along the longitudinal axis.

The curvature and shape of the surface 102 of the arched body 100 can be determined by the required thickness and surface curvature of the convex body 120 . The radius of curvature of the convex body 22 of the second implantable member 20 may be constant, or may vary along the longitudinal convex arc A3, along the transverse convex arc A4, or both. FIG. 18 shows an embodiment of a male member 120 having a substantially constant radius of curvature R1. Alternatively, FIG. 19 shows an embodiment of a convex member 120 having a varying radius of curvature. As shown, the proximal region 128A has a radius of curvature R2, the intermediate region has a radius of curvature R3, and the distal region has a radius of curvature R4, where radii R2 and R4 are greater than radius R3. Similarly, groove 60 (see FIG. 4 ) may include a substantially constant radius of curvature, or, alternatively, may vary as described above.

Figures 20 and 21 show the intervertebral device 10 in use. FIG. 20 shows an embodiment where the second implantable member 14 is engaged with the first implantable member 12 . As shown, the protrusion 22 associated with the second anchor plate 20 is seated and engaged with the recess 18 coupled to the first anchor plate 16 . One or more anchors 24 are positioned on the first and second anchor plates 16, 20, respectively. Force F1 is applied to the middle portion 152 of the second implantable member 14 along the midline _ML of the intervertebral device 10 . As a result, the proximal region of the first implantable member 12 is spaced a distance D1 from the proximal region 150 of the second implantable member 14 .

As the application of force F2 is diverted from the midline _ML of the intervertebral device 10 , the second implantable member 14 rotates within the first implantable member 12 . As shown in FIG. 21 , force F2 is applied to the second implantable member 14 adjacent the proximal region 150 . As a result, the convex body 22 coupled to the second anchor plate 20 rotates within the concave body 18 coupled to the first anchor plate 16 . As a result, the proximal region of the first implantable member 12 is separated from the proximal region 150 of the second implantable member 14 by a distance D2, wherein the distance D2 is less than the distance D1. As shown, movement of the second implantable member 14 within the first implantable member 12 may be free, thereby providing the intervertebral device 10 along the longitudinal axis, the transverse axis, or the greater of both axes. range of motion.

22-24 illustrate an alternative embodiment of a male member 22' in which the rotational movement of the second implantable member 14' within the first implantable member 12 is constrained, limited, or limited. As shown in FIG. 22, the constrained projection 22' includes a body 200 with a bow 202 formed thereon. In one embodiment, the bow 202 is integral with the body 200 . In alternative embodiments, the bow 202 is detachably coupled to the body 200 via various coupling mechanisms including, for example, screws, pegs, pins, and adhesives. Bow 202 may include male coupler 204 for receiving coupling fastener 126 of male member 120 therein (see FIG. 16 ). The body 200 includes an attachment groove 214 formed therein for engaging and retaining the male receptacle 82 of the second anchor plate 20 therein (see FIG. 13 ). At least one limiting flange is formed on the body 200 . In the illustrated embodiment, the first limiting flange 205A and the second limiting flange 205B are disposed along the longitudinal axis L _o of the body 200 . In an alternative embodiment, one or more restraining flanges 205A, 205B may be disposed along the transverse axis L _a of the body 200 .

As shown in FIGS. 23 and 24 , a defined protrusion 22 ′ may be coupled to the second anchor plate 20 . The bow 202 is inserted into and engages with the groove 60 of the first implantable part 12 . Fig. 23 shows the force F3 applied to the first implantable member 12 and the confined implantable member 14' along the centerline _ML . There is a distance D3 between the second limiting flange 205b and the first implantable part 12 . As shown in FIG. 24 , when a force F4 is applied away from the midline _ML , the first restricting flange 205A engages the proximal region 140 of the projection, thereby defining the second restricting flange 205B that can move away from the first implantable component 12. The maximum distance D4.

25-27 Alternative embodiments of intervertebral devices. As shown, the partial or half-disc device 210 may be used to replace a damaged (eg, partially ruptured disc), diseased (eg, scoliotic), or otherwise dysfunctional vertebrae. Like the intervertebral device 10 shown in FIG. 1 , the partial disc device 210 includes a first partial disc member 212 and a second partial disc member 214 . Like the first implantable member 12 previously described, the first partial disc 212 includes a first anchoring plate 216 detachably coupled to a semi-recess 218 . One or more anchors 24 are used to attach the first partial disc device to the patient's anatomy. For example, the anchors may engage and couple the first partial disc device 212 to the endplates of the vertebrae. Similarly, the second partial disc device 214 includes a second anchor plate 220 having one or more anchor members 24 detachably coupled to the semi-convex body 222 . Semi-concave 218 and semi-convex 222 are coupled to first and second anchor plates 216, 220, respectively, using coupling means known in the art. For example, the semi-concave body 218 and the semi-convex body 222, respectively, can be coupled to the first and second anchor plates 216, 220 using the coupling devices and methods described above.

The intervertebral device 10 can be implanted into the patient's spine by various surgical techniques known in the art. For example, in one embodiment, an anterior approach can be used to access the portion of the patient's lumbar spine (such as L2-L5) requiring repair will be described, although various surgical techniques can also be used to implant intervertebral devices into the patient's spine middle. The patient can be positioned in the forward decubitus position with the patient's spine perpendicular to the operating table. In one embodiment, the patient's shoulders and hips are immobilized to ensure that the spine remains absolutely perpendicular to the surgical table. For example, the patient's shoulders and hips are strapped or otherwise secured to the surgical table.

Then, reference positioning marks are drawn on the patient's skin, and X-rays, for example, AP/LAP X-rays of the patient's spine, are made to the marked disc locations. Once the disc is positioned and marked, an incision is made directly on or near the disc space. The length of the incision may vary depending on the patient's anatomy. In another embodiment, the incision in the patient's skin may be 2.5 cm to 10 cm. The incision can start at a medial position, transect the plane, and end at a lateral position. In another embodiment, the center of the incision may extend uniformly 2.5 cm from the axillary midline and 2.5 cm lateral to the space of the intervertebral disc (eg, L5-S1 ) to be repaired. The incision is made through the subcutaneous tissue to the underlying fascia. Alternatively, the external oblique muscle is bluntly dissected along its fibers. A similar blunt dissection is performed on the transverse oblique and internal oblique muscles.

Then, identify the peritoneum and dissect it using blunt instruments. Blunt dissection of the peritoneum is performed behind the vertebral bodies of the patient's spine. A self-retaining retractor is inserted into this location to retain surrounding muscle and provide access to the repair site. The psoas muscle on the vertebral body that needs to be repaired is identified and blunt dissection or muscle splitting is performed therein. This dissection or incision can be performed before and after separation of the intervertebral disc space and endplate without damaging the lumbosacral plexus or nerve roots from surrounding structures. A retractor is inserted into the area of interest to isolate the disc space. For example, a Stiemman pin or a Homer retractor can further immobilize the region of interest.

Dissection of tissue continues and the peritoneum is retracted medial to the cone, rostral and caudal. Optionally, the peritoneum can be retracted caudal to the cone in need of repair. With retraction of the peritoneum, the dissected vessels can, but need not, be ligated and folded back medially and laterally, thereby allowing the disc space to be identified. Continue the anterior and posterior dissection to further isolate the disc gap. A retractor, such as a Homer retractor or a flanged Stiemman pin, can be placed proximal to the disc space, thereby providing anterior or posterior access to the disc.

28-35 illustrate a method of inserting the intervertebral device 10 into the spine of a patient. As shown in Figure 28, an injured intervertebral disc 250 is placed between two adjacent vertebrae. Vertebrae L4 and L5 are shown in Figures 28-30, however, one of ordinary skill in the art will appreciate that the intervertebral device 10 may be inserted into a different location on the patient's spine. The outer annulus fibers are pulled from the endplate, and the nucleus pulposus and annulus are removed from the damaged disc 250, whereby the damaged disc can be removed. As shown in Figures 29 and 30, adjacent vertebrae L4, L5 are separated by a distance D6, and the damaged intervertebral disc 250 is removed from the disc space. Debris, such as osteophytes or residual disc material may be removed from the disc space.

With the disc space clear of debris, the components of the intervertebral device 10 can be inserted into the patient's spine. As shown in Figures 31 and 32, second implantable member 14 may be placed in the disc space and inserted into vertebra L4 such that anchor 24 engages and secures the endplate of the vertebrae therein. With second implantable member 14 secured to vertebra L4, first implantable member 12 may be inserted into adjacent vertebra L5. As shown in Figures 33-35, the first implantable member 12 can be placed in the disc space, and the anchor member 24 is engaged with the endplate of the vertebra L5 and fixed therein. During implantation, the relative relationship of the first and second implantable members 12, 14 to the vertebrae and surrounding anatomy can be monitored by, for example, X-ray, IVUS, and echolocation devices. In the illustrated embodiment, the second implantable part 14 is inserted earlier than the first implantable part 12 and is inserted cephalad relative to the first implantable part 12 . Those of ordinary skill in the art will appreciate that the order of implantation and the position of implantable devices 12, 14 relative to each other may vary and is not limited to the order and positions described above.

36-40 illustrate replacement of components of an implanted intervertebral device 10 during implantation. Fig. 36 shows the intervertebral device 10 having the first implantable part 12 and the second implantable part 14 implanted between the vertebrae L4 and L5. To replace components of the intervertebral device 10, the adjacent vertebrae L4, L5 are separated to provide access to the implanted intervertebral device 10. Then, the coupling means 23 securing the female body 18 or male body 22 to the first or second anchoring plate 16, 20 respectively are removed. As shown in Figs. 37, 38, following removal of the coupling means 23, the projections 22 may be detached from the second anchor plate 20, thereby leaving the second anchor plate 20 coupled to the vertebra L4. Then, as shown in Figures 39 and 40, a replacement protrusion 22 is placed into the disc gap. The coupling groove 114 on the replacement protrusion 22 engages and is retained by the protrusion receiver 82 on the second anchor plate 20 , thereby coupling the replacement protrusion 22 to the second anchor plate 20 . Once coupled, the coupling device 23 can be inserted into the fastening groove 12 of the replacement boss 22 and secured in the fastener receptacle 94 of the second anchor plate 20 . The recess 18 of the first implantable member 12 can be detached from the first anchoring plate 16 and replaced in the same manner as described above.

In an alternative embodiment, the concave body 18 and convex body 22 may be removed from the first and second anchor plates, respectively, and replaced by a disc amalgamation device, thereby merging vertebrae L4 and L5. As shown in FIG. 41, the first and second implantable members 12, 14, implanted vertebrae L4, L5, are separated by a distance D7. The vertebrae L4, L5 are then separated by a distance D8 to provide access to the disc space. Once separated, the coupling 23 is removed from the first and second implantable parts 12, 14, thereby allowing the recess 18 to be removed from the first anchoring plate 16 and the protrusion 22 to be removed from the second anchoring plate 16. Remove from board 20. As shown in Figure 42, the first and second anchor plates 16, 20 are attached to the vertebrae L4, L5. The bonding device 260 is then inserted into the disc space and coupled to the first and second anchoring plates 16, 20 via the one or more couplings 23, thereby bonding the vertebrae L4 and L5 together. Exemplary bonding or implanting devices that may be coupled with the first and second anchoring plates 16, 20 are disclosed in US Patent 6,113,638 to Lytton. A. Williams, the entire disclosure of which is incorporated herein by reference in its entirety.

Once the intervertebral device 10 is implanted, the surgeon can remove the retractor to return the peritoneum to its natural position. Before closing the surgical site, the surgeon may administer the therapeutic agent to the vertebrae, peritoneum, or surrounding tissue. Then, the subcutaneous tissue is closed and sutured.

In conclusion, the embodiments of the invention disclosed herein are illustrations of the preferred embodiments of the invention. Other methods within the spirit of the invention may also be used. Accordingly, the present invention is not limited to what has been shown and described in the present specification.

Claims (31)

1. replacement device comprises:

One first implantable, have first anchor plate and a separable concave volume that is coupling on described first anchor plate that is implanted on first vertebra; And

One second implantable, have second anchor plate and a separable convex body that is coupling on described second anchor plate that is implanted on the second adjacent vertebra, this convex body is used for and the relatively-movable engagement of this concave volume;

Wherein said concave volume uses first male part to be fixed in this manner on described first anchor plate, thereby along with the removing of first male part, allows described concave volume to separate from described first anchor plate, keeps described first anchor plate simultaneously and is implanted on first vertebra; Perhaps/and

Wherein said convex body uses second male part to be fixed in this manner on described second anchor plate, thereby along with the removing of second male part, allows described convex body to separate from described second anchor plate, keeps described second anchor plate simultaneously and is implanted on second vertebra.

2. device as claimed in claim 1 is characterized in that, first male part is or/and second male part is selected from by pin locking piece, button, toggle, friction retention means, magnetic fixing device, and in the cohort formed of snap lock.

3. device as claimed in claim 1 is characterized in that, first male part is or/and second male part is selected from screw or bolt.

4. device as claimed in claim 1 is characterized in that, described first anchor plate further comprises:

One substrate;

At least one keeps wall, and this keeps wall to be communicated with this substrate;

At least one keeps flange, and this keeps flange to be communicated with this maintenance wall, and is shaped on the concave volume receptor that at least one is used for admitting this concave volume within it;

At least one male part receptor, this male part receptor are formed on described first anchor plate; And

At least one anchor log, this anchor log is positioned on the periphery of described substrate, and is used for meshing and being maintained in this vertebral endplate with the end plate of first vertebra.

5. device as claimed in claim 4 is characterized in that described concave volume also comprises at least one supporting walls, and this supporting walls is shaped at least one coupling rail thereon, and described coupling rail is used for making this concave volume and engagement of this first anchor plate and coupling separably.

6. device as claimed in claim 1 is characterized in that described concave volume also comprises the groove that at least one is made within it.

7. device as claimed in claim 6 is characterized in that, described groove limits the vertical arc that is provided with along described concave volume longitudinal axis.

8. device as claimed in claim 6 is characterized in that, described groove limits the transverse arc that is provided with along described concave volume transversal line.

9. device as claimed in claim 6 is characterized in that, described groove limits a vertical arc and a transverse arc.

10. device as claimed in claim 6 is characterized in that also comprising that at least one is positioned at the flange on the described concave volume, and this flange is used for limiting described groove.

11. device as claimed in claim 10 is characterized in that, when described second implantable convex body and described first implantable 's concave volume engagement, described flange contacts with described second implantable, thereby limits this motion of second implantable.

12. device as claimed in claim 1 is characterized in that also comprising that at least one is used for admitting therein the bonder groove with first male part, and described concave volume is fixed on this first anchor plate.

13. device as claimed in claim 12 is characterized in that, described first male part is selected from by pin, locking piece, button, toggle, friction retention means, magnetic fixing device, and the cohort of snap lock composition.

14. device as claimed in claim 1 is characterized in that, described second anchor plate also comprises:

Substrate with inner surface;

One places the convex body receptor on the described substrate inner surface, and this convex body receptor is used for and the convex body engagement, and this convex body is kept within it; And

At least one anchor log, described anchor log places on the periphery of this substrate, and is used for meshing with the end plate of second vertebra, and is held within it.

15. device as claimed in claim 14 is characterized in that, described convex body also comprises:

Toxoplasma with first surface and bottom;

The supporting walls that at least one is communicated with this bottom; And

At least one connects groove, and described connection groove places on this bottom, and this connection groove is used for keeping with this convex body receptor engagement and by this convex body receptor.

16. device as claimed in claim 15 is characterized in that also comprising a convex body bonder, described convex body bonder places on this toxoplasma.

17. device as claimed in claim 16 is characterized in that also comprising a mating surface, this mating surface is coupled with this toxoplasma separably.

18. device as claimed in claim 15, it is characterized in that also comprising at least one limit flange, this limit flange places on this convex body, when described second implantable convex body when described first implantable concave volume is meshed, this limit flange contacts with this first implantable, thereby limits this motion of second implantable.

19. device as claimed in claim 1 is characterized in that, described convex body limits the vertical arc that is provided with along described concave volume longitudinal axis.

20. device as claimed in claim 1 is characterized in that, described convex body limits the transverse arc that is provided with along described convex body transversal line.

21. device as claimed in claim 1 is characterized in that, described convex body limits a vertical arc and a transverse arc.

22. device as claimed in claim 1 is characterized in that, the radius of curvature of described convex body is constant substantially.

23. device as claimed in claim 1 is characterized in that, the radius of curvature of described convex body is transformable.

24. device as claimed in claim 1 is characterized in that, comprises at least one securing member receptor, this securing member receptor is used for admitting second male part within it, is used for this convex body is fixed to this second anchor plate.

25. device as claimed in claim 24 is characterized in that, described second male part is selected from by pin, locking piece, button, toggle, friction retention means, magnetic fixing device, and the cohort of snap lock composition.

26. device as claimed in claim 1 is characterized in that also comprising a plurality of anchor logs, described anchor log places on the periphery of described first anchor plate and second anchor plate, and this anchor log is used for meshing with vertebral endplate.

27. device as claimed in claim 26 is characterized in that, described anchor log comprises a grappling body, and this grappling body limits an anchor cavity, and has terminal tip.

28. device as claimed in claim 27 is characterized in that, this end tip is fined away.

29. device as claimed in claim 27 is characterized in that, this end tip is undamaged.

30. device as claimed in claim 1 is characterized in that, at least one in described this first anchor plate and second anchor plate or described both are plasma sprayings.

31. an intervertebral disc replacement system comprises:

One first implantable, this first implantable has one and is implanted to first anchor plate on first vertebra and is coupled to concave volume on this first anchor plate separably, a plurality of anchor logs that place on the described first anchor plate periphery of this first anchor plate configuration; And

One second implantable, this second implantable has one and is implanted to second anchor plate and on the second adjacent vertebra and is coupled to convex body on this second anchor plate separably, the a plurality of anchor logs that place on the described second anchor plate periphery of this second anchor plate configuration, described convex body is used for meshing movably with described concave volume;

Wherein said concave volume uses first male part to be fixed in this manner on described first anchor plate, thereby along with the removing of first male part, allows described concave volume to separate from described first anchor plate, keeps described first anchor plate simultaneously and is implanted on first vertebra; Perhaps/and

Wherein said convex body uses second male part to be fixed in this manner on described second anchor plate, thereby along with the removing of second male part, allows described convex body to separate from described second anchor plate, keeps described second anchor plate simultaneously and is implanted on second vertebra.

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