DE69637048T2 - Lordotische spondylodeseimplantate - Google Patents
Lordotische spondylodeseimplantate Download PDFInfo
- Publication number
- DE69637048T2 DE69637048T2 DE69637048T DE69637048T DE69637048T2 DE 69637048 T2 DE69637048 T2 DE 69637048T2 DE 69637048 T DE69637048 T DE 69637048T DE 69637048 T DE69637048 T DE 69637048T DE 69637048 T2 DE69637048 T2 DE 69637048T2
- Authority
- DE
- Germany
- Prior art keywords
- implant
- bone
- lower surfaces
- adjacent vertebral
- openings
- 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.)
- Expired - Lifetime
Links
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/442—Intervertebral or spinal discs, e.g. resilient
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0082—Three-dimensional shapes parallelepipedal
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0004—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable
- A61F2250/0009—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof adjustable for adjusting thickness
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
- A61F2250/006—Additional features; Implant or prostheses properties not otherwise provided for modular
- A61F2250/0063—Nested prosthetic parts
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00389—The prosthesis being coated or covered with a particular material
- A61F2310/00592—Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
- A61F2310/00796—Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S606/00—Surgery
- Y10S606/90—Lumbar stabilizer
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- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S606/00—Surgery
- Y10S606/907—Composed of particular material or coated
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
- Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y10S606/00—Surgery
- Y10S606/907—Composed of particular material or coated
- Y10S606/908—Bioabsorbable material
Landscapes
- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Neurology (AREA)
- Transplantation (AREA)
- Veterinary Medicine (AREA)
- General Health & Medical Sciences (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Cardiology (AREA)
- Public Health (AREA)
- Physical Education & Sports Medicine (AREA)
- Prostheses (AREA)
- Organic Low-Molecular-Weight Compounds And Preparation Thereof (AREA)
- Polyoxymethylene Polymers And Polymers With Carbon-To-Carbon Bonds (AREA)
- Nitrogen And Oxygen Or Sulfur-Condensed Heterocyclic Ring Systems (AREA)
- Surgical Instruments (AREA)
Description
- Gebiet der Erfindung
- Die vorliegende Erfindung betrifft allgemein Zwischenkörper-Wirbelsäulenversteifungsimplantate und insbesondere Wirbelsäulenversteifungsimplantate, die dafür ausgebildet sind, zwei benachbarte Wirbel der Wirbelsäule in eine korrekte Winkelbeziehung zurückzuversetzen und in dieser zu halten.
- Beschreibung der verwandten Technik
- Sowohl der Halsbereich wie der Lendenbereich der menschlichen Wirbelsäule sind im gesunden Zustand lordotisch, d.h. konvex nach vorne gewölbt. Diese Lordose geht häufig unter degenerativen Bedingungen verloren. Dadurch wird der Rückenmarkkanal verkürzt und dessen Kapazität herabgesetzt. Weiterhin wird bei einer fehlenden Lordose das Rückenmark nach vorne bewegt, wo es gegen die hinteren Teile der Wirbelkörper und der Bandscheiben gedrückt werden kann. Schließlich stört ein derartiger Verlust der Lordose die Gesamtmechanik der Wirbelsäule, was fortgepflanzte degenerative Veränderungen in den benachbarten Wirbelsegmenten verursachen kann.
- Die chirurgische Behandlung dieser degenerativen Bedingungen der Wirbelsäule, bei denen sich die Bandscheiben in verschiedenen Stadien des Verfalls und außerhalb der Lordose befinden, umfasst gewöhnlich eine Wirbelsäulenversteifung. Darunter ist die Verbindung benachbarter Wirbel durch ein Stück Knochen zu verstehen. Wenn der Knochen sich in dem Raum befindet, der zuvor durch die Bandscheibe eingenommen wurde, spricht man von einer Zwischenkörper-Versteifung. Weitere diesbezügliche Angaben finden sich in der Anmeldung 081263,952 mit dem Titel „Artificial Spinal Fusion Implants" („Elternanmeldung").
- Die Elternanmeldung lehrt die Verwendung von künstlichen Versteifungsimplantaten, die zwischen benachbarten Wirbeln eingesetzt werden können, wobei die Implantate versteifungsfördernde Substanzen wie Knochen enthalten und diese an der Versteifungsstelle vorsehen können. Diese Einrichtungen sind weiterhin in der Lage, die Höhe des Band scheibenraums wiederherzustellen und die Wirbelsäule zu stützen, wobei sie sich selbst und den Bereich der Wirbelsäule, in dem sie eingesetzt sind, stabilisieren.
-
EP 0 493 689 A1 legt eine Bohrung oder Ähnliches in einem Implantat offen, die mit entsprechendem Material gefüllt wird. Das Implantat ist keilförmig. -
EP 0 637 440 A1 legt ein köcherförmiges Implantat mit einem im Wesentlichen kreisförmigen Querschnitt offen. Das Implantat weist eine verminderte Breite auf, weil es gestattet, die Materialmenge leicht zu verringern, aus der das Implantat hergestellt ist. Ferner benutzt es eine Umfangswand mit einer ovalen Gestalt, weil es so besser zu der anatomischen Form der Wirbel passen kann, zwischen die das Implantat eingesetzt wird. - EP-A-637 439 legt ein Implantat mit dem vorab kennzeichnenden Teil von Anspruch 1 offen, wobei dieses Implantat untere und obere Flächen umfasst, die im Wesentlichen parallel zueinander sind.
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FR 2 703 580 - EP-A-0 646 366 und US-A-5 397 364 legen einige Implantate mit unteren und oberen Flächen in einer winkligen Beziehung offen.
- Übersicht über die Erfindung
- Es ist ein Ziel der vorliegenden Erfindung Zwischenkörper-Wirbelsäulenversteifungsimplantate mit einer strukturellen Bauform zur Verfügung zu stellen, die die normale anatomische Winkelbeziehung zweier benachbarter Wirbel der Wirbelsäule zu erhalten und die Lordose der Wirbelsäule herzustellen und das Knochenwachstum förderndes Material auf einfache Art und Weise zur Verfügung zu stellen.
- Dieses Ziel wird durch ein Implantat mit den Merkmalen von Anspruch 1 erreicht.
- Die Wirbelsäulenversteifungsimplantate der vorliegenden Erfindung weisen eine Größe auf, die ganz oder teilweise in den Bandscheibenraum passt, der durch die Entnahme des Bandscheibenmaterials zwischen zwei benachbarten Wirbeln geschaffen wird. Die Wirbelsäulenversteifungsimplantate der vorliegenden Erfindung weisen obere und untere Oberflächen auf, die eine Haltestruktur bilden, die die Endplatten der benachbarten Wirbel kontaktiert. Die oberen und unteren Oberflächen sind mit einer zusammenlaufenden Winkelbeziehung zueinander angeordnet, so dass die Implantate der vorliegenden Erfindung von der Seite betrachtet insgesamt eine „Keilform" aufweisen können. Die Winkelbeziehung der oberen und unteren Oberflächen bringt die Wirbel neben den Oberflächen in eine Winkelbeziehung zueinander und hält diese aufrecht, so dass die gewünschte Lordose hergestellt und aufrechterhalten wird. Die Flächen der Implantate der vorliegenden Erfindung weisen Öffnungen auf, welche ganz durch sie hindurchgehen können oder nicht, und eine mittige Kammer, die mit der Fläche durch Löcher in Verbindung steht.
- Die Implantate der vorliegenden Erfindung können Ungleichmäßigkeiten in der Oberfläche aufweisen, um die Oberfläche zu vergrößern und/oder um das Eingreifen in den benachbarten Knochen und damit die Stabilität zu fördern. Die lordotischen Implantate der vorliegenden Erfindung können Ungleichmäßigkeiten in der Oberfläche aufweisen, die insgesamt eine gleichmäßige Höhe entlang der Längsachse der obere und unteren Oberflächen zum Eingreifen in die Wirbel oder eine von einem Ende zum anderen Ende des Implantats zunehmende Höhe aufweisen können. Das heißt, der Körper des Implantats und die an ihm ausgebildete Oberfläche bzw. die Vorsprünge derselben können in ähnlicher Weise insgesamt keilförmig sein. Die Gesamtkontur der Oberflächenvorsprünge kann mehr oder weniger rechteckig sein, während das darunterliegende Implantat keilförmig sein kann, oder umgekehrt kann der darunterliegende Körper des Implantats mehr oder weniger rechteckig sein, während die Gesamtkontur der Oberflächenvorsprünge von einem Ende des Implantats zu anderen keilförmig ist.
- Die Implantate der vorliegenden Erfindung weisen verschiedene Seiten auf, die gekrümmt sein können, um sich der Form der Oberfläche der Wirbel neben dem Bandscheibenraum anzupassen. Die Öffnungen können beliebige Größen und/oder Formen und/oder Verteilungen aufweisen. Die Implantate selbst können aus Materialien zusammengesetzt sein und/oder Oberflächenbehandlungen ausgesetzt sein, um das mikroskopische Einwachsen des Knochens in die Implantate zu fördern.
- Kurze Beschreibung der Zeichnungen
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1 ist eine perspektivische Ansicht des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats der vorliegenden Erfindung mit einem Schiebefenster, die in einer teilweise geöffneten Position gezeigt ist und einen Zugriff auf die Innenkammer des Implantats erlaubt. -
2 ist eine Draufsicht auf das lordotische Zwischenkörper-Wirbelsäulenversteifungsimplantat der vorliegenden Erfindung. -
3 ist eine Seitenansicht von links des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats der vorliegenden Erfindung. -
4 ist eine Seitenansicht von rechts des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats der vorliegenden Erfindung, die das Schiebefenster in einer teilweise geöffneten Position zeigt. -
5 ist eine Vorderendansicht des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats der vorliegenden Erfindung, die das Schiebefenster in einer teilweise geöffneten Position zeigt. -
6 ist eine Rückendansicht des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats der vorliegenden Erfindung, die die Einrichtung für die Verbindung mit einem Instrument zum Einsetzen zeigt. -
7 ist eine vergrößerte Teilansicht des Bereichs7 in2 , die die Oberflächenkonfiguration zum Eingreifen in den Knochen des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats der vorliegenden Erfindung zeigt. -
7A ist eine Seitenansicht eines Abschnitts der Wirbelsäule, bei dem lordotische Implantate der vorliegenden Erfindung an verschiedenen Stellen in den Bandscheibenraum zwischen benachbarten Wirbeln eingesetzt sind, um die korrekte anatomische Ausrichtung der benachbarte Wirbel wiederherzustellen und aufrechtzuerhalten. -
8 ist eine Draufsicht auf eine alternative Ausführungsform des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats der vorliegenden Erfindung. -
9 ist eine Seitenansicht von links des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats von8 . -
10 ist eine Vorderendansicht des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats von8 . -
11 ist eine Rückendansicht des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats von8 , die die Einrichtung für die Verbindung mit dem Instrument zum Einsetzen zeigt. -
12 ist eine vergrößerte Teilansicht des Bereichs12 von8 , die die Oberflächenkonfiguration zum Eingreifen in den Knochen des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats der vorliegenden Erfindung zeigt. - Ausführliche Beschreibung der Zeichnungen
- In
1 bis7 ist das mit dem Bezugszeichen100 angegebene lordotische Zwischenkörper-Wirbelsäulenversteifungsimplantat der vorliegenden Erfindung für die Verwendung im Bandscheibenraum zwischen zwei benachbarten Wirbeln gezeigt. Das Implantat weist eine im Wesentlichen rechteckige Konfiguration mit einer oberen Oberfläche112 und einer unteren Oberfläche114 auf. In der bevorzugten Ausführungsform sind die obere und die untere Oberfläche112 und114 des Implantats100 mit einer zueinander zusammenlaufenden Winkelbeziehung angeordnet, so dass das Implantat100 von der Seite betrachtet „keilförmig" erscheint, wie in3 und4 gezeigt. Die obere und die untere Oberfläche112 und114 weisen jeweils eine Innenoberfläche auf, die eine die Endplatten des benachbarten Wirbels kontaktierende Haltestruktur bilden, wenn das Implantat100 eingesetzt ist. Die Winkelbeziehung der oberen und der unteren Oberfläche112 und114 bringt die Wirbel neben diesen Oberflächen in eine Winkelbeziehung zueinander und hält diese aufrecht, wodurch die gewünschte Lordose der Wirbelsäule hergestellt und aufrechterhalten wird. - Die obere und untere Oberfläche
112 und114 des Implantats100 kann flach oder gebogen sein, um der Form der Endplatten der benachbarten Wirbel zu entsprechen, zwischen denen das Implantat100 eingesetzt ist. Das Implantat100 entspricht der Form des Gallertkerns und einem Teil des von den Wirbeln entfernten Faserknorpelrings. Die obere und die untere Oberfläche112 und114 sind geraut, so dass sie in die benachbar ten Wirbel eingreifen können, um das chirurgisch im Bandscheibenraum eingesetzte Implantat100 zu stabilisieren. Die geraute obere und untere Oberfläche112 und114 weisen eine Oberflächenriffelung121 auf. -
7 zeigt eine vergrößerte Teilansicht der Oberflächenriffelung121 des Implantats100 in der Form eines diamantförmigen Musters für das Eingreifen in den Knochen. Das Implantat100 kann die Oberflächenriffelung121 auf der gesamten oberen und unteren Oberfläche112 und114 oder nur auf einem Teil der oberen und unteren Oberfläche112 und114 aufweisen, ohne dass dadurch vom Schutzumfang der vorliegenden Erfindung abgewichen wird. Es ist ebenfalls zu beachten, dass die Oberflächenriffelung121 verschiedene andere Konfigurationen als die gezeigte aufweisen kann. - In dieser Ausführungsform ist das Implantat
100 hohl und weist eine Vielzahl von Öffnungen112 und114 auf, die sich durch die untere und obere Oberfläche112 und114 und in eine zentrale Hohlkammer116 erstrecken. Die Öffnungen115 sehen vor, dass ein Knochenwuchs von den Wirbeln durch die Öffnungen115 in die Innenkammer116 auftritt. Die Öffnungen114 sind kreisförmig gezeigt, wobei aber zu beachten ist, dass die Öffnungen115 jede Form, Größe, Konfiguration oder Verteilung aufweisen können, die für die Verwendung in einem Implantat für die Wirbelsäule geeignet ist, ohne dass dadurch vom Schutzumfang der vorliegenden Erfindung abgewichen wird. Die Öffnungen können zum Beispiel die Konfiguration von Tränentropfen aufweisen, wie die in1 und2 gezeigten Öffnungen115a . Die obere und untere Oberfläche112 und114 des Implantats100 werden durch eine Seitenwand118 gestützt und voneinander beabstandet, die ebenfalls eine Vielzahl von Öffnungen122 aufweisen kann. - Das Implantat
100 weist ein Einsetzende120 und ein Hinterende130 auf, die beide gekrümmt oder flach sein können. Das Hinterende130 des Implantats kann konvex oder konkav sein, um der Krümmung der Wirbel zu entsprechen, und weist eine Einrichtung für die Verbindung mit einem Instrument zum Einsetzen auf, die einen vertieften Teil124 mit einer zentralen Öffnung126 mit einem Gewinde zum Aufnehmen des Verbindungsendes eines Einsetzinstruments umfasst. Das Einsetzende120 des Implantats100 umfasst eine Zugriffsöffnung132 und ein Schiebfenster134 , das die Öffnung132 bedeckt. Das Schiebefenster134 bedeckt die Öffnung132 in die Kammer116 und erlaubt das Einsetzen eines autogenen Knochenmaterials in die Kammer116 . - Bei der Verwendung wird das Schiebefenster
134 in die geöffnete Position zum Laden von Material in die Kammer116 geschoben. Das Schiebefenster134 weist eine Vertiefung136 auf, die das Öffnen und Schließen der Tür erleichtert. Die Innenkammer116 kann mit einem geeigneten natürlichen Material oder einem künstlichen osteokonduktiven, osteoinduktiven, osteogenen oder anderem versteifungsfördernden Material gefüllt sein, um dasselbe zu halten. Zu diesen Materialien gehören dem Patienten entnommener Knochen, oder ein den Knochenwuchs induzierendes Material wie Hydroxylapatit, Hydroxylapatittrikalciumphosphat oder knochenmorphogenes Protein, wobei vorstehende Aufzählung keineswegs einschränkend aufzufassen ist. Das Implantat selbst ist aus einem für die Implantation im menschlichen Körper geeigneten Material wie Titan hergestellt und/oder kann aus einem das Einwachsen des Knochens fördernden Material wie Hydroxylapatit, Hydroxylapatittrikalciumphosphat, einem osteokonduktiven, osteoinduktiven, osteogenen Material oder einem anderem versteifungsfördernden Material hergestellt und/oder gefüllt und/oder beschichtet sein. - Das in die Kammer
116 des Implantats100 gepackte versteifungsfördernde Material dient dazu, das Einwachsen des Knochens der benachbarten Wirbel in das Implantat zu fördern. Sobald das Einwachsen des Knochens auftritt ist das Implantat permanent fixiert, wobei eine Verschiebung des Implantats wie auch eine Bewegung zwischen den benachbarten Wirbeln verhindert wird. - Das Schiebefenster
134 wird dann vor der Implantation geschlossen. In der geschlossenen Position entspricht das Schiebefenster der Krümmung des Einsetzendes120 des Implantats100 . Verschiedene Verfahren zum Packen des Implantats mit autogenem Knochenmaterial können verwendet werden, um ein vollständig gepacktes Implantat100 zu erhalten. - Das Verfahren zum Einsetzen des Implantats
11 wird in der Anmeldung 08/263 952 im Detail erläutert. Das Gewindeende eines Instruments zum Einsetzen wird mit der Gewindeöffnung126 im Hinterende120 des Implantats100 verbunden, wobei das Einfügen des Instruments zum Einsetzen in den vertieften Teil124 eine Bewegung des Implantats gegenüber dem Instrument verhindert. Das Implantat100 wird dann am Eingang in den Bandscheibenraum zwischen zwei benachbarten Wirbeln platziert. Das Instrument zum Einsetzen wird dann mit einem Hammer geklopft, der ausreichend hart ist, um das Implantat in den Bandscheibenraum zu treiben. - Die Größe des Implantats
100 ist im wesentlichen gleich der des Bandscheibenmaterials, das es ersetzt, und kann deshalb größer oder kleiner sein, was von der Menge des Bandscheibenmaterials abhängt, das entfernt wurde, um den freien Bandscheibenraum zu schaffen, in den das Implantat eingesetzt werden soll. In der bevorzugten Ausführungsform für die Verwendung in der Lendenwirbelsäule ist das Implantat100 28 bis 48 mm breit, wobei ungefähr 36 mm bevorzugt werden. Das Implantat100 weist eine Höhe auf, die zur Wiederherstellung der anatomischen Höhe des Bandscheibenraums ausreicht, wobei die Durchschnittshöhe im Bereich von 8 bis 16 mm liegt und wobei die bevorzugte Durchschnittshöhe bei 10 bis 12 mm liegt. Die Tiefe liegt maximal im Bereich von 20 bis 34 mm, wobei 26 bis 32 mm die bevorzugte maximale Tiefe ist. In der Halswirbelsäule liegt die Breite des Implantats im Bereich von ungefähr 14 bis 28 mm, wobei die bevorzugte Breite 18 bis 22 mm ist. Das Implantat weist hier eine Höhe von 5 bis 10 mm auf, wobei die bevorzugte Höhe 6 bis 8 mm ist. Und die Tiefe des Implantats liegt hier im Bereich von ungefähr 11 bis 21 mm, wobei die bevorzugte Tiefe zwischen 11 bis 13 mm beträgt. -
7A zeigt eine Seitenansicht eines Abschnitts der Wirbelsäule S, bei dem das Implantat100 in den Bandscheibenraum D2 zwischen zwei benachbarten Wirbeln V2 und V3 eingesetzt ist. Das Implantat100 wird in der Richtung des Pfeils A in den Bandscheibenraum D2 eingesetzt und hält die zwei Wirbel V2 und V3 in einer Winkelbeziehung zueinander, so dass die natürliche Lordose des Abschnitts der Wirbelsäule S wiederhergestellt wird. Die Vorwärtsbewegung des Implantats100 wird durch die natürlichen Knochenvorsprünge B in den Endplatten der Wirbel V2 und V3 blockiert. Das Zurückgleiten des Implantats100 wird durch die Oberflächenriffelung121 zum Eingreifen in den Knochen der oberen und unteren Oberfläche112 und114 verhindert. -
8 bis12 zeigen eine mit dem Bezugszeichen200 angegebene alternative Ausführungsform des lordotischen Zwischenkörper-Wirbelsäulenversteifungsimplantats der vorliegenden Erfindung. Das Implantat weist eine ähnliche Gesamtkonfiguration auf wie das oben beschriebene Implantat100 . In der bevorzugten Ausführungsform ist das Implantat200 solide und umfasst eine Vielzahl von Kanälen215 , die von der oberen Oberfläche212 zur unteren Oberfläche214 durch das Implantat200 verlaufen. Die Kanäle215 fördern das Einwachsen des Knochens und erleichtern die Integration des Implantats200 in die Versteifungsmasse. Die Kanäle können auch vor der Implantation mit versteifungsfördernden Materialien, wie den weiter oben beschriebenen Materialien, geladen werden. - Dabei ist zu beachten, dass die Kanäle
215 sich nicht alle durch das Implantat200 erstrecken müssen, sondern Vertiefungen sein können, die die versteifungsfördernden Materialien halten und das Einwachsen des Knochens in die obere und untere Oberfläche212 und214 des Implantats200 erlauben. - Zusätzlich zu den Kanälen
215 kann das Implantat200 kleine Öffnungen222 auf den Seitenwänden218 aufweisen, die sich durch das gesamte Implantat200 erstrecken können oder nicht. Dieselben Öffnungen222 können mit den Kanälen215 kommunizieren, so dass ein Einwachsen des Knochens von den Öffnungen222 zu den Kanälen215 auftritt, um das Implantat in die Versteifungsmasse zu sperren. Wenn die Öffnungen sich nicht durch das gesamte Implantat200 erstrecken, können sie als kleine Vertiefungen zum Halten von versteifungsfördernden Materialien dienen. - In der bevorzugten Ausführungsform des Implantats
200 weisen die Kanäle einen Durchmesser im Bereich von 0,1 bis 6 mm auf, wobei 2 bis 3 mm der bevorzugte Durchmesser ist. Die Öffnungen222 weisen einen Durchmesser im Bereich von 0,1 bis 6 mm auf, wobei der bevorzugte Bereich des Durchmessers zwischen 1 und 3 mm liegt. Die Kanäle215 und222 sind mit einer im Wesentlichen runden Konfiguration gezeigt, wobei jedoch zu beachten ist, dass die Kanäle215 und die Öffnungen222 jede zweckmäßige Größe, Form, Konfiguration und Verteilung aufweisen können. Das Implantat200 weist eine Vielzahl von sägezahnförmigen Kerben250 an der oberen und der unteren Oberfläche212 und214 zum Eingreifen in den Knochen der benachbarten Wirbel auf. Die sägezahnförmigen Kerben250 umfassen eine Kante252 zum Eingreifen in den Knochen und einen winkeligen Teil254 . - Wie insbesondere in
9 gezeigt, ist das Implantat200 von der Seite betrachtet keilförmig, wobei das Hinterende230 größer ist als das Einsetzende220 . Die Vielzahl von sägezahnförmigen Kerben250 sind in der Richtung des Einsteckendes220 ausgerichtet, um ein Einweg-Einstecken des Implantats200 vorzusehen, wenn die Kanten252 in die Wirbel eingreifen und das Zurückgleiten des eingesetzten Implantats verhindern. Alternativ dazu können die sägezahnförmigen Kerben am Hinterende weniger hoch sein, so dass die Gesamtkonfiguration der Gruppe der sägezahnförmigen Kerben konvex ist. - Wie in
11 gezeigt, weist das Hinterende230 des Implantats200 eine Einrichtung für die Verbindung mit einem Instrument zum Einsetzen auf, das eine, wie oben mit Bezug auf das Implantat100 beschriebene, Öffnung226 mit einem Gewinde aufweist. -
12 zeigt eine vergrößerte Teilansicht des Bereichs12 von8 , die die Oberflächenkonfiguration des Implantats200 darstellt. Die obere und untere Oberfläche212 und214 des Implantats200 umfassen zusätzlich zu den sägezahnförmigen Kerben250 eine poröse Textur260 , um eine ungleichmäßige Oberfläche vorzusehen, die das Einwachsen des Knochens fördert. Die poröse Textur260 kann auch versteifungsfördernde Materialien halten und sieht eine vergrößerte Oberfläche vor, die während des Versteifungsprozesses in den Knochen eingreift und dadurch eine größere Stabilität vorsieht. Die poröse Textur260 kann auch an den Seitenwänden218 vorgesehen sein. Die Außenoberfläche und/oder das gesamte Implantat200 können ein anderes poröses Material oder eine geraute Oberfläche aufweisen, die versteifungsfördernde Substanzen halten können und/oder das Einwachsen des Knochens fördern und/oder während des Versteifungsprozesses in den Knochen eingreifen können. Das Implantat200 kann weiterhin mit bioaktiven versteifungsfördernden Substanzen beschichtet sein, wie Hydroxylapatit, Hydroxylapatitverbindungen und knochenmorphogenen Proteinen. - Die vorliegende Erfindung wurde mit Bezug auf eine bevorzugte Ausführungsform und mehrere alternative Ausführungsformen beschrieben, wobei jedoch zu beachten ist, dass andere Ausführungsformen der vorliegenden Erfindung möglich sind, die im Schutzumfang der vorliegenden Erfindung enthalten sind.
Claims (11)
- Zwischenkörper-Wirbelsäulenversteifungsimplantat (
100 ,200 ,300 ) zum Einsetzen über die Höhe eines Bandscheibenraums zwischen zwei aneinandergrenzenden Wirbelkörpern einer menschlichen Wirbelsäule, wobei das Implantat umfasst: ein Einsetzende (120 ), das zuerst in die Wirbelsäule eingesetzt wird, sowie ein Hinterende (130 ) gegenüber dem Einsetzende (120 ), eine Längsachse und eine Tiefe entlang der Längsachse; und eine obere Oberfläche (112 ) und eine untere Oberfläche (114 ) zwischen dem Einsetz- und dem Hinterende (120 ,130 ), wobei die Oberflächen (112 ,114 ) flach sind und eine Haltestruktur bilden, die an den benachbarten Wirbelkörpern anliegt, das Implantat eine Höhe zwischen den Oberflächen (112 ,114 ) hat, wobei jede Oberfläche (112 ,114 ) wenigstens eine Öffnung (115 ) durch sie hindurch aufweist und die Öffnungen (115 ) in Verbindung miteinander stehen, um das Wachsen von Knochen von benachbartem Wirbelkörper zu benachbartem Wirbelkörper durch das Implantat zu ermöglichen, und einander gegenüberliegende Wände (118 ) zwischen der oberen und der unteren Oberfläche (112 ,114 ) und zwischen dem Einführ- und dem Hinterende (120 ,130 ) und eine Breite zwischen den einander gegenüberliegenden Seiten, wobei die obere und die untere Oberfläche (112 ,114 ) jeweils eine Innenoberfläche aufweisen, und diese voneinander beabstandet sind, um einen hohlen Innenraum (116 ) in Verbindung mit den Öffnungen (115 ) zu bilden, wobei das Implantat eine maximale Breite zwischen einander gegenüberliegenden Wänden (118 ) hat, die größer ist als eine maximale Höhe zwischen der oberen und der unteren Oberfläche (112 ,114 ) des Implantats, dadurch gekennzeichnet, dass die obere und die untere Oberfläche (112 ,114 ) in einer Winkelbeziehung zu der Längsachse entlang der Tiefe des Implantats sind, das Implantat (100 ) eine Zugriffsöffnung (132 ) zwischen der oberen und der unteren Oberfläche (112 ,114 ) enthält, wobei die Zugriffsöffnung so konfiguriert ist, dass sie das Einsetzen von das Einwachsen des Knochens förderndem Material in den hohlen Innenraum zulässt, und die Zugriffsöffnung (132 ) größer ist als die größte der Öffnungen (115 ) mit einer Schiebetür als Einrichtung zum Verschließen der Zugriffsöffnung (132 ). - Implantat nach Anspruch 1, dadurch gekennzeichnet, dass das Implantat des Weiteren Einrichtungen zum Eingreifen in den Knochen (
122 ,252 ,254 ) an der oberen und der unteren Oberfläche (112 ,114 ,2212 ,214 ) umfasst, die mit den benachbarten Wirbelkörpern in Eingriff kommen, um das Implantat in dem Bandscheibenraum zu halten. - Implantat nach Anspruch 2, dadurch gekennzeichnet, dass die Einrichtungen zum Eingreifen in den Knochen (
121 ,252 ,254 ) wenigstens sägezahnförmige Kerben, Riffelungen, Dornen, Stege oder Stifte enthalten. - Implantat nach Anspruch 2, dadurch gekennzeichnet, dass die Einrichtungen zum Eingreifen in den Knochen Stege (
250 ) enthalten, die in der Richtung des Einsetzens des Implantats gewandt sind, um zu verhindern, dass das Implantat austritt, wenn es zwischen benachbarte Wirbelkörper eingeführt ist. - Implantat nach einem der obenstehenden Ansprüche, dadurch gekennzeichnet, dass die einander gegenüberliegenden Wände (
118 ) im Allgemeinen parallel zueinander sind. - Implantat nach einem der obenstehenden Ansprüche, dadurch gekennzeichnet, dass das Implantat (
100 ) so konfiguriert ist, dass es sich von dem Hinterende zu dem Einsetzende verjüngt. - Implantat nach einem der Ansprüche 1 bis 5, dadurch gekennzeichnet, dass das Implantat (
100 ) ein Keil ist. - Implantat nach einem der vorangehenden Ansprüche, dadurch gekennzeichnet, dass das Implantat (
100 ,200 ,300 ) wenigstens teilweise bioresorbierbar ist. - Implantat nach einem der obenstehenden Ansprüche, dadurch gekennzeichnet, dass das Implantat (
100 ,200 ,300 ) mit einer versteifungsfördernden Substanz kombiniert ist. - Implantat nach Anspruch 9, dadurch gekennzeichnet, dass die versteifungsfördernde Substanz wenigstens Knochen, knochenmorphogenes Protein, Hydroxylapatit oder Hydroxylapatit-Tricalciumphosphat enthält.
- Implantat nach einem der obenstehenden Ansprüche, dadurch gekennzeichnet, dass das Implantat (
100 ,200 ,300 ) in Kombination mit einem Eindrückinstrument zum Einsetzen des Implantats in die Wirbelsäule verwendet wird.
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/482,146 US5609635A (en) | 1988-06-28 | 1995-06-07 | Lordotic interbody spinal fusion implants |
US482146 | 1995-06-07 | ||
PCT/US1996/008620 WO1996040015A1 (en) | 1995-06-07 | 1996-06-06 | Lordotic interbody spinal fusion implants |
Publications (2)
Publication Number | Publication Date |
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DE69637048D1 DE69637048D1 (de) | 2007-06-06 |
DE69637048T2 true DE69637048T2 (de) | 2007-08-16 |
Family
ID=23914883
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Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
DE69638030T Expired - Lifetime DE69638030D1 (de) | 1995-06-07 | 1996-06-06 | Wirbelsäulenfusionsimplantat mit Zugangsport |
DE29623362U Expired - Lifetime DE29623362U1 (de) | 1995-06-07 | 1996-06-06 | Lordotische Zwischenkörper-Wirbelsäulenversteifungsimplantate |
DE69637048T Expired - Lifetime DE69637048T2 (de) | 1995-06-07 | 1996-06-06 | Lordotische spondylodeseimplantate |
Family Applications Before (2)
Application Number | Title | Priority Date | Filing Date |
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DE69638030T Expired - Lifetime DE69638030D1 (de) | 1995-06-07 | 1996-06-06 | Wirbelsäulenfusionsimplantat mit Zugangsport |
DE29623362U Expired - Lifetime DE29623362U1 (de) | 1995-06-07 | 1996-06-06 | Lordotische Zwischenkörper-Wirbelsäulenversteifungsimplantate |
Country Status (10)
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---|---|
US (8) | US5609635A (de) |
EP (2) | EP0840580B1 (de) |
JP (2) | JPH11506658A (de) |
KR (1) | KR100383413B1 (de) |
CN (1) | CN1167391C (de) |
AT (1) | ATE360402T1 (de) |
AU (1) | AU722080B2 (de) |
CA (1) | CA2223964C (de) |
DE (3) | DE69638030D1 (de) |
WO (1) | WO1996040015A1 (de) |
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1995
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1996
- 1996-06-06 JP JP9501156A patent/JPH11506658A/ja active Pending
- 1996-06-06 DE DE69638030T patent/DE69638030D1/de not_active Expired - Lifetime
- 1996-06-06 EP EP96918001A patent/EP0840580B1/de not_active Expired - Lifetime
- 1996-06-06 DE DE29623362U patent/DE29623362U1/de not_active Expired - Lifetime
- 1996-06-06 KR KR1019970709089A patent/KR100383413B1/ko not_active IP Right Cessation
- 1996-06-06 CA CA002223964A patent/CA2223964C/en not_active Expired - Fee Related
- 1996-06-06 DE DE69637048T patent/DE69637048T2/de not_active Expired - Lifetime
- 1996-06-06 EP EP07008252A patent/EP1829503B1/de not_active Expired - Lifetime
- 1996-06-06 WO PCT/US1996/008620 patent/WO1996040015A1/en active IP Right Grant
- 1996-06-06 CN CNB961955856A patent/CN1167391C/zh not_active Expired - Fee Related
- 1996-06-06 AT AT96918001T patent/ATE360402T1/de not_active IP Right Cessation
- 1996-06-06 AU AU60364/96A patent/AU722080B2/en not_active Ceased
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1997
- 1997-03-10 US US08/813,283 patent/US6302914B1/en not_active Expired - Lifetime
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1999
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2002
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2004
- 2004-08-26 US US10/926,766 patent/US7789914B2/en not_active Expired - Fee Related
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2007
- 2007-05-17 JP JP2007131765A patent/JP2007236972A/ja active Pending
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2010
- 2010-09-07 US US12/807,489 patent/US8021430B2/en not_active Expired - Fee Related
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2011
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Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
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DE102011079821A1 (de) * | 2011-07-26 | 2013-01-31 | Rita Leibinger GmbH & Co. KG | Tibiaimplantat zur Straffung der Kniescheibenbänder |
US9186252B2 (en) | 2011-07-26 | 2015-11-17 | Rita Leibinger GmbH & Co. KG | Tibia implant for tightening the patella tendons |
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