US20070093900A1 - Modular articulating and fusion spinal disc implant system - Google Patents
Modular articulating and fusion spinal disc implant system Download PDFInfo
- Publication number
- US20070093900A1 US20070093900A1 US11/534,946 US53494606A US2007093900A1 US 20070093900 A1 US20070093900 A1 US 20070093900A1 US 53494606 A US53494606 A US 53494606A US 2007093900 A1 US2007093900 A1 US 2007093900A1
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- US
- United States
- Prior art keywords
- end plate
- intermediate component
- vertebral body
- retention member
- intervertebral implant
- 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.)
- Abandoned
Links
- 0 CC*CC(C1)N2C(CC3)(C3CO*CCC3)C(C)C1CCC3C(*)C2C Chemical compound CC*CC(C1)N2C(CC3)(C3CO*CCC3)C(C)C1CCC3C(*)C2C 0.000 description 4
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- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
- A61F2002/30899—Protrusions pierced with apertures
- A61F2002/30901—Protrusions pierced with apertures longitudinally
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2002/4622—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof having the shape of a forceps or a clamp
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2002/4625—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
- A61F2002/4627—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2002/4625—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
- A61F2002/4628—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about an axis transverse to the instrument axis or to the implantation direction, e.g. clamping
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
- A61F2220/0033—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- 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
- A61F2250/0006—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 angular orientation
-
- 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
- A61F2250/0062—Kits of prosthetic parts to be assembled in various combinations for forming different prostheses
-
- 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
- A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
- A61F2250/0097—Visible markings, e.g. indicia
Definitions
- the present invention relates generally to spinal orthopedics, and more precisely, to intervertebral implants.
- Severe back pain can be caused by a number of different ailments, including spinal stenosis, degenerative disc disease, spondylolisthesis, and the like. Many such ailments can be corrected by controlling or limiting relative motion between the affected vertebrae. Accordingly, a variety of devices including artificial discs and fusion devices have been proposed.
- Such devices are limited in that they typically provide only one mode of correction. Many such devices cannot be replaced or corrected. This is particularly true with intervertebral implants, in which bone-growth is often stimulated to integrate the implants with the surrounding bone tissue. Thus, if the device fails to solve the problem, there may be no other recourse for the patient.
- FIG. 1 is a perspective view illustrating a portion of a spine.
- FIG. 2 is a perspective lateral view of one embodiment of a total disc implant implanted in the spine, comprising inferior and superior end plates, inferior and superior bearings, and a plurality of clips.
- FIG. 3 is a perspective anterior view of the total disc implant of FIG. 2 in an disassembled state.
- FIG. 4 is a bottom elevation view of the clip shown in FIG. 3 .
- FIG. 5 is a top elevation view of the clip shown in FIG. 3 .
- FIG. 6 is a perspective side view of the clip shown in FIG. 3 .
- FIG. 7 is a perspective posterior view of the bone engaging side of the inferior end plate shown in FIG. 3 .
- FIG. 8 is a lateral end view of the inferior end plate shown in FIG. 3 .
- FIG. 9 is a perspective anterior view of the bearing engaging side of the inferior end plate shown in FIG. 3 , and one clip.
- FIG. 10 is a perspective posterior view of the bearing engaging side of the superior end plate shown in FIG. 3 , and one clip.
- FIG. 11 is a perspective posterior view of the caudal side of the inferior bearing and one clip shown in FIG. 3 .
- FIG. 12 is an anterior side view of the inferior bearing shown in FIG. 3 .
- FIG. 13 is a perspective anterior view of the cephalad side of the inferior bearing shown in FIG. 3 .
- FIG. 14 is a perspective anterior view of the cephalad side of the superior bearing and one clip shown in FIG. 3 .
- FIG. 15 is an anterior side view of the superior bearing shown in FIG. 3 .
- FIG. 16 is a perspective posterior view of the caudal side of the superior bearing shown in FIG. 3 .
- FIG. 17 is an anterior side view of the total disc implant of FIG. 3 , in a partially assembled state.
- FIG. 18 is a perspective lateral view of one embodiment of a fusion block implant, shown in a portion of the spine.
- FIG. 19 is a perspective anterior view of the cephalad side of the fusion block shown in FIG. 16 .
- FIG. 20 is an anterior side view of the fusion block shown in FIG. 16 .
- FIG. 21 is a perspective anterior-cephalad view of the fusion block shown in FIG. 16 , and two clips.
- FIG. 22 is a perspective lateral side view of the fusion block implant of FIG. 18 , in a partially assembled state.
- the present invention relates to human spinal disc replacement systems.
- Those of skill in the art will recognize that the systems and methods described herein may be readily adapted for other modular implant systems for anatomic replication of orthopedic joints by man made implant systems.
- FIG. 1 a perspective view illustrates a portion of a spine 10 .
- FIG. 1 illustrates only the bony structures; accordingly, ligaments, cartilage, and other soft tissues are omitted for clarity.
- the spine 10 has a cephalad direction 12 , a caudal direction 14 , an anterior direction 16 , a posterior direction 18 , and a medial/lateral axis 20 , all of which are oriented as shown by the arrows bearing the same reference numerals.
- “left” and “right” are used with reference to a posterior view, i.e., a view from behind the spine 10 .
- Medial refers to a position or orientation toward a sagittal plane (i.e., plane of symmetry that separates left and right sides from each other) of the spine 10
- lateral refers to a position or orientation relatively further from the sagittal plane.
- the portion of the spine 10 illustrated in FIG. 1 includes a first vertebra 24 , which may be the L5 (Fifth Lumbar) vertebra of a patient, and a second vertebra 26 , which may be the L4 (Fourth Lumbar) vertebra of the patient.
- the systems and methods may be applicable to any vertebra or vertebrae of the spine 10 and/or the sacrum (not shown).
- the term “vertebra” may be broadly interpreted to include the sacrum.
- the first vertebra 24 has a body 28 with a generally disc-like shape and two pedicles 30 that extend posteriorly from the body 28 .
- a posterior arch, or lamina 32 extends between the posterior ends of the pedicles 30 to couple the pedicles 30 together.
- the first vertebra 24 also has a pair of transverse processes 34 that extend laterally from the pedicles 30 generally along the medial/lateral axis 20 , and a spinous process 36 that extends from the lamina 32 along the posterior direction 18 .
- the second vertebra 26 has a body 48 from which two pedicles 50 extend posteriorly.
- a posterior arch, or lamina 52 extends between the posterior ends of the pedicles 50 to couple the pedicles 50 together.
- the second vertebra 26 also has a pair of transverse processes 54 , each of which extends from the corresponding pedicle 50 generally along the medial/lateral axis 20 , and a spinous process 56 that extends from the lamina 52 along the posterior direction 18 .
- the vertebrae 24 , 26 are separated from each other by an intervertebral disc 66 .
- a perspective view illustrates one embodiment of an implant 70 , which may be referred to as a total disk implant.
- the implant 70 is designed for placement between spinal vertebrae to replace degenerated intervertebral disc material. More specifically, the implant 70 is designed to be inserted between the vertebral bodies 28 , 48 of the first and second vertebrae 24 , 26 , respectively, after removal of the intervertebral disc 66 .
- the implant 70 has end plates which secure the implant to the vertebral bodies, and an intermediate component which engages with the end plates, to control or prevent relative motion between the vertebral bodies.
- the intermediate component may be a first bearing surface configured to articulate with a second bearing surface, to provide relative motion between the vertebral bodies.
- the intermediate component may also be a deformable elastic insert which provides motion between the vertebral bodies, or a rigid insert to promote fusion, thus preventing relative motion between the vertebral bodies.
- Retention members which in this embodiment of the invention take the form of clips, secure the intermediate component to the end plates.
- the assembled implant 70 is of a generally rectangular box-like shape with rounded edges, with top and bottom surfaces which form a slight wedge.
- implant 70 need not have a rectangular box shaped configuration but can be square, circular, or have any other polygonal or irregular configuration.
- the implant 70 can be configured at any desired wedge angle or can have substantially parallel top and bottom surfaces.
- the implant 70 comprises an inferior end plate 100 , an inferior bearing 300 , a superior bearing 400 , and a superior end plate 200 .
- the inferior bearing 300 is releasably attached to the inferior end plate 100 by a plurality of clips 500 .
- the superior bearing 400 is releasably attached to the superior end plate 200 by a plurality of clips 500 .
- FIG. 3 depicts the implant 70 in a disassembled state, to illustrate the individual components of the implant.
- the inferior bearing 300 has a rounded dome, surrounded by a trough, which fits into a cup, surrounded by a ridge, on the superior bearing 400 .
- the inclusion of the ridge and trough in the bearing design allows the patient less impeded flexion/extension and lateral bending.
- the inferior 100 and superior 200 end plates are placed in the intervertebral space, adjacent to the vertebral bodies 28 , 48 .
- the end plates 100 , 200 are identical, but are inserted in an opposite orientation from one another.
- the inferior end plate 100 is inserted adjacent to vertebral body 28 with a bone engaging side 102 in a caudal direction 14 and a bearing engaging side 104 in a cephalad direction 12 .
- the superior end plate 200 is inserted adjacent to vertebral body 48 with a bone engaging side 202 in a cephalad direction 12 and a bearing engaging side 204 in a caudal direction 14 .
- end plates 100 , 200 in this embodiment are identical except in orientation, only the inferior end plate 100 will be described in detail below. All description of the structure of the inferior end plate 100 also applies to the superior end plate 200 . However, it is appreciated that in alternative embodiments of the invention, end plates of varying configurations may be used in combination.
- FIG. 4 depicts a bottom side view of the clip 500 .
- the clip 500 is roughly quadrilateral in shape, with substantially parallel top and bottom sides, and is bilaterally symmetrical.
- the clip 500 may vary in configuration and/or use. It has a top side 510 , a bottom side 512 , an interior edge 514 and an exterior edge 516 .
- the interior edge 514 is chamfered on the bottom side 512 .
- the exterior edge 516 has a tab 502 which extends perpendicularly from the edge.
- the tab 502 is configured to fit a gap in each end plate 100 or 200 , and moving the tab into the gap snaps the clip 500 to the end plate 100 or 200 .
- a body 506 extends from the tab 502 and the exterior edge 516 toward the interior edge 514 .
- One arm 504 extends perpendicularly from each lateral side of the body 506 , on either side of the tab 502 .
- a T-shape is formed by the arms 504 and the body 506 .
- two prongs 508 extend initially perpendicularly from the body 506 , then, turning right angles, extend back toward the arms 504 .
- a top side view of the clip 500 is shown.
- the outside edges of the prongs 508 are chamfered on the top side 510 , forming chamfered edges 518 .
- the chamfered edges 518 of the prongs 508 are slightly angled in their lengthwise orientation; that is, the width of the clip 500 at the interior edge 514 is slightly narrower than its width at the arms 508 and exterior edge 516 .
- a protrusion 520 projects from the body 506 on the top side 510 .
- the protrusion 520 appears as a square projecting upward from the top side 510 , and is centered between the arms 508 .
- the protrusion 520 is wedge-shaped in profile, the higher end adjacent to the tab 502 , and the opposite end slanting down until it is flush with the body 506 at the midpoint of the body 506 .
- FIG. 6 depicts a side profile view of the clip 500 .
- the clip 500 has a spring bias 522 , such that when the clip 500 is not secured to another component, the body 506 , the arms 504 and the tab 502 are held at a slight downward angle relative to the prongs 508 ; that is, the body 506 , the arms 504 and the tab 502 angle in the direction of the bottom side 512 .
- the inferior end plate 100 is of a quadrilateral shape with rounded corners, and is bilaterally symmetrical. It has an anterior end 120 , a posterior end 122 , a right end 124 and a left end 126 .
- the inferior end plate 100 has a bone engaging face 106 and a bearing engaging face 108 which are connected by a support member 1 10 .
- Projecting from the bone engaging face 106 is a plurality of bone engaging spikes 112 .
- Each bone engaging spike 112 is columnar in form and projects perpendicularly in the caudal direction 14 from the bone engaging face 106 .
- each bone engaging spike 112 tapers and terminates in an acute angle. This angled tapering creates a point which facilitates seating the inferior end plate 100 in the adjacent vertebral body 28 during the implantation process; the point will more easily penetrate the vertebral body 28 than would a blunt end.
- a hollow grafting channel 114 runs through the center of each bone engaging spike 112 .
- Each grafting channel 114 originates on the bearing engaging face 108 , runs through the support member 110 , and ends at the pointed termination of the bone engaging spike 1 12 .
- This hollowed point configuration may be compared to the hollow point of a hypodermic needle, and further facilitates the penetration of the vertebral body 28 by the bone engaging spikes 112 .
- the grafting channels 114 also allow for the growth of bony columns from the vertebral body 28 through the channels, thereby fusing the inferior end plate 100 to the vertebral body 28 .
- a plurality of grafting ports 116 is present in the inferior end plate 100 .
- Each grafting port is an opening from the bearing engaging face 108 through the support member 110 to the bone engaging face 106 .
- the grafting ports 116 allow for the growth of bony material from the vertebral body 28 through the ports, thereby fusing the inferior end plate 100 to the vertebral body 28 .
- a groove 118 is present on each outer corner of the inferior end plate 100 .
- Each groove 118 is an indentation into the support member 1 10 .
- Each groove 118 is designed to fit closely around the end of an insertion tool such that the insertion tool (not shown) may securely grip the inferior end plate 100 during insertion or removal of the end plate.
- a lateral end view of the inferior end plate 100 is shown. It is slightly wedge shaped when viewed from either lateral end. That is, the height of the inferior end plate 100 at the posterior end 122 is shorter than its height at the anterior end 120 . This is because this embodiment of the invention is designed for the lumbar portion of the spine, which is curved such that the intervertebral space is wider at the anterior end than at the posterior end.
- the inferior end plate 100 can be configured at any desired wedge angle or can have substantially parallel top and bottom surfaces.
- FIG. 9 illustrates the bearing engaging side 104 of the inferior end plate 100 , with one clip 500 snapped on the left side.
- the end plate 100 has symmetrically placed lateral gaps 128 in the right end 124 and the left end 126 .
- the anterior end 120 has an anterior gap 130 which is identically shaped as the lateral gaps 128 but is located perpendicular to them.
- the lateral 128 and anterior 130 gaps are shaped to accommodate the insertion of clips 500 , which releasably hold the inferior bearing 300 to the inferior end plate 100 .
- the caudal or lower portions of the gaps 128 , 130 which are cut out of the bone engaging side 102 of the inferior end plate 100 , are shaped to fit the tab 502 of the clip 500 .
- the cephalad or upper portions of the gaps 128 , 130 are wider to accommodate passage of arms 504 of the clip 500 .
- the walls 132 of the gaps 128 , 130 are formed from the support member 110 , and are perpendicular to the bearing engaging side 104 of the inferior end plate 100 .
- each lateral 128 and anterior 130 gap is adjacent to a pocket 134 , which is recessed into the bearing engaging face 108 .
- the sides of the pocket 134 are part of the support member 1 10 .
- the pocket 134 is T-shaped to fit the arms 504 and the body 506 of the clip 500 when it is snapped to the inferior end plate 100 .
- the floor of the pocket 134 is sloped such that the pocket arms 136 are deeper than the pocket body 138 .
- the floor of the pocket body 138 slopes upward until it is flush with a slot 140 .
- the slot 140 extends from the pocket 134 to the central grafting port 116 .
- the slot 140 is also recessed into the bearing engaging face 108 but to a lesser extent than the pocket 134 .
- Each slot 140 has two side walls which are chamfered, forming two opposing chamfered edges 142 into which prongs 508 of the clip 500 fit closely.
- the opposing chamfered edges 142 of each slot 140 are slightly angled toward one another as the edges approach the center of the inferior end plate 100 .
- a chamfered wall 144 is formed by the continuation of the posterior chamfered edges 142 of the two lateral slots 140 ; the two posterior chamfered edges 142 continue past their respective slots 140 and meet, forming the chamfered wall 144 .
- the gaps 128 , 130 , the pocket 134 and the slot 140 are shaped to hold the clip 500 in place once it has been inserted. Once the clip 500 has been inserted, the chamfered edges 142 retain the prongs 508 of the clip 500 , while the tab 502 of the clip fits into the lateral 128 or anterior 130 gap.
- the spring bias 522 of the clip 500 causes the body 506 , arms 504 and tab 502 to be held in the pocket 134 against the bearing engaging side 104 of the inferior end plate 100 once the clip 500 has been inserted and the tab 502 snapped into the gap 128 or 130 .
- the inferior end plate 100 is intended to be implanted using one of three approaches into the intervertebral area with two clips 500 snapped to it. Implantation may be from an anterior approach, a right lateral approach, or a left lateral approach. If implantation is from the anterior approach, the anterior gap 130 is left empty with no clip secured, and with clips 500 snapped in the right and left lateral gaps 128 . When the inferior bearing 300 is later inserted, an anterior clip 500 will inserted with it, and once inserted, the anterior clip 500 is snapped to the inferior end plate 100 , into the empty anterior gap 130 .
- the right lateral gap 128 is left empty with no clip secured, and clips 500 are snapped in the anterior gap 130 and left gap 128 prior to implantation.
- a right lateral clip 500 will be inserted with it, and once inserted, the right lateral clip 500 is snapped to the inferior end plate 100 , into the empty right lateral gap 128 .
- the left lateral gap 128 is left empty with no clip secured and clips 500 are snapped in the anterior gap 130 and right gap 128 prior to insertion.
- a left lateral clip 500 will be inserted with it, and once inserted, the left lateral clip 500 is snapped to the inferior end plate 100 , into the empty left lateral gap 128 .
- the number and location of gaps and associated clips may vary.
- the superior end plate 200 has a bone facing side 206 and a bearing facing side 208 . It has a plurality of grafting channels 214 and grafting ports 216 .
- An anterior end 220 has an anterior gap 230 , shaped to receive a clip 500 .
- the end plate 200 has a right lateral end 224 with a gap 228 , and a left lateral end with a gap 228 .
- Each gap 228 , 230 leads into a pocket 234 .
- Each pocket 234 extends into a slot 240 , with chamfered edges 242 .
- the posterior chamfered edges 242 of the two lateral slots 240 meet, forming a chamfered wall 244 .
- the superior end plate 200 is similarly placed, but in a superior orientation on the superior vertebral body 48 .
- the superior end plate 200 will also have two clips 500 snapped to it, in the same positions of the clips 500 snapped to the inferior end plate 100 .
- a caudal side of the inferior bearing 300 is shown, with one clip 500 .
- the bearing 300 is quadrilateral in form with rounded edges, and is bilaterally symmetrical. It has a caudal side 302 , a cephalad side 304 , a posterior end 306 , an anterior end 308 , a right end 310 and a left end 312 .
- the caudal side 302 has an end plate engaging surface 314 .
- Adjacent to the anterior end 308 is an anterior pocket 316 , which is recessed into the end plate engaging surface 314 .
- adjacent to the right end 310 is a right pocket 318 and adjacent to the left end 312 is a left pocket 320 .
- Each pocket 316 , 318 , 320 is recessed into the end plate engaging surface 314 , and is shaped to fit around the protrusion 520 of the clip 500 .
- a side profile view of the inferior bearing 300 is shown.
- a square detent 322 is located on the end plate engaging surface 314 , laterally centered but slightly displaced toward posterior end 306 .
- the detent 322 is elevated from the end plate engaging surface 314 and has chamfered edges 324 .
- the cephalad side 304 has an inferior articulation surface 330 from which arises a round dome 332 .
- FIG. 13 illustrates the cephalad side 304 of the inferior bearing 300 .
- the dome 332 is encircled by a trough 334 , which is a recessed ring surrounding the dome 332 .
- the dome 332 and its encircling trough 334 are centered laterally on the cephalad side 304 of the inferior bearing 300 , but are slightly displaced toward the posterior end 306 .
- Recessed into the interior articulation surface 330 on the anterior end 308 is a notch 336 .
- the notch is recessed partway into the interior articulation surface 330 and extends perpendicularly from the edge of the anterior end 308 to the trough 334 .
- Similar notches 336 are present on the right 310 and left 312 ends of the inferior bearing 300 .
- the notches 336 are designed to fit closely around the end of an insertion tool such that the insertion tool may securely grip the inferior bearing 300 during insertion or removal of the bearing. It is appreciated that the design and placement of notches may vary in other embodiments of the invention.
- the superior bearing 400 with one clip 500 in the right lateral position is shown.
- the superior bearing 400 is quadrilateral in form with rounded edges. It has a cephalad side 402 , a caudal side 404 , a posterior end 406 , an anterior end 408 , a right end 410 and a left end 412 .
- the cephalad side 402 has an end plate engaging surface 414 . Adjacent to the anterior end is an anterior pocket 416 , which is recessed into the end plate engaging surface 414 . Similarly, adjacent to the right end 410 is a right pocket 418 and adjacent to the left end 412 is a left pocket 420 . Each pocket 416 , 418 , 420 recessed into the end plate engaging surface 414 , and is configured to fit around the protrusion 520 on the clip 500 .
- a side profile view of the superior bearing 400 is shown.
- a square detent 422 is located on the end plate engaging surface 414 , laterally centered but slightly displaced toward posterior end 406 .
- the detent 422 is elevated from the end plate engaging surface 414 and has chamfered edges 424 .
- the caudal side 404 has a superior articulation surface 430 into which is depressed a circular cup 432 .
- the cup 432 is encircled by a ridge 434 , which appears as a raised ring or donut surrounding the cup 432 .
- FIG. 16 a caudal side view of the superior bearing 400 is shown.
- the cup 432 and its encircling ridge 434 are centered laterally on the caudal side 404 of the superior bearing 400 , but are slightly displaced toward the posterior end 406 .
- Recessed into the superior articulation surface 430 on the anterior end 408 is a notch 436 .
- the notch is recessed partway into the superior articulation surface 430 and extends perpendicularly from the edge of the anterior end 408 to the ridge 434 .
- Similar notches 436 are present on the right 410 and left 412 ends of the superior bearing 400 .
- the notches 436 are designed to fit closely around the end of an insertion tool such that the insertion tool may securely grip the superior bearing 400 during insertion or removal of the bearing. It is appreciated that the design and placement of notches may vary in other embodiments of the invention.
- the inferior bearing 300 and the superior bearing 400 are inserted together into the space between the end plates 100 , 200 . Inserting the bearings 300 , 400 together requires less distraction of the vertebral bodies 28 , 48 than if they were inserted separately. If inserted separately, additional distraction would be required to allow the dome 332 on the inferior bearing 300 to pass by the ridge 434 on the superior bearing 400 . When inserted together, the dome 332 is fit into the cup 432 , allowing the two bearings 300 , 400 to fit into the smallest space possible.
- the bearings 300 , 400 can be inserted from an anterior approach, a right lateral approach, or a left lateral approach; they will be inserted using whichever approach was chosen for the placement of the end plates 100 , 200 during the same surgical procedure. However, it is appreciated that should there be any subsequent procedure for replacement or adjustment of the bearings 300 , 400 such procedure may be carried out from any one of the three approaches.
- one clip 500 is held in place next to the inferior bearing 300 as it is being inserted.
- the clip may be placed in an anterior position, a right lateral position, or a left lateral position, depending upon which surgical approach is implemented. If an anterior approach is implemented, the chamfered interior edge 514 of the clip is placed under the anterior chamfered edge 324 of the detent 322 of the inferior bearing 300 . Thus, the top side 510 of the clip 500 is held against the caudal side 302 of the inferior bearing 300 .
- the protrusion 520 of the clip 500 fits into the anterior pocket 316 of the inferior bearing 300 , when the inferior bearing 300 and the clip 500 are held together.
- the chamfered interior edge 514 of the clip is placed under the right chamfered edge 324 of the detent 322 of the inferior bearing 300 .
- the protrusion 520 of the clip 500 fits into right pocket 318 of the inferior bearing 300 , when the inferior bearing 300 and the clip 500 are held together.
- the chamfered interior edge 514 of the clip is placed under the left chamfered edge 324 of the detent 322 of the inferior bearing 300 .
- the protrusion 520 of the clip 500 fits into left pocket 320 of the inferior bearing 300 , when the inferior bearing 300 and the clip 500 are held together.
- one clip 500 is held in place next to the superior bearing 400 as it is being inserted.
- the clip may be placed in an anterior position, a right lateral position, or a left lateral position, depending upon which surgical approach is implemented. If an anterior approach is implemented, the chamfered interior edge 514 of the clip is placed under the anterior chamfered edge 424 of the detent 422 of the superior bearing 400 . Thus, the top side 510 of the clip 500 is held against the cephalad side 402 of the superior bearing 400 .
- the protrusion 520 of the clip 500 fits into the anterior pocket 416 of the superior bearing 400 , when the superior bearing 400 and the clip 500 are held together.
- the chamfered interior edge 514 of the clip is placed under the right chamfered edge 424 of the detent 422 of the superior bearing 400 .
- the protrusion 520 of the clip 500 fits into right pocket 418 of the superior bearing 400 , when the superior bearing 400 and the clip 500 are held together.
- the chamfered interior edge 514 of the clip is placed under the left chamfered edge 424 of the detent 422 of the superior bearing 400 .
- the protrusion 520 of the clip 500 fits into left pocket 420 of the superior bearing 400 , when the superior bearing 400 and the clip 500 are held together.
- the bearings 300 , 400 are shown immediately prior to being inserted in between the end plates 100 , 200 from a left lateral direction. As the inferior bearing 300 and the superior bearing 400 and their associated clips 500 are inserted, they are held together and slid along the medial-lateral axis 20 into the space between the end plates 100 , 200 . The bearings 300 , 400 and clips 500 are slid between the end plates 100 , 200 and into the open left lateral gaps 128 , 228 until the leading chamfered edge 324 of the detent 322 engages under the interior edge 514 of the opposite lateral clip 500 already in place.
- the leading chamfered edge 424 of the detent 422 engages under the interior edge 514 of the opposite lateral clip 500 already in place.
- the bearings cannot slide in any further.
- the chamfered edges 518 on the prongs 508 also slide under the chamfered edges 142 , 242 of the pockets.
- the bearings 300 , 400 and clips 500 are slid in a posterior direction parallel to the end plates 100 , 200 so that the detents 322 , 422 slide into the empty anterior gaps 130 , 230 . They are slid until the leading chamfered edge 324 of the detent 322 engages under the chamfered wall 144 at the end of the slot 140 . Simultaneously, on the superior bearing 400 , the leading chamfered edge 424 of the detent 422 engages under the chamfered wall 244 at the end of the slot 240 .
- the tabs 502 are pinched downward or caudally following the spring bias 522 so that the tabs 502 snap into the anterior gaps 130 or lateral gap 128 of the inferior end plate 100 , and the arms 504 are seated in the pockets 134 .
- the tabs 502 on the clips 500 adjacent to the superior end plate 200 are pinched upward in the cephalic direction, so that the tabs 502 snap into the anterior gaps 230 or lateral gaps 228 of the superior end plate 200 , and the arms 504 are seated in the pockets 234 .
- the spring bias 522 holds the clips 500 against end plates 100 , 200 , and bearings 300 , 400 are prevented from slipping in a lateral, anterior, posterior, caudal or cephalad direction.
- the initial implantation can be accomplished by any of the three approaches: anterior, right lateral, or left lateral.
- the bearings 300 , 400 need to be replaced by those of a different size or configuration (or by an elastic insert or the fusion block that will be described below)
- the surgery may be approached from a different direction than the initial implantation, thus avoiding disturbance of scar tissue.
- the tabs 502 of the two clips 500 on one approach are pinched together.
- the tab 502 of the anterior clip 500 on the inferior end plate 100 is pinched toward the tab 502 of the anterior clip 500 on the superior end plate 200 .
- the pinching action will free the tab arms 504 from the pockets 134 , 234 of the inferior 100 and superior 200 end plates.
- the protrusions 520 on the clips 500 will fit into the pockets 316 , 416 in the inferior 300 and superior 400 bearings.
- the clips are then pulled perpendicularly away from the end plates 100 , 200 , with the bearings 300 , 400 held between them.
- the replacement bearings 300 , 400 can then be inserted with clips 500 in place, as described in the original insertion procedure.
- FIG. 18 illustrates a fusion block 600 , shown assembled with the inferior end plate 100 and the superior end plate 200 , within a portion of the spine.
- a plurality of clips 500 are used to position the fusion block 600 and attach it to the end plates 100 , 200 .
- the fusion block 600 may be inserted in place of the inferior bearing 300 and the superior bearing 400 , if fusion of the involved vertebrae is desired. Insertion of the fusion block 600 may occur during the initial procedure, following the placement of the inferior and superior end plates 100 , 200 . Alternatively, it can be used to replace the inferior and superior bearings 300 , 400 after they have been implanted in the patient for some period of time.
- the fusion block 600 may be inserted from the anterior, right lateral, or left lateral approach.
- fusion block 600 is of a quadrilateral shape with rounded corners. It has a cephalad side 602 and a caudal side 604 , which are substantially parallel. It has an anterior end 606 , a posterior end 608 , a right end 610 and a left end 612 .
- the cephalad side has a first end plate engaging surface 640
- the caudal side has a second end plate engaging surface 642 .
- the cephalad and caudal sides 602 , 604 are identical, and the fusion block 600 is bilaterally symmetrical, with identical right and left ends 610 , 612 .
- sides and ends may vary from one another and symmetry may or may not occur.
- a plurality of grafting ports 614 passing through a support member 620 , is present on the fusion block 600 .
- these grafting ports 614 are configured to line up with the grafting ports 116 , 216 on the inferior and superior end plates 100 , 200 .
- These adjacent openings extend through the entire implant to allow growth of bone material through the fusion block 600 and the end plates 100 , 200 , thus fusing the fusion block 600 , end plates 100 , 200 , and vertebral bodies 28 , 48 together.
- the fusion block 600 is at least partially packed with an osteogenic substance.
- osteogenic substance is broadly intended to include natural bone, such as autogenous bone graft or bone allograft, synthetic bone, growth factors and cytokines (including bone morphogenic proteins), and/or combinations thereof.
- FIG. 20 an anterior side view of the fusion block 600 is shown.
- a plurality of grafting holes 616 is present on each side of the block, passing through the support member 620 .
- the grafting holes 616 allow growth of bone material throughout the fusion block 600 .
- Grooves 618 are recessed into the support member 620 on each outer corner of the block. Each groove 618 is designed to fit closely around the end of an insertion tool such that the insertion tool (not shown) may securely grip the fusion block 600 during insertion of the block.
- a square first detent 622 is located on the cephalad side 602 while a similar, square second detent 624 is on the caudal side 604 .
- the detents 622 , 624 are laterally centered but slightly displaced toward the posterior end 608 .
- the detents 622 , 624 project outward from the end plate engaging surfaces 640 , 642 of each side 602 , 604 .
- the first detent 622 has chamfered edges 626
- the second detent 624 has chamfered edges 628 .
- a pocket 630 adjacent to the anterior end 608 is a pocket 630 , which is recessed into the first end plate engaging surface 640 . Similar pockets 630 are adjacent to the right end 610 and the left end 612 . Each pocket 630 is recessed into the first end plate engaging surface 640 , and is configured to fit around the protrusion 520 on the clip 500 . Three pockets 630 are similarly located on the second end plate engaging surface 642 .
- the end plates 100 , 200 are placed against the vertebral bodies 28 , 48 as previously described, each with two clips 500 snapped in place.
- the clips 500 are used to position the fusion block 600 during the insertion process, and then hold the fusion block in place once inserted.
- the interior edge 514 of a clip 500 is slid under a chamfered edge 626 of the first detent 622 on the cephalad side 602 .
- the clip Once the clip is in place, its protrusion 520 fits into the facing pocket 630 on the first end plate engaging surface 640 .
- a clip 500 is slid under the matching chamfered edge 628 of the second detent 624 on the caudal side 604 , with that clip's protrusion 520 in the facing pocket 630 of the second end plate engaging surface 642 .
- the fusion block 600 is sandwiched between two clips 500 , the clips being in matching anterior, right lateral or left lateral positions.
- the fusion block 600 is shown as is it being inserted from the anterior approach into the gap between the end plates 100 , 200 .
- the fusion block 600 and its associated clips 500 are held together and slid into the empty anterior gaps 130 , 230 on the end plates 100 , 200 .
- the fusion block 600 and clips 500 are held parallel to the end plates and slid posteriorly into place such that the lateral chamfered edges 626 of the first detent 622 engage under the chamfered edges 242 of the open pocket 234 on the superior end plate 200 .
- the lateral chamfered edges 628 of the second detent 624 engage under the chamfered edges 142 of the open pocket 134 on the inferior end plate 100 .
- the fusion block 600 and clips 500 are slid until the leading chamfered edges 626 , 628 of the detents 622 , 624 engage under the chamfered walls 244 , 144 at the end of the slots 240 , 140 .
- the fusion block 600 and clips 500 are slid until the leading chamfered edges 626 , 628 of the detents 622 , 624 engage under the interior edges 514 of the opposite lateral clips 500 already in place.
- the fusion block cannot slide in any further.
- the chamfered edges 518 on the prongs 508 also slide under the chamfered edges 142 , 242 of the pockets 134 , 234 .
- the tabs 502 are pinched individually toward the end plates following the spring bias 522 so that the tabs 502 snap into the anterior gaps 130 , 230 or lateral gaps 128 , 228 of the end plates 100 , 200 and the arms 504 are seated in the pockets 134 , 234 .
- the spring bias 522 holds the clips 500 against the end plates 100 , 200 and the fusion block 600 is prevented from slipping in a lateral, anterior, posterior, caudal or cephalad direction.
- the fusion block 600 As with the bearings, if revision of the initial implantation of the fusion block is necessary, it can be accomplished by any of the three approaches: anterior, right lateral, or left lateral.
- anterior, right lateral, or left lateral For example, if the fusion block 600 needs to be replaced by one of a different size or configuration, the surgery may be approached from a different direction than the initial implantation, thus avoiding disturbance of scar tissue.
- the tabs 502 of the two clips 500 on one approach are pinched together.
- the anterior approach is used, the tab 502 of the anterior clip 500 on the cephalad side 602 is pinched toward the tab 502 of the anterior clip 500 on the caudal side 604 .
- the pinching action will free the tab arms 504 from the pockets 134 , 234 of the inferior 100 and superior 200 end plates.
- the protrusions 520 on the clips 500 will fit into the pockets 630 in the first and second end plate engaging surfaces 640 , 642 .
- the clips are then pulled perpendicularly away from the end plates 100 , 200 , with the fusion block 600 held between them.
- a replacement fusion block 600 , elastic insert, or bearings 300 , 400 can then be inserted with clips 500 snapped in place, as described in the original insertion procedure.
Abstract
The present invention provides an intervertebral implant for replacing intervertebral disc material and controlling relative motion between adjacent vertebral bodies. The intervertebral implant may have at least one end plate and an intermediate component which slides into engagement with the end plate. The intermediate component may be engageable with the end plate from an anterior approach, or a right or left lateral approach. The intermediate component can be a set of bearing surfaces which articulate to provide relative motion between two vertebral bodies, an elastic insert which deforms to provide motion between two vertebral bodies, or a rigid insert which prevents relative motion between two vertebral bodies. The intermediate component is replaceable with a different intermediate component which provides a different function. The present invention also provides one or more retaining members which snap into engagement with the end plate and secure the intermediate component to the end plate.
Description
- This application claims the benefit of the following:
- U.S. Provisional Application No. 60,720,513, filed Sep. 26, 2005, which carries Applicants' Docket No. MLI-45 PROV and is entitled MODULAR ARTICULATING AND FUSION SPINAL DISC IMPLANT SYSTEM;
- U.S. Provisional Application No. 60/720,514, filed Sep. 26, 2005, which carries Applicants' Docket No. MLI-46 PROV and is entitled UNIVERSAL SPINAL DISC IMPLANT SYSTEM FOR PROVIDING INTERVERTEBRAL ARTICULATION AND FUSION; and
- U.S. Provisional Application No. 60/741,513, filed Nov. 30, 2005, which carries Applicants' Docket No. MLI-50 PROV and is entitled SYSTEM AND METHOD FOR INTERVERTEBRAL IMPLANT DELIVERY AND REMOVAL.
- All of the foregoing are incorporated herein by reference.
- 1. The Field of the Invention
- The present invention relates generally to spinal orthopedics, and more precisely, to intervertebral implants.
- 2. The Relevant Technology
- Severe back pain can be caused by a number of different ailments, including spinal stenosis, degenerative disc disease, spondylolisthesis, and the like. Many such ailments can be corrected by controlling or limiting relative motion between the affected vertebrae. Accordingly, a variety of devices including artificial discs and fusion devices have been proposed.
- Such devices are limited in that they typically provide only one mode of correction. Many such devices cannot be replaced or corrected. This is particularly true with intervertebral implants, in which bone-growth is often stimulated to integrate the implants with the surrounding bone tissue. Thus, if the device fails to solve the problem, there may be no other recourse for the patient.
- Further, many known devices are expensive or difficult to manufacture, or are difficult to implant. Some known intervertebral devices require the adjacent vertebrae to be distracted excessively, thereby endangering the surrounding ligaments and other connective tissues. Accordingly, there is a need in the art for a device that remedies these problems. Such a device would considerably enhance outcomes for patients with spinal disorders.
- Various embodiments of the present invention will now be discussed with reference to the appended drawings. It is appreciated that these drawings depict only typical embodiments of the invention and are therefore not to be considered limiting of its scope.
-
FIG. 1 is a perspective view illustrating a portion of a spine. -
FIG. 2 is a perspective lateral view of one embodiment of a total disc implant implanted in the spine, comprising inferior and superior end plates, inferior and superior bearings, and a plurality of clips. -
FIG. 3 is a perspective anterior view of the total disc implant ofFIG. 2 in an disassembled state. -
FIG. 4 is a bottom elevation view of the clip shown inFIG. 3 . -
FIG. 5 is a top elevation view of the clip shown inFIG. 3 . -
FIG. 6 is a perspective side view of the clip shown inFIG. 3 . -
FIG. 7 is a perspective posterior view of the bone engaging side of the inferior end plate shown inFIG. 3 . -
FIG. 8 is a lateral end view of the inferior end plate shown inFIG. 3 . -
FIG. 9 is a perspective anterior view of the bearing engaging side of the inferior end plate shown inFIG. 3 , and one clip. -
FIG. 10 is a perspective posterior view of the bearing engaging side of the superior end plate shown inFIG. 3 , and one clip. -
FIG. 11 is a perspective posterior view of the caudal side of the inferior bearing and one clip shown inFIG. 3 . -
FIG. 12 is an anterior side view of the inferior bearing shown inFIG. 3 . -
FIG. 13 is a perspective anterior view of the cephalad side of the inferior bearing shown inFIG. 3 . -
FIG. 14 is a perspective anterior view of the cephalad side of the superior bearing and one clip shown inFIG. 3 . -
FIG. 15 is an anterior side view of the superior bearing shown inFIG. 3 . -
FIG. 16 is a perspective posterior view of the caudal side of the superior bearing shown inFIG. 3 . -
FIG. 17 is an anterior side view of the total disc implant ofFIG. 3 , in a partially assembled state. -
FIG. 18 is a perspective lateral view of one embodiment of a fusion block implant, shown in a portion of the spine. -
FIG. 19 is a perspective anterior view of the cephalad side of the fusion block shown inFIG. 16 . -
FIG. 20 is an anterior side view of the fusion block shown inFIG. 16 . -
FIG. 21 is a perspective anterior-cephalad view of the fusion block shown inFIG. 16 , and two clips. -
FIG. 22 is a perspective lateral side view of the fusion block implant ofFIG. 18 , in a partially assembled state. - The present invention relates to human spinal disc replacement systems. Those of skill in the art will recognize that the systems and methods described herein may be readily adapted for other modular implant systems for anatomic replication of orthopedic joints by man made implant systems.
- Referring to
FIG. 1 , a perspective view illustrates a portion of aspine 10.FIG. 1 illustrates only the bony structures; accordingly, ligaments, cartilage, and other soft tissues are omitted for clarity. Thespine 10 has acephalad direction 12, acaudal direction 14, ananterior direction 16, aposterior direction 18, and a medial/lateral axis 20, all of which are oriented as shown by the arrows bearing the same reference numerals. In this application, “left” and “right” are used with reference to a posterior view, i.e., a view from behind thespine 10. “Medial” refers to a position or orientation toward a sagittal plane (i.e., plane of symmetry that separates left and right sides from each other) of thespine 10, and “lateral” refers to a position or orientation relatively further from the sagittal plane. - As shown, the portion of the
spine 10 illustrated inFIG. 1 includes afirst vertebra 24, which may be the L5 (Fifth Lumbar) vertebra of a patient, and asecond vertebra 26, which may be the L4 (Fourth Lumbar) vertebra of the patient. The systems and methods may be applicable to any vertebra or vertebrae of thespine 10 and/or the sacrum (not shown). In this application, the term “vertebra” may be broadly interpreted to include the sacrum. - As shown, the
first vertebra 24 has abody 28 with a generally disc-like shape and twopedicles 30 that extend posteriorly from thebody 28. A posterior arch, orlamina 32, extends between the posterior ends of thepedicles 30 to couple thepedicles 30 together. Thefirst vertebra 24 also has a pair oftransverse processes 34 that extend laterally from thepedicles 30 generally along the medial/lateral axis 20, and aspinous process 36 that extends from thelamina 32 along theposterior direction 18. - Similarly, the
second vertebra 26 has abody 48 from which twopedicles 50 extend posteriorly. A posterior arch, orlamina 52, extends between the posterior ends of thepedicles 50 to couple thepedicles 50 together. Thesecond vertebra 26 also has a pair oftransverse processes 54, each of which extends from the correspondingpedicle 50 generally along the medial/lateral axis 20, and aspinous process 56 that extends from thelamina 52 along theposterior direction 18. Thevertebrae intervertebral disc 66. - Referring to
FIG. 2 , a perspective view illustrates one embodiment of animplant 70, which may be referred to as a total disk implant. Theimplant 70 is designed for placement between spinal vertebrae to replace degenerated intervertebral disc material. More specifically, theimplant 70 is designed to be inserted between thevertebral bodies second vertebrae intervertebral disc 66. Theimplant 70 has end plates which secure the implant to the vertebral bodies, and an intermediate component which engages with the end plates, to control or prevent relative motion between the vertebral bodies. The intermediate component may be a first bearing surface configured to articulate with a second bearing surface, to provide relative motion between the vertebral bodies. The intermediate component may also be a deformable elastic insert which provides motion between the vertebral bodies, or a rigid insert to promote fusion, thus preventing relative motion between the vertebral bodies. Retention members, which in this embodiment of the invention take the form of clips, secure the intermediate component to the end plates. - In the embodiment depicted in
FIG. 2 , the assembledimplant 70 is of a generally rectangular box-like shape with rounded edges, with top and bottom surfaces which form a slight wedge. In alternative embodiments, it is appreciated thatimplant 70 need not have a rectangular box shaped configuration but can be square, circular, or have any other polygonal or irregular configuration. Furthermore, it is appreciated that theimplant 70 can be configured at any desired wedge angle or can have substantially parallel top and bottom surfaces. Theimplant 70 comprises aninferior end plate 100, aninferior bearing 300, asuperior bearing 400, and asuperior end plate 200. When fully assembled, theinferior bearing 300 is releasably attached to theinferior end plate 100 by a plurality ofclips 500. Thesuperior bearing 400 is releasably attached to thesuperior end plate 200 by a plurality ofclips 500. -
FIG. 3 depicts theimplant 70 in a disassembled state, to illustrate the individual components of the implant. Theinferior bearing 300 has a rounded dome, surrounded by a trough, which fits into a cup, surrounded by a ridge, on thesuperior bearing 400. The inclusion of the ridge and trough in the bearing design allows the patient less impeded flexion/extension and lateral bending. - During the implantation procedure, initially the inferior 100 and superior 200 end plates are placed in the intervertebral space, adjacent to the
vertebral bodies end plates FIGS. 2 and 3 , theinferior end plate 100 is inserted adjacent tovertebral body 28 with abone engaging side 102 in acaudal direction 14 and abearing engaging side 104 in acephalad direction 12. Conversely, thesuperior end plate 200 is inserted adjacent tovertebral body 48 with abone engaging side 202 in acephalad direction 12 and abearing engaging side 204 in acaudal direction 14. Because the features of theend plates inferior end plate 100 will be described in detail below. All description of the structure of theinferior end plate 100 also applies to thesuperior end plate 200. However, it is appreciated that in alternative embodiments of the invention, end plates of varying configurations may be used in combination. -
FIG. 4 depicts a bottom side view of theclip 500. In this embodiment of the invention theclip 500 is roughly quadrilateral in shape, with substantially parallel top and bottom sides, and is bilaterally symmetrical. However, it is appreciated that in alternative embodiments, theclip 500 may vary in configuration and/or use. It has atop side 510, abottom side 512, aninterior edge 514 and anexterior edge 516. Theinterior edge 514 is chamfered on thebottom side 512. Theexterior edge 516 has atab 502 which extends perpendicularly from the edge. Thetab 502 is configured to fit a gap in eachend plate clip 500 to theend plate body 506 extends from thetab 502 and theexterior edge 516 toward theinterior edge 514. Onearm 504 extends perpendicularly from each lateral side of thebody 506, on either side of thetab 502. A T-shape is formed by thearms 504 and thebody 506. At the interior end of thebody 506, twoprongs 508 extend initially perpendicularly from thebody 506, then, turning right angles, extend back toward thearms 504. - Referring to
FIG. 5 , a top side view of theclip 500 is shown. The outside edges of theprongs 508 are chamfered on thetop side 510, forming chamferededges 518. The chamfered edges 518 of theprongs 508 are slightly angled in their lengthwise orientation; that is, the width of theclip 500 at theinterior edge 514 is slightly narrower than its width at thearms 508 andexterior edge 516. Aprotrusion 520 projects from thebody 506 on thetop side 510. Theprotrusion 520 appears as a square projecting upward from thetop side 510, and is centered between thearms 508. Theprotrusion 520 is wedge-shaped in profile, the higher end adjacent to thetab 502, and the opposite end slanting down until it is flush with thebody 506 at the midpoint of thebody 506. -
FIG. 6 depicts a side profile view of theclip 500. Theclip 500 has aspring bias 522, such that when theclip 500 is not secured to another component, thebody 506, thearms 504 and thetab 502 are held at a slight downward angle relative to theprongs 508; that is, thebody 506, thearms 504 and thetab 502 angle in the direction of thebottom side 512. - Referring to
FIG. 7 , a bone-engaging side view of theinferior end plate 100 is shown. In this embodiment theinferior end plate 100 is of a quadrilateral shape with rounded corners, and is bilaterally symmetrical. It has ananterior end 120, aposterior end 122, aright end 124 and aleft end 126. Theinferior end plate 100 has abone engaging face 106 and abearing engaging face 108 which are connected by a support member 1 10. Projecting from thebone engaging face 106 is a plurality of bone engaging spikes 112. Eachbone engaging spike 112 is columnar in form and projects perpendicularly in thecaudal direction 14 from thebone engaging face 106. The protruding end of eachbone engaging spike 112 tapers and terminates in an acute angle. This angled tapering creates a point which facilitates seating theinferior end plate 100 in the adjacentvertebral body 28 during the implantation process; the point will more easily penetrate thevertebral body 28 than would a blunt end. - A
hollow grafting channel 114 runs through the center of eachbone engaging spike 112. Each graftingchannel 114 originates on thebearing engaging face 108, runs through thesupport member 110, and ends at the pointed termination of the bone engaging spike 1 12. This hollowed point configuration may be compared to the hollow point of a hypodermic needle, and further facilitates the penetration of thevertebral body 28 by the bone engaging spikes 112. The graftingchannels 114 also allow for the growth of bony columns from thevertebral body 28 through the channels, thereby fusing theinferior end plate 100 to thevertebral body 28. - A plurality of grafting
ports 116 is present in theinferior end plate 100. Each grafting port is an opening from thebearing engaging face 108 through thesupport member 110 to thebone engaging face 106. The graftingports 116 allow for the growth of bony material from thevertebral body 28 through the ports, thereby fusing theinferior end plate 100 to thevertebral body 28. - A
groove 118 is present on each outer corner of theinferior end plate 100. Eachgroove 118 is an indentation into the support member 1 10. Eachgroove 118 is designed to fit closely around the end of an insertion tool such that the insertion tool (not shown) may securely grip theinferior end plate 100 during insertion or removal of the end plate. - Referring to
FIG. 8 , a lateral end view of theinferior end plate 100 is shown. It is slightly wedge shaped when viewed from either lateral end. That is, the height of theinferior end plate 100 at theposterior end 122 is shorter than its height at theanterior end 120. This is because this embodiment of the invention is designed for the lumbar portion of the spine, which is curved such that the intervertebral space is wider at the anterior end than at the posterior end. However, it is appreciated that theinferior end plate 100 can be configured at any desired wedge angle or can have substantially parallel top and bottom surfaces. -
FIG. 9 illustrates thebearing engaging side 104 of theinferior end plate 100, with oneclip 500 snapped on the left side. Theend plate 100 has symmetrically placedlateral gaps 128 in theright end 124 and theleft end 126. Theanterior end 120 has ananterior gap 130 which is identically shaped as thelateral gaps 128 but is located perpendicular to them. The lateral 128 and anterior 130 gaps are shaped to accommodate the insertion ofclips 500, which releasably hold theinferior bearing 300 to theinferior end plate 100. The caudal or lower portions of thegaps bone engaging side 102 of theinferior end plate 100, are shaped to fit thetab 502 of theclip 500. The cephalad or upper portions of thegaps arms 504 of theclip 500. Thewalls 132 of thegaps support member 110, and are perpendicular to thebearing engaging side 104 of theinferior end plate 100. - Moving toward the center of the
inferior end plate 100, each lateral 128 and anterior 130 gap is adjacent to apocket 134, which is recessed into thebearing engaging face 108. The sides of thepocket 134 are part of the support member 1 10. Thepocket 134 is T-shaped to fit thearms 504 and thebody 506 of theclip 500 when it is snapped to theinferior end plate 100. The floor of thepocket 134 is sloped such that thepocket arms 136 are deeper than thepocket body 138. The floor of thepocket body 138 slopes upward until it is flush with aslot 140. - Continuing toward the center of the
inferior end plate 100, theslot 140 extends from thepocket 134 to thecentral grafting port 116. Theslot 140 is also recessed into thebearing engaging face 108 but to a lesser extent than thepocket 134. Eachslot 140 has two side walls which are chamfered, forming two opposing chamferededges 142 into which prongs 508 of theclip 500 fit closely. The opposing chamferededges 142 of eachslot 140 are slightly angled toward one another as the edges approach the center of theinferior end plate 100. Achamfered wall 144 is formed by the continuation of the posterior chamferededges 142 of the twolateral slots 140; the two posterior chamferededges 142 continue past theirrespective slots 140 and meet, forming thechamfered wall 144. Thegaps pocket 134 and theslot 140 are shaped to hold theclip 500 in place once it has been inserted. Once theclip 500 has been inserted, the chamferededges 142 retain theprongs 508 of theclip 500, while thetab 502 of the clip fits into the lateral 128 or anterior 130 gap. Thespring bias 522 of theclip 500 causes thebody 506,arms 504 andtab 502 to be held in thepocket 134 against thebearing engaging side 104 of theinferior end plate 100 once theclip 500 has been inserted and thetab 502 snapped into thegap - In the embodiment depicted, the
inferior end plate 100 is intended to be implanted using one of three approaches into the intervertebral area with twoclips 500 snapped to it. Implantation may be from an anterior approach, a right lateral approach, or a left lateral approach. If implantation is from the anterior approach, theanterior gap 130 is left empty with no clip secured, and withclips 500 snapped in the right and leftlateral gaps 128. When theinferior bearing 300 is later inserted, ananterior clip 500 will inserted with it, and once inserted, theanterior clip 500 is snapped to theinferior end plate 100, into the emptyanterior gap 130. - If implantation is from the right lateral approach, the right
lateral gap 128 is left empty with no clip secured, and clips 500 are snapped in theanterior gap 130 and leftgap 128 prior to implantation. When theinferior bearing 300 is later inserted, a rightlateral clip 500 will be inserted with it, and once inserted, the rightlateral clip 500 is snapped to theinferior end plate 100, into the empty rightlateral gap 128. - If implantation is from the left lateral approach, the left
lateral gap 128 is left empty with no clip secured andclips 500 are snapped in theanterior gap 130 andright gap 128 prior to insertion. When theinferior bearing 300 is later inserted, a leftlateral clip 500 will be inserted with it, and once inserted, the leftlateral clip 500 is snapped to theinferior end plate 100, into the empty leftlateral gap 128. It is appreciated that in alternative embodiments of the invention, the number and location of gaps and associated clips may vary. - Referring to
FIG. 10 , a bearing facing side of thesuperior end plate 200 is shown, with oneclip 500 snapped on the right side. Thesuperior end plate 200 has abone facing side 206 and abearing facing side 208. It has a plurality of graftingchannels 214 and graftingports 216. Ananterior end 220 has ananterior gap 230, shaped to receive aclip 500. Theend plate 200 has a rightlateral end 224 with agap 228, and a left lateral end with agap 228. Eachgap pocket 234. Eachpocket 234 extends into aslot 240, withchamfered edges 242. The posterior chamferededges 242 of the twolateral slots 240 meet, forming achamfered wall 244. - Returning to
FIGS. 2 and 3 , following the surgical placement of theinferior end plate 100 with twoclips 500 snapped to it, thesuperior end plate 200 is similarly placed, but in a superior orientation on the superiorvertebral body 48. Thesuperior end plate 200 will also have twoclips 500 snapped to it, in the same positions of theclips 500 snapped to theinferior end plate 100. - Referring to
FIG. 11 , a caudal side of theinferior bearing 300 is shown, with oneclip 500. Thebearing 300 is quadrilateral in form with rounded edges, and is bilaterally symmetrical. It has acaudal side 302, acephalad side 304, aposterior end 306, ananterior end 308, aright end 310 and aleft end 312. Thecaudal side 302 has an endplate engaging surface 314. Adjacent to theanterior end 308 is ananterior pocket 316, which is recessed into the endplate engaging surface 314. Similarly, adjacent to theright end 310 is aright pocket 318 and adjacent to theleft end 312 is aleft pocket 320. Eachpocket plate engaging surface 314, and is shaped to fit around theprotrusion 520 of theclip 500. - Referring to
FIG. 12 , a side profile view of theinferior bearing 300 is shown. Asquare detent 322 is located on the endplate engaging surface 314, laterally centered but slightly displaced towardposterior end 306. Thedetent 322 is elevated from the endplate engaging surface 314 and has chamferededges 324. Thecephalad side 304 has aninferior articulation surface 330 from which arises around dome 332. -
FIG. 13 illustrates thecephalad side 304 of theinferior bearing 300. Thedome 332 is encircled by atrough 334, which is a recessed ring surrounding thedome 332. Thedome 332 and itsencircling trough 334 are centered laterally on thecephalad side 304 of theinferior bearing 300, but are slightly displaced toward theposterior end 306. Recessed into theinterior articulation surface 330 on theanterior end 308 is anotch 336. The notch is recessed partway into theinterior articulation surface 330 and extends perpendicularly from the edge of theanterior end 308 to thetrough 334.Similar notches 336 are present on the right 310 and left 312 ends of theinferior bearing 300. Thenotches 336 are designed to fit closely around the end of an insertion tool such that the insertion tool may securely grip theinferior bearing 300 during insertion or removal of the bearing. It is appreciated that the design and placement of notches may vary in other embodiments of the invention. - Referring to
FIG. 14 , thesuperior bearing 400 with oneclip 500 in the right lateral position is shown. Thesuperior bearing 400 is quadrilateral in form with rounded edges. It has acephalad side 402, acaudal side 404, aposterior end 406, ananterior end 408, aright end 410 and aleft end 412. Thecephalad side 402 has an endplate engaging surface 414. Adjacent to the anterior end is ananterior pocket 416, which is recessed into the endplate engaging surface 414. Similarly, adjacent to theright end 410 is aright pocket 418 and adjacent to theleft end 412 is aleft pocket 420. Eachpocket plate engaging surface 414, and is configured to fit around theprotrusion 520 on theclip 500. - Referring to
FIG. 15 a side profile view of thesuperior bearing 400 is shown. Asquare detent 422 is located on the endplate engaging surface 414, laterally centered but slightly displaced towardposterior end 406. Thedetent 422 is elevated from the endplate engaging surface 414 and has chamferededges 424. Thecaudal side 404 has asuperior articulation surface 430 into which is depressed acircular cup 432. Thecup 432 is encircled by aridge 434, which appears as a raised ring or donut surrounding thecup 432. - Referring to
FIG. 16 , a caudal side view of thesuperior bearing 400 is shown. Thecup 432 and its encirclingridge 434 are centered laterally on thecaudal side 404 of thesuperior bearing 400, but are slightly displaced toward theposterior end 406. Recessed into thesuperior articulation surface 430 on theanterior end 408 is anotch 436. The notch is recessed partway into thesuperior articulation surface 430 and extends perpendicularly from the edge of theanterior end 408 to theridge 434.Similar notches 436 are present on the right 410 and left 412 ends of thesuperior bearing 400. Thenotches 436 are designed to fit closely around the end of an insertion tool such that the insertion tool may securely grip thesuperior bearing 400 during insertion or removal of the bearing. It is appreciated that the design and placement of notches may vary in other embodiments of the invention. - The
inferior bearing 300 and thesuperior bearing 400 are inserted together into the space between theend plates bearings vertebral bodies dome 332 on theinferior bearing 300 to pass by theridge 434 on thesuperior bearing 400. When inserted together, thedome 332 is fit into thecup 432, allowing the twobearings bearings end plates bearings - Returning to
FIG. 11 , oneclip 500 is held in place next to theinferior bearing 300 as it is being inserted. The clip may be placed in an anterior position, a right lateral position, or a left lateral position, depending upon which surgical approach is implemented. If an anterior approach is implemented, the chamferedinterior edge 514 of the clip is placed under the anteriorchamfered edge 324 of thedetent 322 of theinferior bearing 300. Thus, thetop side 510 of theclip 500 is held against thecaudal side 302 of theinferior bearing 300. Theprotrusion 520 of theclip 500 fits into theanterior pocket 316 of theinferior bearing 300, when theinferior bearing 300 and theclip 500 are held together. - If a right lateral approach is implemented, the chamfered
interior edge 514 of the clip is placed under the rightchamfered edge 324 of thedetent 322 of theinferior bearing 300. Theprotrusion 520 of theclip 500 fits intoright pocket 318 of theinferior bearing 300, when theinferior bearing 300 and theclip 500 are held together. If a left lateral approach is implemented, the chamferedinterior edge 514 of the clip is placed under the left chamferededge 324 of thedetent 322 of theinferior bearing 300. Theprotrusion 520 of theclip 500 fits intoleft pocket 320 of theinferior bearing 300, when theinferior bearing 300 and theclip 500 are held together. - Returning to
FIG. 14 , oneclip 500 is held in place next to thesuperior bearing 400 as it is being inserted. The clip may be placed in an anterior position, a right lateral position, or a left lateral position, depending upon which surgical approach is implemented. If an anterior approach is implemented, the chamferedinterior edge 514 of the clip is placed under the anteriorchamfered edge 424 of thedetent 422 of thesuperior bearing 400. Thus, thetop side 510 of theclip 500 is held against thecephalad side 402 of thesuperior bearing 400. Theprotrusion 520 of theclip 500 fits into theanterior pocket 416 of thesuperior bearing 400, when thesuperior bearing 400 and theclip 500 are held together. - If a right lateral approach is implemented, the chamfered
interior edge 514 of the clip is placed under the rightchamfered edge 424 of thedetent 422 of thesuperior bearing 400. Theprotrusion 520 of theclip 500 fits intoright pocket 418 of thesuperior bearing 400, when thesuperior bearing 400 and theclip 500 are held together. If a left lateral approach is implemented, the chamferedinterior edge 514 of the clip is placed under the left chamferededge 424 of thedetent 422 of thesuperior bearing 400. Theprotrusion 520 of theclip 500 fits intoleft pocket 420 of thesuperior bearing 400, when thesuperior bearing 400 and theclip 500 are held together. - Referring to
FIG. 17 , thebearings end plates inferior bearing 300 and thesuperior bearing 400 and their associatedclips 500 are inserted, they are held together and slid along the medial-lateral axis 20 into the space between theend plates bearings clips 500 are slid between theend plates lateral gaps edge 324 of thedetent 322 engages under theinterior edge 514 of the oppositelateral clip 500 already in place. Simultaneously, on thesuperior bearing 400, the leading chamferededge 424 of thedetent 422 engages under theinterior edge 514 of the oppositelateral clip 500 already in place. Thus engaged, the bearings cannot slide in any further. As theclips 500 are slid in with thebearings edges 518 on theprongs 508 also slide under the chamferededges - If an anterior approach is used, the
bearings clips 500 are slid in a posterior direction parallel to theend plates detents anterior gaps edge 324 of thedetent 322 engages under the chamferedwall 144 at the end of theslot 140. Simultaneously, on thesuperior bearing 400, the leading chamferededge 424 of thedetent 422 engages under the chamferedwall 244 at the end of theslot 240. - After the
bearings clips 500 are fully slid in with all chamfered edges engaged, thetabs 502 are pinched downward or caudally following thespring bias 522 so that thetabs 502 snap into theanterior gaps 130 orlateral gap 128 of theinferior end plate 100, and thearms 504 are seated in thepockets 134. Similarly, thetabs 502 on theclips 500 adjacent to thesuperior end plate 200 are pinched upward in the cephalic direction, so that thetabs 502 snap into theanterior gaps 230 orlateral gaps 228 of thesuperior end plate 200, and thearms 504 are seated in thepockets 234. Once thetabs 502 are thus pinched, thespring bias 522 holds theclips 500 againstend plates bearings - Should revision of the initial implantation be necessary, it can be accomplished by any of the three approaches: anterior, right lateral, or left lateral. For example, if the
bearings bearings tabs 502 of the twoclips 500 on one approach (anterior, right or left) are pinched together. For example, if the anterior approach is used, thetab 502 of theanterior clip 500 on theinferior end plate 100 is pinched toward thetab 502 of theanterior clip 500 on thesuperior end plate 200. The pinching action will free thetab arms 504 from thepockets protrusions 520 on theclips 500 will fit into thepockets end plates bearings replacement bearings clips 500 in place, as described in the original insertion procedure. -
FIG. 18 illustrates afusion block 600, shown assembled with theinferior end plate 100 and thesuperior end plate 200, within a portion of the spine. A plurality ofclips 500 are used to position thefusion block 600 and attach it to theend plates fusion block 600 may be inserted in place of theinferior bearing 300 and thesuperior bearing 400, if fusion of the involved vertebrae is desired. Insertion of thefusion block 600 may occur during the initial procedure, following the placement of the inferior andsuperior end plates superior bearings end plates bearings fusion block 600 may be inserted from the anterior, right lateral, or left lateral approach. - As viewed in
FIG. 19 ,fusion block 600 is of a quadrilateral shape with rounded corners. It has acephalad side 602 and acaudal side 604, which are substantially parallel. It has ananterior end 606, aposterior end 608, aright end 610 and aleft end 612. The cephalad side has a first endplate engaging surface 640, and the caudal side has a second endplate engaging surface 642. In this embodiment of the invention the cephalad andcaudal sides fusion block 600 is bilaterally symmetrical, with identical right and left ends 610, 612. However, it is appreciated that in alternative embodiments, sides and ends may vary from one another and symmetry may or may not occur. - A plurality of grafting
ports 614, passing through asupport member 620, is present on thefusion block 600. In this embodiment of the invention, these graftingports 614 are configured to line up with the graftingports superior end plates fusion block 600 and theend plates fusion block 600,end plates vertebral bodies end plates fusion block 600 is at least partially packed with an osteogenic substance. In this application, “osteogenic substance” is broadly intended to include natural bone, such as autogenous bone graft or bone allograft, synthetic bone, growth factors and cytokines (including bone morphogenic proteins), and/or combinations thereof. - Referring to
FIG. 20 , an anterior side view of thefusion block 600 is shown. A plurality of graftingholes 616 is present on each side of the block, passing through thesupport member 620. As with the graftingports 614 previously described, the grafting holes 616 allow growth of bone material throughout thefusion block 600.Grooves 618 are recessed into thesupport member 620 on each outer corner of the block. Eachgroove 618 is designed to fit closely around the end of an insertion tool such that the insertion tool (not shown) may securely grip thefusion block 600 during insertion of the block. - A square
first detent 622 is located on thecephalad side 602 while a similar, squaresecond detent 624 is on thecaudal side 604. Thedetents posterior end 608. Thedetents plate engaging surfaces side first detent 622 has chamferededges 626, and thesecond detent 624 has chamferededges 628. - As depicted in
FIG. 21 , adjacent to theanterior end 608 is apocket 630, which is recessed into the first endplate engaging surface 640.Similar pockets 630 are adjacent to theright end 610 and theleft end 612. Eachpocket 630 is recessed into the first endplate engaging surface 640, and is configured to fit around theprotrusion 520 on theclip 500. Threepockets 630 are similarly located on the second endplate engaging surface 642. - Returning to
FIG. 18 , before insertion of thefusion block 600, theend plates vertebral bodies clips 500 snapped in place. Theclips 500 are used to position thefusion block 600 during the insertion process, and then hold the fusion block in place once inserted. Prior to insertion of the block, theinterior edge 514 of aclip 500 is slid under achamfered edge 626 of thefirst detent 622 on thecephalad side 602. Once the clip is in place, itsprotrusion 520 fits into the facingpocket 630 on the first endplate engaging surface 640. Similarly, theinterior edge 514 of aclip 500 is slid under the matching chamferededge 628 of thesecond detent 624 on thecaudal side 604, with that clip'sprotrusion 520 in the facingpocket 630 of the second endplate engaging surface 642. As a result, thefusion block 600 is sandwiched between twoclips 500, the clips being in matching anterior, right lateral or left lateral positions. - Referring to
FIG. 22 , thefusion block 600 is shown as is it being inserted from the anterior approach into the gap between theend plates fusion block 600 and its associatedclips 500 are held together and slid into the emptyanterior gaps end plates fusion block 600 andclips 500 are held parallel to the end plates and slid posteriorly into place such that the lateral chamferededges 626 of thefirst detent 622 engage under the chamferededges 242 of theopen pocket 234 on thesuperior end plate 200. Simultaneously, the lateral chamferededges 628 of thesecond detent 624 engage under the chamferededges 142 of theopen pocket 134 on theinferior end plate 100. - If an anterior approach is used, the
fusion block 600 andclips 500 are slid until the leading chamferededges detents walls slots fusion block 600 andclips 500 are slid until the leading chamferededges detents interior edges 514 of the oppositelateral clips 500 already in place. Thus engaged, the fusion block cannot slide in any further. As theclips 500 are slid in with thefusion block 600, the chamferededges 518 on theprongs 508 also slide under the chamferededges pockets - After the
fusion block 600 andclips 500 are fully slid in with all chamfered edges engaged, thetabs 502 are pinched individually toward the end plates following thespring bias 522 so that thetabs 502 snap into theanterior gaps lateral gaps end plates arms 504 are seated in thepockets tabs 502 are thus snapped into place, thespring bias 522 holds theclips 500 against theend plates fusion block 600 is prevented from slipping in a lateral, anterior, posterior, caudal or cephalad direction. - As with the bearings, if revision of the initial implantation of the fusion block is necessary, it can be accomplished by any of the three approaches: anterior, right lateral, or left lateral. For example, if the
fusion block 600 needs to be replaced by one of a different size or configuration, the surgery may be approached from a different direction than the initial implantation, thus avoiding disturbance of scar tissue. To remove thefusion block 600, thetabs 502 of the twoclips 500 on one approach (anterior, right or left) are pinched together. For example, if the anterior approach is used, thetab 502 of theanterior clip 500 on thecephalad side 602 is pinched toward thetab 502 of theanterior clip 500 on thecaudal side 604. The pinching action will free thetab arms 504 from thepockets protrusions 520 on theclips 500 will fit into thepockets 630 in the first and second endplate engaging surfaces end plates fusion block 600 held between them. Areplacement fusion block 600, elastic insert, orbearings clips 500 snapped in place, as described in the original insertion procedure. - The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. It is appreciated that various features of the above-described examples can be mixed and matched to form a variety of other alternatives. As such, the described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.
Claims (56)
1. An intervertebral implant comprising:
a first end plate configured to be secured to a first vertebral body; and
a first intermediate component that is slidable into engagement with the first end plate along either of at least two selections from the group consisting of a first lateral direction, a second lateral direction different from the first lateral direction, and a posterior direction.
2. The intervertebral implant of claim 1 , wherein the first intermediate component is selected from the group consisting of a first bearing surface configured to articulate with a second bearing surface to provide relative motion between the first vertebral body and a second vertebral body, an elastic insert configured to deform to provide motion between the first vertebral body and a second vertebral body, and a rigid insert configured to substantially prevent relative motion between the first vertebral body and a second vertebral body.
3. The intervertebral implant of claim 1 , wherein the first intermediate component is detachable from the first end plate to permit replacement of the first intermediate component with a second intermediate component.
4. The intervertebral implant of claim 3 , wherein the second intermediate component causes the intervertebral implant to perform a function which is different from a function performed with the first intermediate component.
5. The intervertebral implant of claim 1 , further comprising a first retention member configured to be secured to the first end plate independently of the first intermediate component to secure the first intermediate component to the first end plate.
6. The intervertebral implant of claim 5 , wherein the first retention member is configured to be inserted into engagement with the first intermediate component.
7. The intervertebral implant of claim 5 , wherein the first retention member snaps into securement with the first end plate.
8. The intervertebral implant of claim 5 , further comprising a second retention member configured to be secured to the first end plate independently of the first intermediate component and the first retention member to further secure the first intermediate component to the first end plate.
9. The intervertebral implant of claim 8 , wherein the first retention member is securable to the first end plate prior to insertion of the first intermediate component along a first direction of the two selections, and the second retention member is securable to the first end plate after the insertion of the first intermediate component, and wherein the second retention member is securable to the first end plate prior to the insertion of the first intermediate component along a second direction of the two selections, and the first retention member is securable to the first end plate after the insertion of the intermediate component.
10. The intervertebral implant of claim 1 , further comprising a second end plate configured to be secured to a second vertebral body, wherein the first intermediate component is slidable into engagement with the second end plate along either of at least two selections from the group consisting of the first lateral direction, the second lateral direction, and the posterior direction.
11. An intervertebral implant comprising:
a first end plate configured to be secured to a first vertebral body;
a first intermediate component configured to engage the first end plate to control or prevent motion of the first vertebral body relative to a second vertebral body; and
a first retention member configured to be engageable to the first end plate, wherein the first retention member is slidable into engagement with the first end plate to secure the first intermediate component to the first end plate.
12. The intervertebral implant of claim 11 , wherein the first intermediate component is selected from the group consisting of a first bearing surface configured to articulate with a second bearing surface to provide relative motion between the first vertebral body and a second vertebral body, an elastic insert configured to deform to provide motion between the first vertebral body and a second vertebral body, and a rigid insert configured to substantially prevent relative motion between the first vertebral body and a second vertebral body.
13. The intervertebral implant of claim 11 , wherein the first intermediate component is detachable from the first end plate to permit replacement of the first intermediate component with a second intermediate component.
14. The intervertebral implant of claim 13 , wherein the second intermediate component causes the intervertebral implant to perform a function which is different from a function performed with the first intermediate component.
15. The intervertebral implant of claim 11 , further comprising a second retention member configured to be secured to the first end plate independently of the first intermediate component and the first retention member to further secure the first intermediate component to the first end plate.
16. The intervertebral implant of claim 15 , wherein the first and second retention members are independently slidable into engagement with the first end plate along either of at least two selections from the group consisting of a first lateral direction, a second lateral direction different from the first lateral direction, and a posterior direction.
17. The intervertebral implant of claim 16 , wherein the first retention member is securable to the first end plate prior to insertion of the first intermediate component along a first direction of the two selections, and the second retention member is securable to the first end plate after the insertion of the first intermediate component, and wherein the second retention member is securable to the first end plate prior to the insertion of the first intermediate component along a second direction of the two selections, and the first retention member is securable to the first end plate after the insertion of the intermediate component.
18. The intervertebral implant of claim 11 , wherein the first retention member is configured to be inserted into engagement with the first intermediate component.
19. The intervertebral implant of claim 11 , wherein the first retention member snaps into securement with the first end plate.
20. The intervertebral implant of claim 11 , further comprising a second end plate configured to be secured to a second vertebral body, wherein the first intermediate component is slidable into engagement with the second end plate along either of at least two selections from the group consisting of a first lateral direction, a second lateral direction different from the first lateral direction, and a posterior direction.
21. An intervertebral implant comprising:
a first end plate configured to be secured to a first vertebral body;
a first intermediate component configured to engage the first end plate to control or prevent motion of the first vertebral body relative to a second vertebral body; and
at least two retention members that are activatable independently of each other to secure the first intermediate component to the first end plate.
22. The intervertebral implant of claim 21 , wherein the first intermediate component is selected from the group consisting of a first bearing surface configured to articulate with a second bearing surface to provide relative motion between the first vertebral body and a second vertebral body, an elastic insert configured to deform to provide motion between the first vertebral body and a second vertebral body, and a rigid insert configured to substantially prevent relative motion between the first vertebral body and a second vertebral body.
23. The intervertebral implant of claim 21 , wherein the first intermediate component is detachable from the first end plate to permit replacement of the first intermediate component with a second intermediate component.
24. The intervertebral implant of claim 23 , wherein the second intermediate component causes the intervertebral implant to perform a function which is different from a function performed with the first intermediate component.
25. The intervertebral implant of claim 21 , wherein the first intermediate component is slidable into engagement with the first end plate.
26. The intervertebral implant of claim 21 , wherein each of the retention members is slidable into engagement with the first end plate along either of at least two selections from the group consisting of a first lateral direction, a second lateral direction different from the first lateral direction, and a posterior direction.
27. The intervertebral implant of claim 21 , further comprising a third retention member that is independently activatable to secure the first intermediate component to the first end plate.
28. The intervertebral implant of claim 21 , wherein each retention member has an engaged position and a free position relative to the first end plate, and wherein each retention member snaps into engagement in response to motion from the free position to the engaged position.
29. A method for implanting an intervertebral implant, the method comprising:
securing a first end plate to a first vertebral body; and
sliding a first intermediate component into engagement with the first end plate along either of at least two selections from the group consisting of a first lateral direction, a second lateral direction different from the first lateral direction, and a posterior direction.
30. The method of claim 29 , further comprising selecting the first intermediate component from the group consisting of a first bearing surface configured to articulate with a second bearing surface to provide relative motion between the first vertebral body and a second vertebral body, an elastic insert configured to deform to provide motion between the first vertebral body and a second vertebral body, and a rigid insert configured to substantially prevent relative motion between the first vertebral body and a second vertebral body.
31. The method of claim 30 , wherein the first intermediate component is replaceable, wherein replacing the first intermediate component comprises detaching the first intermediate component from the first end plate and engaging a second intermediate component with the first end plate.
32. The method of claim 31 , wherein engaging the second intermediate component causes the intervertebral implant to perform a function which is different than the function performed with the first intermediate component.
33. The method of claim 29 , further comprising securing at least one retention member to the first end plate independently of the first intermediate component, wherein securing the retention member secures the first intermediate component to the first end plate.
34. The method of claim 33 , further comprising inserting the first retention member with the first intermediate component.
35. The method of claim 33 , further comprising snapping the first retention member to the first end plate to secure the first retention member to the first end plate.
36. The method of claim 33 , further comprising securing a second retention member to the first end plate independently of the first intermediate component, wherein securing the second retention member further secures the first intermediate component to the first end plate.
37. The method of claim 36 , further comprising selecting from a group including securing the first retention member to the first end plate prior to inserting the first intermediate component along a first direction of the two selections, then securing the second retention member to the first end plate after inserting the first intermediate component, and securing the second retention member to the first end plate prior to inserting the first intermediate component along a second direction of the two selections, then securing the first retention member to the first end plate after the insertion of the first intermediate component.
38. The method of claim 29 , further comprising securing a second end plate to a second vertebral body, and sliding the first intermediate component into engagement with the second end plate along either of at least two selections from the group consisting of the first lateral direction, the second lateral direction, and the posterior direction.
39. A method for implanting an intervertebral implant, the method comprising:
securing a first end plate to a first vertebral body;
engaging a first intermediate component with the first end plate to control or prevent motion of the first vertebral body relative to a second vertebral body; and
sliding a first retention member into engagement with the first end plate to secure the first intermediate component to the first end plate.
40. The method of claim 39 , further comprising selecting the first intermediate component from the group consisting of a first bearing surface configured to articulate with a second bearing surface to provide relative motion between the first vertebral body and the second vertebral body, an elastic insert configured to deform to provide motion between the first vertebral body and the second vertebral body, and a rigid insert configured to substantially prevent relative motion between the first vertebral body and the second vertebral body.
41. The method of claim 39 , wherein the first intermediate component is replaceable, wherein replacing the first intermediate component comprises detaching the first intermediate component from the first end plate and engaging a second intermediate component with the first end plate.
42. The method of claim 41 , wherein engaging the second intermediate component causes the intervertebral implant to perform a function which is different than the function performed with the first intermediate component.
43. The method of claim 39 , further comprising securing a second retention member to the first end plate independently of the first intermediate component and the first retention member, to further secure the first intermediate component to the first end plate.
44. The method of claim 43 , further comprising sliding the first and second retention members independently into engagement with the first end plate along either of at least two selections from the group consisting of a first lateral direction, a second lateral direction different from the first lateral direction, and a posterior direction.
45. The method of claim 44 , further comprising selecting from a group including securing the first retention member to the first end plate prior to inserting the first intermediate component along a first direction of the two selections, then securing the second retention member to the first end plate after inserting the first intermediate component, and securing the second retention member to the first end plate prior to inserting the first intermediate component along a second direction of the two selections, then securing the first retention member to the first end plate after the insertion of the first intermediate component.
46. The method of claim 39 , further comprising inserting the first retention member with the first intermediate component.
47. The method of claim 39 , further comprising snapping the first retention member to the first end plate to secure the first retention member to the first end plate.
48. The method of claim 39 , further comprising securing a second end plate to the second vertebral body, and sliding the first intermediate component into engagement with the second end plate along either of at least two selections from the group consisting of a first lateral direction, a second lateral direction different from the first lateral direction, and a posterior direction.
49. A method for implanting a device within an intervertebral space, the method comprising:
securing a first end plate to a first vertebral body;
engaging a first intermediate component with the first end plate to control or prevent motion of the first vertebral body relative to a second vertebral body; and
activating at least two retention members independently of each other to secure the first intermediate component to the first end plate.
50. The method of claim 49 , further comprising selecting the first intermediate component from the group consisting of a first bearing surface configured to articulate with a second bearing surface to provide relative motion between the first vertebral body and the second vertebral body, an elastic insert configured to deform to provide motion between the first vertebral body and the second vertebral body, and a rigid insert configured to substantially prevent relative motion between the first vertebral body and the second vertebral body.
51. The method of claim 49 , wherein the first intermediate component is replaceable, wherein replacing the first intermediate component comprises detaching the first intermediate component from the first end plate and engaging a second intermediate component with the first end plate.
52. The method of claim 51 , wherein engaging the second intermediate component causes the intervertebral implant to perform a function which is different than the function performed with the first intermediate component.
53. The method of claim 49 , further comprising sliding the first intermediate component into engagement with the first end plate.
54. The method of claim 49 , further comprising sliding each of the retention members into engagement with the first end plate along either of at least two selections from the group consisting of a first lateral direction, a second lateral direction different from the first lateral direction, and a posterior direction.
55. The method of claim 49 , further comprising independently activating a third retention member to further secure the first intermediate component to the first end plate.
56. The method of claim 49 , further comprising snapping each retention member in response to motion from a free position to an engaged position relative to the first end plate.
Priority Applications (9)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11/535,033 US8435295B2 (en) | 2005-09-26 | 2006-09-25 | System and method for intervertebral implant delivery and removal |
US11/534,946 US20070093900A1 (en) | 2005-09-26 | 2006-09-25 | Modular articulating and fusion spinal disc implant system |
US11/534,985 US7618459B2 (en) | 2005-09-26 | 2006-09-25 | Universal spinal disc implant system |
EP06815587A EP1928364A4 (en) | 2005-09-26 | 2006-09-26 | Modular intervertebral implant and instrumentation |
AU2006294725A AU2006294725A1 (en) | 2005-09-26 | 2006-09-26 | Modular intervertebral implant and instrumentation |
PCT/US2006/037695 WO2007038611A2 (en) | 2005-09-26 | 2006-09-26 | Modular intervertebral implant and instrumentation |
JP2008533570A JP2009509662A (en) | 2005-09-26 | 2006-09-26 | Modular intervertebral implants and instruments |
US12/615,989 US20100057205A1 (en) | 2005-09-26 | 2009-11-10 | Universal Spinal Disc Implant System |
US13/855,164 US20130231748A1 (en) | 2005-09-26 | 2013-04-02 | System and method for intervertebral implant delivery and removal |
Applications Claiming Priority (6)
Application Number | Priority Date | Filing Date | Title |
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US72051405P | 2005-09-26 | 2005-09-26 | |
US72051305P | 2005-09-26 | 2005-09-26 | |
US74151305P | 2005-11-30 | 2005-11-30 | |
US11/535,033 US8435295B2 (en) | 2005-09-26 | 2006-09-25 | System and method for intervertebral implant delivery and removal |
US11/534,946 US20070093900A1 (en) | 2005-09-26 | 2006-09-25 | Modular articulating and fusion spinal disc implant system |
US11/534,985 US7618459B2 (en) | 2005-09-26 | 2006-09-25 | Universal spinal disc implant system |
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US12/615,989 Abandoned US20100057205A1 (en) | 2005-09-26 | 2009-11-10 | Universal Spinal Disc Implant System |
US13/855,164 Abandoned US20130231748A1 (en) | 2005-09-26 | 2013-04-02 | System and method for intervertebral implant delivery and removal |
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US13/855,164 Abandoned US20130231748A1 (en) | 2005-09-26 | 2013-04-02 | System and method for intervertebral implant delivery and removal |
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Also Published As
Publication number | Publication date |
---|---|
US8435295B2 (en) | 2013-05-07 |
WO2007038611A2 (en) | 2007-04-05 |
WO2007038611A3 (en) | 2007-05-31 |
JP2009509662A (en) | 2009-03-12 |
US20100057205A1 (en) | 2010-03-04 |
AU2006294725A1 (en) | 2007-04-05 |
US7618459B2 (en) | 2009-11-17 |
US20070072475A1 (en) | 2007-03-29 |
US20130231748A1 (en) | 2013-09-05 |
EP1928364A4 (en) | 2011-10-12 |
US20070073311A1 (en) | 2007-03-29 |
EP1928364A2 (en) | 2008-06-11 |
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