[go: up one dir, main page]

WO2010136860A1 - Nécessaire pour l'implantation d'un support vertébral - Google Patents

Nécessaire pour l'implantation d'un support vertébral Download PDF

Info

Publication number
WO2010136860A1
WO2010136860A1 PCT/IB2010/000911 IB2010000911W WO2010136860A1 WO 2010136860 A1 WO2010136860 A1 WO 2010136860A1 IB 2010000911 W IB2010000911 W IB 2010000911W WO 2010136860 A1 WO2010136860 A1 WO 2010136860A1
Authority
WO
WIPO (PCT)
Prior art keywords
distraction
levers
vertebral
adjacent vertebrae
toolkit
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/IB2010/000911
Other languages
English (en)
Inventor
Giancarlo Guizzardi
Piero Petrini
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Cousin Biotech SAS
Smart Hospital SRL
Original Assignee
Cousin Biotech SAS
Smart Hospital SRL
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Cousin Biotech SAS, Smart Hospital SRL filed Critical Cousin Biotech SAS
Publication of WO2010136860A1 publication Critical patent/WO2010136860A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/025—Joint distractors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8866—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices for gripping or pushing bones, e.g. approximators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00685—Archimedes screw
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/02—Surgical instruments, devices or methods for holding wounds open, e.g. retractors; Tractors
    • A61B17/025—Joint distractors
    • A61B2017/0256—Joint distractors for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/2833—Locking means
    • A61B2017/2837—Locking means with a locking ratchet

Definitions

  • the present invention relates to a toolkit for implanting a prosthesis, in particular an intervertebral support device, for example an interlaminar or an interspinous vertebral support device.
  • the toolkit is adapted to apply an implant by a minimally invasive approach.
  • Discal diseases which cause a reduction of the intervertebral space, and therefore cause pain and other troubles to the patients.
  • Many types of prostheses or vertebral support devices are also known for maintaining an adequate distance between adjacent vertebrae, without excessively limiting the loss of spinal mobility.
  • interspinous support devices are arranged between the spinous processes of the vertebrae, whereas interlaminar support devices are placed within a space between the laminae of the two vertebrae.
  • FIG. 1 and 2 show an interlaminar prosthesis 1 that is also described in WO2004/084743 and in WO2005/044118, and comprises: - a front portion 11 to be located into a space between the laminae 22a/b of two adjacent vertebrae 21a/b, to reduce intervertebral stress on a disc 26; - a rear portion 12, which is arranged for most of its extension between the spinous processes 23a/b; the rear portion has an upper face 13 that is adapted to firmly engage with the junction 27 between laminae 22a and spinous processes 23a of upper vertebra 21a, in order to provide a suitable anatomical gap between the vertebrae, i.e. in order to space vertebrae 21a/b by actuating the spinous processes.
  • the support device is made of a material that is adapted to locally ensure spinal mobility.
  • Prosthesis 1 is effective only if it is pushed as forward as possible inside interlaminar space 24. However, if it approaches the spinal channel too closely, nervous tissue 25 could be damaged, which makes it critical to implant prosthesis 1.
  • Intervertebral distraction devices are known that are bulky instruments, and make it difficult an access and visibility of the interspinous space 28, through which the support device must be inserted, and of the recess 24-28 where the support device must be located. Furthermore, an operation carried out with such known distraction devices is particularly invasive.
  • a vertebral distraction device of this kind is disclosed in WO2007/085909.
  • the region of the spinous processes in which vertebral distraction force has to be exerted must be chosen such that the two adjacent vertebrae
  • intervertebral distraction devices are arranged in a central region of interspinous space 28, therefore a too small space of manoeuvre is left, which complicates the introduction of the interlaminar prosthesis.
  • the skin and the muscular tissue that surrounds the access aperture tend to return to its starting position, which makes it even more difficult to create a minimally invasive access to the intervertebral recess.
  • US2002165550 relates to an implant for introduction into a disc space between two vertebrae, as well as to a technique and to a toolkit to provide a fusion of such vertebrae.
  • the toolkit comprises a tool having a shaped insert that can be put into an intervertebral space for testing whether sufficient amount of material has been removed from the intervertebral space in order to insert the implant.
  • the shaped inserts may have various sizes for assisting the surgeon to choose the correct sizes of the implant.
  • WO2006/135889 relates to interspinous implants, as well as to systems and toolkits that include such implants, and to procedures to apply such implants.
  • a distraction device is described for spacing apart or distracting the spinous processes of two adjacent vertebrae before applying the implant, comprising a couple of levers that have a means for assisting a measurable and/or fine distraction.
  • a gauge device is also described for measuring the interspinous space before introducing the implant, to properly select implant size.
  • the gauge device comprises longitudinal indentations or markers on at least one central portion, which can be viewed under fluoroscopy. Furthermore, the gauge device allows determining up to which rate the distraction has to be made.
  • a feature of the present invention to provide a toolkit for implanting a vertebral support device, such as an interlaminar or an interspinous support device, which allows creating and maintaining a vertebral distraction, and at the same time allows a thorough visibility and an easy access of the interlaminar space in which the prosthesis has to be implanted. It is, furthermore, a feature of the present invention to provide such a toolkit, which is adapted to perform the implant by a minimally invasive approach whose size is less than that is required by prior art instruments.
  • a toolkit for implanting a vertebral support device in a space between two adjacent vertebrae of a patient, in particular by a minimally invasive approach, through a, incision that is defined by a first and a second cut edges facing the two adjacent vertebrae, the two adjacent vertebrae having an interspinous space, which is defined by respective spinous processes of the two adjacent vertebrae
  • the toolkit comprises a vertebral distractor for causing and/or maintaining a predetermined vertebral distraction of the two adjacent vertebrae
  • the vertebral distractor comprising: a couple of mutually rotatably hinged levers, the levers being rotatable with respect to each other between a first, i.e. approached position, and a second, i.e. spaced-apart position; the levers having respective distraction portions in use adapted to engage with the spinous processes to distract them until a predetermined distraction is reached;
  • first and second retraction means adapted to keep the edges in a mutually spaced-apart position, whose main feature is that the first retraction means is adapted to keep one of the edges in an open position and comprises respective retraction portions of the levers, and that said second retraction means is adapted to keep the other of the edges at an open position and comprise a reverse pliers that is provided with:
  • first load arm that has an embracing portion adapted to engage with a embracing portion of one of the levers; a second load arm that has a retraction portion, such that, by actuating the reverse pliers, the first and second retraction means shift from a closed position to a spread-apart position to cause, in use, the edges to open, whereas the distraction portions keep the spinous processes at a spaced-apart position.
  • the retraction portions of the levers and the retraction portion of the reverse pliers maintain open the aperture between the tissues, and create a tubular entrance channel to the interspinous space to allow positioning the prosthesis up to an interlaminar position, whereas the distraction portions maintains the spinous processes in a spaced-apart state.
  • the embracing portion is a groove that is made in a seat of the threaded hole and/or in a seat that is integral to the other lever.
  • the embracing portion of one of the levers is adapted to engage with the embracing portion of the first load arm by a joint selected from the group comprised of:
  • - a prismatic joint - a prismatic joint that is associated with a means that is adapted to prevent the embracing portion of one of the levers and the first load arm from longitudinally sliding with respect to each other when the reverse pliers is in a spaced-apart position, preferably a rack;
  • the retraction portions of the levers and the retraction portion of the second load arm extend along respective curved surfaces, in particular along respective cylindrical surfaces, such that the retraction portion of the second load arm and the retraction portions of the levers cooperate to form a substantially tubular introduction space for the prosthesis. This way, it is ensured that also minimally invasive, minimum size passageways are and remain accessible.
  • said vertebral distractor comprises a reversible and self- locking means for maintaining the predetermined distraction of the spinous processes.
  • the distraction means for causing and/or maintaining the vertebral distraction comprise a couple of teeth that respectively extend from the retraction portions of the levers, the teeth adapted to be inserted into the interspinous space according to a direction that is substantially parallel to the mid-sagittal plane of the patient.
  • the teeth have respective oppositely convex portions.
  • said levers have respective intermediate portions at an angle greater than 45° with respect to the first retraction means, such that the intermediate portions extend along a plane at an angle with respect to the mid- sagittal plane of the patient and a thorough visibility and access to the space between the two adjacent vertebrae is provided to an operator.
  • a prosthesis introduction passageway is available that is wider than the passageways obtainable by the prior art distraction devices, in order to assist better the work of the surgeon and to achieve a safer operation.
  • the angle between the plane, along which the intermediate portions extend, and the first retraction means is greater than 75°; in particular this angle is a substantially right angle.
  • the width of the passageway which is allowed by the vertebral distractor according to the invention, makes it possible to exploit at best an experimentally observed synergistic effect that exists between the compression exerted by the spinous processes against the prosthesis, when it is implanted, and the inwardly directed pneumatic forces caused by the spine movements. Such synergistic effect assists properly the application of the prosthesis, so that the nervous tissue within the spinal channel is less likely to be damaged.
  • the distraction means for moving the levers between the first and second position, and the reversible and self-locking means comprise a threaded rod that engages: a through threaded hole that is made at one of the levers, in particular the threaded hole made through a housing that is rotatably arranged about an axis, said axis perpendicular to the plane in which the levers extend; - a housing that is integral to the other lever, the housing being selected from the group comprised of:
  • a manoeuvre portion is provided at one end of the threaded rod.
  • said teeth have such a position and such a shape that the teeth engage respective regions of the spinous processes proximate to the transition zones between the spinous processes and respective laminae of the adjacent vertebrae, whereby the movement of the adjacent vertebrae, which takes place during the distraction of the adjacent vertebrae, is a substantially translational relative movement.
  • the reverse pliers comprises a reversible block means for blocking it in a spaced-apart position.
  • the block means comprises preferably:
  • the load arms comprise respective gripping portions that are shaped like scissor finger bows.
  • a toolkit for implanting a vertebral support device in a space between two adjacent vertebrae of a patient, the two adjacent vertebrae having an interspinous space, which is defined by respective spinous processes of the two adjacent vertebrae, the toolkit comprising:
  • a vertebral distractor comprising: a couple of distraction elements adapted to be inserted into the interspinous space; a means for bringing the distraction elements from an introduction mutual distance to a distraction mutual distance that is greater than the introduction mutual distance, and vice-versa, such that a predetermined vertebral distraction is created between the spinous processes of the two adjacent vertebrae by bringing the distraction elements to the distraction mutual distance;
  • the main feature of this toolkit is that it comprises, furthermore, an interspinous spacer that has a spacer portion adapted to be inserted between the spinous processes when the vertebral distraction has been created between the two adjacent vertebrae, the interspinous spacer having a nominal size that corresponds to a distance between the spinous processes.
  • the interspinous vertebral spacer is mounted before removing the vertebral distractor, by means of which the vertebral distraction has been previously created.
  • the invention provides a tool that has the sole function of maintaining the vertebral distraction, which is distinct from the instrument that creates the vertebral distraction.
  • the convex portion of this cross section is preferably a conical cross section, in particular it may be selected from the group comprised of: an elliptic arc; a parabolic arc.
  • the interspinous vertebral spacer may comprise a rod that serves as a handle, and is substantially parallel to the convex surface of the monoaxially bent portion.
  • the vertebral spacer can be arranged in a peripheral position between the spinous processes. This way, once the vertebral distractor has been removed, a prosthesis introduction passageway remains available, said passageway wider than if the vertebral distractor were left in its own position, which assists the work of the surgeon and provides for a safer operation.
  • interspinous vertebral spacer is much less cumbersome than the prior art distraction devices.
  • the vertebral spacer enables the surgeon to withdraw the vertebral distractor; this way a more thorough visibility and an easier access is obtained to the implant region.
  • the vertebral distractor is mounted between the spinous processes in such a position that the relative movement of the adjacent vertebrae during the distraction is substantially a translational movement. If the vertebral spacer were located at a peripheral position of the interspinous space, upon removal of the vertebral distractor the region where the distracting force is exerted would move towards this peripheral position, which would create a bending moment.
  • the system consisting of an intervertebral disk and two adjacent vertebrae has a viscoelastic behaviour, and the prosthesis is implanted in a relatively short time, whereby the vertebrae do not have time enough to appreciably rotate and to further compress the front portion of the disc. In other words, after removal of the vertebral distractor, the relative position of the vertebrae changes very slowly, and no significant relative rotation takes place during the time that is needed for implanting the prosthesis between the adjacent vertebrae.
  • the vertebral distractor has the shape of a reverse pliers, which comprises: - a couple of reciprocally hinged levers;
  • a couple of teeth that are integral to respective ends of respective load arms, the couple of teeth adapted to be inserted into the interspinous space; a reversible block means of a relative position of the two levers.
  • the spacer portion is a monoaxially bent spacer portion, comprising: a couple of substantially planar support device elements, each support device element having a support device surface to provide a support device to a respective spinous process of a respective adjacent vertebra, the support device surfaces having a mutual distance responsive to the nominal size, - a convex introduction end, the introduction end providing a radius between said walls support device elements of the couple.
  • the toolkit comprises a plurality of interspinous spacers of different nominal sizes.
  • the nominal size is selected from the group comprised of: 8, 10, 12, 14 and 16 mm. Such sizes fit the dimension of the interspinous space of patients of any size and age.
  • the toolkit can comprise furthermore, surgical tools selected from the group comprised of:
  • a pincers for removing a ligament
  • a measuring device for measuring the interlaminar space, preferably comprising a plurality of gauges associated with a gauge placing means for placing the gauges within the interlaminar housing, preferably comprising a rod that has an end adapted to engage with a housing of said gauges; a gripper for application of the prosthesis; - a tapping means for compressing the prosthesis into the interlaminar recess, said tapping means preferably comprising one or more rods in use connected to an end portion that conformed according to a face exposed in use at the rear portion of the prosthesis;
  • the gauges have nominal size selected from the group comprised of: 8, 10, 12, 14 and 16 mm. Such gauges allow to suitably select the size of the prosthesis to be implanted.
  • the synthetic ligament is used for provide a plastic replacement of the supraspinous fibrous complex (supraspinous plastic or augmentetion) that it is necessary if, after the implant, the superspinous ligament and the articular capsule allow an excessive local spinal mobility, which is a possible cause of micro-instability and/or of kyphotization of the spine where the operation is effected.
  • figure 1 is a perspective view of the interlaminar vertebral support device described in PCT WO2005/044118;
  • - figure 2 shows a cross sectional view of an implant of the above prosthesis between two lumbar vertebrae
  • - figure 3 is a perspective view of a vertebral distractor according to the invention, comprising a couple of levers for distracting two adjacent vertebrae and a reverse pliers for keeping the tissues surrounding a minimally invasive approach at an open position;
  • FIG. 4 shows three steps of a minimally invasive approach for implanting an interlaminar prosthesis, by means of the device of Fig. 3;
  • figure 7 shows a conventional interspinous vertebral distractor;
  • figure 8 shows an interspinous vertebral spacer that comprises a fixed vertebral spacing element, according to the invention, which can be used in association with the vertebral distractor of Fig. 7;
  • - figure 9 shows a Rongeur gripper for removing the interspinous ligament and for creating a subligamentous interspinous recess;
  • - figures 10A and 10B show a gauge for measuring the height of the interlaminar space
  • - figure 12 shows a device for pushing the prosthesis into the interlaminar housing
  • FIG. 13 shows a couple of devices for guiding a synthetic ligament that serves for maintaining the prosthesis in its position. Description of preferred exemplary embodiments
  • a vertebral distractor 10 that belongs to a toolkit for implanting a vertebral support device according to the invention; in particular distractor 10 is adapted to implant an interspinous intervertebral support device by a minimally invasive approach 29 into the body 50 of a patient, through an incision of a tissue 20.
  • Vertebral distractor 10 has a portion 30 that comprises a couple of levers 31a/b, which are reciprocally constrained by a hinge 15 and comprise retraction portions 32a/b arranged at respective ends.
  • curved and convex opposite respective distraction teeth 33a/b extend from ends 32a/b.
  • Couple 30 of levers is adapted to cause a vertebral distraction of two adjacent vertebrae (Fig. 2 21a, 21b), whose spinous processes 23a/b are shown in Fig. 4.
  • Distraction teeth 33a/b are adapted to be inserted between spinous processes 23a/b, when couple 30 of levers of vertebral distractor 10 is closed (Fig. 4).
  • a screw threaded rod 34 is provided which engages two threaded holes 35a/b of respective housings 36a/b integral to respective levers 31a/b.
  • Hole 35a is a through hole, and housing 36a can preferably rotate about an axis that is perpendicular to the plane along which the two levers extend; hole 35b is a blind hole and offers an abutment surface to one end of threaded rod 34.
  • a manoeuvre head 38 which is integral with the opposite end of threaded rod 34, allows rotating rod 34, which causes a self-locking relative rotation of threaded rod 34 and housing 36 and, therefore, causes couple of levers 30 of vertebral distractor 10 to close or open.
  • the plane where intermediate portions 37a/b extend is at an angle with respect to the mid-sagittal plane of the patient, in this case, it is at a right angle.
  • Couple of levers 30 is associated with a reverse pliers 40, which is shown in more detail in Fig. 3, and is described below.
  • the combination of couple of levers 30 and of reverse pliers 40 forms distractor 10 of the toolkit according to the invention.
  • Reverse pliers 40 comprises two load arms 41a/b that are constrained to each other by means of a hinge 44.
  • Load arm 41a is adapted to engage with two corrugated grooves 39a/b that are provided externally at housings 36a/b of two levers 31a/b (Fig. 3).
  • a longitudinal sliding of load arm 41a of reverse pliers 40 with respect to couple 30 of levers is hindered (Figs. 5 and 6) by engagement of a rack arm 42 with corresponding engagement teeth of corrugated grooves 39a/b, not shown.
  • a retraction portion 43 is arranged which, in an exemplary embodiment described herein, can rotate about an axis perpendicular to the plane where arms 41a/b extend, owing to a hinge 51.
  • Retraction portion 43 has a concave side that is adapted to face retraction portions 32a/b, which also have a concave portion that correspondingly is adapted to face retraction portion 43, as well as it has a convex side that, in use, is adapted to push against edge 29", and similarly retraction portions 32a/b have a convex portion that, in use, is adapted to push against edge 29" of minimally invasive approach 29 (Figs. 5 and 6), which has been obtained made by incision of tissue 20.
  • edge 29" is spaced apart from edge 29' and brought and/or maintained in an open position (Fig. 6) by retraction portion 43.
  • retraction portions 32a/b maintain edge 29' in its actual position, at the height of spinous processes 23a, b.
  • Reverse pliers 40 comprises also load arms 45a/b whose handgrip is preferably shaped like scissor finger bows; load arm 45a has, furthermore, a protruding toothed part 47 that faces load arm 45b. Teeth 53 of the protruding part can engage a locking tooth 48 for reversibly locking gripper 40 in a prefixed position. This is possible since locking tooth 48 is the end of a lever 49 that is pivotally arranged about an axis integral to load arm 41b. In an alternative embodiment, load arm 41a could be locked against one of the two levers of couple 30 of levers by a hinge or a fixed joint.
  • couple 30 of levers and reverse pliers 40 of vertebral distractor 10 of the toolkit according to the invention would be integral to each other.
  • Intermediate portions 37a/b of levers 31a/b (Fig. 3) are connected to retraction portions 32a/b that in turn support device teeth 33a/b.
  • Retraction portions 32a/b extend along semi cylindrical and convexly opposed surfaces to retraction portion 43 of reverse pliers 40. Therefore, retraction portion 43 and retraction portions 32a/b, in a maximum mutually spaced-apart position form a tubular channel for introducing the prosthesis by means of suitable instruments, as described hereinafter.
  • a conventional type interspinous vertebral distractor 80 that comprises two levers 81a/b that are hinged at a fulcrum 82, and are provided with a couple of teeth- shaped distraction elements 83a/b at respective ends, which are therefore adapted to be inserted into space 28 between spinous processes 23a/b (Fig. 2) to cause a predetermined vertebral distraction.
  • the vertebral distraction is applied by a toothed block that is provided with a slide 85 that is slidingly arranged with slack within a longitudinal groove 86 of a load arm 87b of lever 81b; a tooth 79 of slide 85 can engage in a lock position a rod 89 that is transversally arranged within groove 86.
  • the opposite end of slide 85 is connected via a hinge 88 to load arm 87a of lever 81a; slide 85 can be unlocked by rotating the slide about hinge 88.
  • Interspinous vertebral distractor 80 comprises also a couple of springs 78 that are arranged between load arms 84a/b of levers 81a/b and tend to close levers 81a/b.
  • a vertebral spacer 90 which comprises a spacer portion 91 that is adapted to be introduced between spinous processes 23a/b when adjacent vertebrae 21a/b have to be distracted.
  • Interspinous spacer 90 has a nominal size 99 that corresponds to the distance between spinous processes 23a/b when interspinous spacer 90 engages with two spinous processes 23a/b.
  • spacer portion 91 is axially bent, and comprises a couple of substantially plane and mutually parallel support elements 93a/b, each having a support surface 97a/b that supports a respective spinous process 23a/b of a respective adjacent vertebra 21a/b when interspinous spacer 90 is arranged between two spinous processes 23a/b.
  • Distance 99 between support device surfaces 97a/b defines the nominal size of interspinous spacer 90.
  • a convex introduction end 92 works as a connection member between support elements 93a/b and assists the introduction of spacer portion 91 between spinous processes 23a/b.
  • This convex end comprises an arch that subtends an angle that is smaller than 180°.
  • the opposite end of spacer portion 91 is integral to a handle 95, for example by a welded connection.
  • Handle 95 consists of a cylindrical rod that has a handgrip 96 that comprises a rubber hollow cylinder, and is therefore adapted to be forced about an end portion of the handle, thus obtaining a connection that avoids mutual rotation and translation in normal use conditions of interspinous vertebral spacer 90.
  • the toolkit comprises preferably five interspinous spacers whose nominal sizes are 8, 10, 12, 14 and 16 mm.
  • Fig. 9 shows a conventional rounger or rongeur-type pincers for removing a ligament, which belongs to the toolkit according to the invention.
  • a step of measuring the target interlaminar space is provided.
  • the measurement is carried out by placing into the interlaminar space one or more gauges, for examples gauges 120 of Fig. 10A, which have preferably respective nominal sizes of 8, 10, 12, 14, 16 mm, corresponding to respective interlaminar prosthesis sizes.
  • Gauge 120 is brought into the interlaminar region by a rod 121 , as shown in Fig. 10B, which has a manoeuvre end equipped with a handgrip 122, and an opposite threaded end 123 adapted to engage with a threaded blind hole 124 of gauge 120.
  • a first trial arrangement of the prosthesis within the interlaminar housing is carried out by means of the gripper by application 130, which consists of two levers 131a/b that are connected by a hinge 135. Gripping ends 132a/b of levers 131a/b are a conformation suitable for holding an interlaminar prosthesis, in particular the prosthesis which is disclosed in WO2004/084743 and in WO2005/044118 (Figs. 1 and 2).
  • a reversible lock means for reversibly locking the gripper by application 130 at a predetermined opening, that comprises a branch 132 of lever 131a that faces lever 131b, and has a toothed surface 133 whose teeth can engage a surface of lever 131b, thus mutually blocking two levers 131 a/1 b; the block can be removed carrying out on manoeuvre portions 134a/4b.
  • the interlaminar prosthesis is compressed and pushed forward by means of a pushing device 140, which is shown in Fig. 12.
  • Device 140 has a handle 141 , which is provided with a handgrip 142 for holding the device, by means of a soft surface layer made of a material, such as rubber, and/or by means of a knurled surface.
  • a tool extends from an end 143 of the handle, and comprises a rectilinear stem 144 and a portion 145 that has a shape which fits the rear face of the interlaminar support device, in particular of the prosthesis that is disclosed in WO2004/084743 and in WO2005/044118 (Figs. 1 and 2).
  • a couple of devices for guiding an artificial ligament (indicated as 27 in Fig. 2), which serves for keeping prosthesis 1 in its position.
  • Each guiding device has a handle 151 , with a handgrip for holding the device, by a surface layer of soft material, such as rubber, and/or a knurled surface.
  • a tool which comprises a straight stem 153 and a right-handed helix 154a or a left-handed helix 154b, extends from an end 152 of the handle.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

La présente invention concerne un nécessaire permettant d'effectuer l'implantation aisée d'un support vertébral, plus particulièrement une prothèse intervertébrale, par un accès chirurgical minimalement invasif. Dans un mode de réalisation représentatif, le nécessaire comprend un distracteur vertébral (10) qui est doté d'un moyen permettant de créer et de maintenir une distraction prédéterminée entre deux vertèbres adjacentes (21a/b) et d'un moyen permettant de maintenir les bords 29' et 29" d'une incision tissulaire (29) pratiquée pour une approche minimalement invasive au niveau d'une position ouverte, ceci assurant la stabilisation contre un retour élastique des tissus (20). Dans un mode de réalisation représentatif préféré, on utilise un distracteur qui comprend une paire (30) de leviers (31a/b) qui sont mobiles autour d'une charnière (15) et qui peuvent être verrouillés au niveau d'une position prédéterminée, et comportant à une extrémité une paire de parties distractrices (33a/b) conçues pour être insérées entre des apophyses épineuses (23a/b), de sorte que l'écartement des leviers (31a/b) produise la distraction des deux vertèbres (21a/b).
PCT/IB2010/000911 2009-04-22 2010-04-22 Nécessaire pour l'implantation d'un support vertébral Ceased WO2010136860A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
ITPI2009A000044 2009-04-22
IT000044A ITPI20090044A1 (it) 2009-04-22 2009-04-22 Strumentario per l'impianto di una protesi intervertebrale

Publications (1)

Publication Number Publication Date
WO2010136860A1 true WO2010136860A1 (fr) 2010-12-02

Family

ID=41647060

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IB2010/000911 Ceased WO2010136860A1 (fr) 2009-04-22 2010-04-22 Nécessaire pour l'implantation d'un support vertébral

Country Status (2)

Country Link
IT (1) ITPI20090044A1 (fr)
WO (1) WO2010136860A1 (fr)

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103110438A (zh) * 2013-02-20 2013-05-22 南京医科大学第一附属医院 一种用于脊柱后路微创置钉小切口的撑开维持装置
ITPI20130068A1 (it) * 2013-07-13 2015-01-14 Giancarlo Guizzardi Distrattore vertebrale integrato con divaricatore di tessuti
US9066701B1 (en) 2012-02-06 2015-06-30 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9486133B2 (en) 2010-08-23 2016-11-08 Nuvasive, Inc. Surgical access system and related methods
US9655505B1 (en) 2012-02-06 2017-05-23 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9757067B1 (en) 2012-11-09 2017-09-12 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9795367B1 (en) 2003-10-17 2017-10-24 Nuvasive, Inc. Surgical access system and related methods
FR3128867A1 (fr) 2021-11-10 2023-05-12 Cousin Biotech Instrument chirurgical

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020165550A1 (en) 1999-10-21 2002-11-07 George Frey Devices and techniques for a posterior lateral disc space approach
WO2003024298A2 (fr) * 2001-09-18 2003-03-27 St. Francis Medical Technologies, Inc. Dispositif de calibrage d'implant et d'ecartement de processus epineux a tete fendue et indicateur de dimension, et procede
US20030149341A1 (en) * 2002-02-06 2003-08-07 Clifton Guy L. Retractor and/or distractor for anterior cervical fusion
WO2004084743A1 (fr) 2003-03-28 2004-10-07 Smart Hospital S.R.L. Prothese vertebrale interlaminaire
WO2005044118A1 (fr) 2003-10-24 2005-05-19 Cousin Biotech, S.A.S. Support inter-lamaire
WO2006135889A2 (fr) 2005-06-13 2006-12-21 Globus Medical, Inc. Espaceur pour apophyse épineuse
WO2007044705A2 (fr) * 2005-10-07 2007-04-19 Abdou Samy M Appareils et méthodes pour positionner un appareil orthopédique intervertébral
WO2007085909A2 (fr) 2005-09-08 2007-08-02 Synthes (Usa) Dispositif retracteur et distracteur de colonne vertébrale

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020165550A1 (en) 1999-10-21 2002-11-07 George Frey Devices and techniques for a posterior lateral disc space approach
WO2003024298A2 (fr) * 2001-09-18 2003-03-27 St. Francis Medical Technologies, Inc. Dispositif de calibrage d'implant et d'ecartement de processus epineux a tete fendue et indicateur de dimension, et procede
US20030149341A1 (en) * 2002-02-06 2003-08-07 Clifton Guy L. Retractor and/or distractor for anterior cervical fusion
WO2004084743A1 (fr) 2003-03-28 2004-10-07 Smart Hospital S.R.L. Prothese vertebrale interlaminaire
WO2005044118A1 (fr) 2003-10-24 2005-05-19 Cousin Biotech, S.A.S. Support inter-lamaire
WO2006135889A2 (fr) 2005-06-13 2006-12-21 Globus Medical, Inc. Espaceur pour apophyse épineuse
WO2007085909A2 (fr) 2005-09-08 2007-08-02 Synthes (Usa) Dispositif retracteur et distracteur de colonne vertébrale
WO2007044705A2 (fr) * 2005-10-07 2007-04-19 Abdou Samy M Appareils et méthodes pour positionner un appareil orthopédique intervertébral

Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9795367B1 (en) 2003-10-17 2017-10-24 Nuvasive, Inc. Surgical access system and related methods
US9486133B2 (en) 2010-08-23 2016-11-08 Nuvasive, Inc. Surgical access system and related methods
US9924859B2 (en) 2010-08-23 2018-03-27 Nuvasive, Inc. Surgical access system and related methods
US10172515B2 (en) 2010-08-23 2019-01-08 Nuvasive, Inc. Surgical access system and related methods
US10980525B2 (en) 2010-08-23 2021-04-20 Nuvasive, Inc. Surgical access system and related methods
US11457907B2 (en) 2010-08-23 2022-10-04 Nuvasive, Inc. Surgical access system and related methods
US12426866B2 (en) 2010-08-23 2025-09-30 Nuvasive, Inc. Surgical access system and related methods
US9066701B1 (en) 2012-02-06 2015-06-30 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9655505B1 (en) 2012-02-06 2017-05-23 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
US9757067B1 (en) 2012-11-09 2017-09-12 Nuvasive, Inc. Systems and methods for performing neurophysiologic monitoring during spine surgery
CN103110438A (zh) * 2013-02-20 2013-05-22 南京医科大学第一附属医院 一种用于脊柱后路微创置钉小切口的撑开维持装置
ITPI20130068A1 (it) * 2013-07-13 2015-01-14 Giancarlo Guizzardi Distrattore vertebrale integrato con divaricatore di tessuti
FR3128867A1 (fr) 2021-11-10 2023-05-12 Cousin Biotech Instrument chirurgical
WO2023083779A1 (fr) 2021-11-10 2023-05-19 Cousin Biotech Instrument chirurgical

Also Published As

Publication number Publication date
ITPI20090044A1 (it) 2010-10-23

Similar Documents

Publication Publication Date Title
WO2010136860A1 (fr) Nécessaire pour l'implantation d'un support vertébral
US11096797B2 (en) Zero-profile expandable intervertebral spacer devices for distraction and spinal fusion and a universal tool for their placement and expansion
US20210378842A1 (en) Spinal implants and instruments
CN107847328B (zh) 可伸展植入物
KR101387163B1 (ko) 최소 침습적 고정 시스템
US20200113606A1 (en) Tissue Retraction And Vertebral Displacement Devices, Systems, And Methods For Posterior Spinal Fusion
US8382767B2 (en) Implant insertion tool
AU2013215075B2 (en) Intervertebral disc prosthesis and method
US20100160985A1 (en) Spinal implant apparatus, method and system
KR101617502B1 (ko) 양측성 추궁판 임플란트
US8323292B2 (en) Adjustable pin drill guide and methods therefor
KR102154560B1 (ko) 척추 유합 케이지의 케이지 홀더
US12303121B2 (en) Surgical system and method
EP3047811B1 (fr) Réducteur de tige
KR20070048712A (ko) 척추 원반 보철물 삽입을 위한 방법 및 장치
EP2722022B1 (fr) Dispositif d'insertion à utiliser avec une cage expansible
US9168073B2 (en) Spinous process fixator
WO2002087466A2 (fr) Procede et instrument permettant de distracter un espace intervertebral
US20230404627A1 (en) A modified compression appliance and associated hardware for use in spinal surgery

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 10759966

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 10759966

Country of ref document: EP

Kind code of ref document: A1