WO2005094704A1 - Intervertebral connecting device with controlled multi-directional movements - Google Patents

Intervertebral connecting device with controlled multi-directional movements Download PDF

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Publication number
WO2005094704A1
WO2005094704A1 PCT/FR2005/000766 FR2005000766W WO2005094704A1 WO 2005094704 A1 WO2005094704 A1 WO 2005094704A1 FR 2005000766 W FR2005000766 W FR 2005000766W WO 2005094704 A1 WO2005094704 A1 WO 2005094704A1
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WO
WIPO (PCT)
Prior art keywords
osteosynthesis device
tubular element
movements
fixing
helical spring
Prior art date
Application number
PCT/FR2005/000766
Other languages
French (fr)
Inventor
Olivier Carli
Original Assignee
Scient'x
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Scient'x filed Critical Scient'x
Publication of WO2005094704A1 publication Critical patent/WO2005094704A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7014—Longitudinal elements, e.g. rods with means for adjusting the distance between two screws or hooks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7026—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form
    • A61B17/7028—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form the flexible part being a coil spring
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7007—Parts of the longitudinal elements, e.g. their ends, being specially adapted to fit around the screw or hook heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7049—Connectors, not bearing on the vertebrae, for linking longitudinal elements together
    • A61B17/705—Connectors, not bearing on the vertebrae, for linking longitudinal elements together for linking adjacent ends of longitudinal elements

Definitions

  • the present invention relates to the field of osteosynthesis devices intended in particular for the treatment of defects or pathological conditions of the spine or vertebrae.
  • the object of the invention relates more precisely to an intervertebral stabilization device making it possible to maintain in suitable relative position at least two vertebrae with a view to correcting in a patient, for example, a compacting of the vertebrae, a scoliosis, a lordosis, a kyphosis or intervertebral instability.
  • osteosynthesis devices each comprising a connection system connected on either side to fixing parts adapted to be fixed on vertebrae by the through bone anchors.
  • a first category of osteosynthesis device comprising a rigid connection system connected on either side to the fixing parts on the vertebrae.
  • a rigid stabilization device leads to a transfer of mechanical stresses on the intervertebral joints adjacent to those stabilized.
  • a second category of osteosynthesis device has been proposed, comprising an elastically deformable connection system connected on either side to the fixing parts on the vertebrae.
  • such a so-called dynamic intervertebral stabilization device comprises a deformable system which is elastically able to react to elongation and to axial compression.
  • Such a stabilization device is capable of damping the movement in compression as well as that in traction, thus allowing physiological movement of the vertebral segments.
  • the object of the invention aims to remedy the drawbacks of the state of the art, by proposing a dynamic intervertebral connection device having a reduced bulk while being capable of damping and controlling the compression-traction movements, flexion-extension and lateral inflection.
  • the object of the invention relates to an osteosynthesis device for a spinal column comprising at least one elastically deformable connection system connected on either side to at least first and second fixing parts.
  • the device is produced in the form of a tubular element in which the elastically deformable connection system is produced by a helical spring having a determined stiffness to exert a restoring force for flexion-extension movements, traction-compression and lateral inflection of the fixing parts.
  • the osteosynthesis device according to the invention thus presents a reduced bulk and a simple design while offering a multidirectional clearance compatible with the movements of the instrumented vertebrae.
  • the tubular element comprises two deformable connection systems elastically arranged on two localized zones which on the one hand, are connected to each other by a junction zone and, on the other hand are each extended by a terminal zone of fixation.
  • each elastically deformable connection system is produced by at least one cut in the form of a helix arranged in the tubular element in order to produce the helical spring.
  • the helical spring is produced by at least one helical cutout forming at least one turn of parallelepipedal cross section.
  • the osteosynthesis device according to the invention comprises means for limiting the flexion-extension, traction-compression and lateral inflection movements between the fixing parts, mounted inside the spring and being supported by at least one fixing part.
  • the movement limitation means comprise means for adjusting the limits of the flexion-extension, traction-compression and lateral inflection movements.
  • the movement limitation means are produced by a tail extending axially with a clearance inside the helical spring.
  • the tail is mounted axially movable inside the helical spring in order to allow the limits of the movements of the fixing parts to be adjusted.
  • the tail is part of a finger mounted from the free end of the tubular element.
  • a finger is mounted from each free end of the tubular element.
  • a finger is formed by a shouldered head resting on a free end of the tubular element, this shouldered head being connected to the tail by a junction body extending inside the tubular element, at the more along the length of the terminal attachment zone.
  • the tail extends with play inside the tubular element over at least the entire length of the localized zone forming a helical spring.
  • the shouldered head is provided with a chamfer for connection with the tubular element.
  • the helical spring is extended on both sides by a rod connected to a fixing part.
  • FIG. 1 is a perspective view of a first embodiment of an osteosynthesis device according to the invention.
  • Figure 2 is a sectional elevation view of an osteosynthesis device as illustrated in FIG. 1.
  • Figure 3 is an elevational sectional view showing an alternative embodiment of an osteosynthesis device according to the invention.
  • Figure 4 is a perspective view illustrating another embodiment of an osteosynthesis device according to the invention.
  • Figure 5 is an external view of another embodiment of an osteosynthesis device according to the invention.
  • FIG. 6 is a view in longitudinal section taken substantially according to the NI-NI of FIG. 5.
  • the subject of the invention relates to an osteosynthesis device 1 for the spine comprising at least one elastically deformable connection system 2 connected on either side to at least one first fixing part 3 and to a second fixing part 4.
  • the elastically deformable connection system 2 is produced by a helical spring having a determined stiffness to exert a restoring force to allow multidirectional movements of the fixing parts 3, 4.
  • the movements of the fixing parts 3 and 4 can be decomposed in an elementary manner so that the helical spring 2 has a determined stiffness to exert a restoring force for movements of flexion-extension, traction-compression and lateral inflection of the fixing parts 3 and 4.
  • the movements of the spine imposed on the device correspond to the one or more of these so-called elementary movements combined or not.
  • the helical spring 2 is produced by a tubular element 7 in which is arranged at least one notch or cutout 9 in the form of a helix.
  • the tubular element has a helical cutout 9 making it possible to form at least one turn 10 of parallelepipedal cross section.
  • the osteosynthesis device 1 comprises means 12 for limiting the flexion-extension, traction-compression and lateral inflection movements between the fixing parts 3 and 4.
  • These limitation means 12 are supported by at least one fixing part 3, 4.
  • Such limiting means 12 make it possible to control the amplitude of the movements capable of being carried out in traction-compression, in flexion-extension or according to a lateral inflection.
  • the movement limitation means 12 are produced by a rod, a keel or a tail 13 extending axially with a clearance, inside the helical spring 2, being connected for example to the part of the fixing 4.
  • the dimensioning of this tail 13 makes it possible to control the movements between the fixing parts 3 and 4 insofar as the free fixing part 3 relative to the tail 13 comes into abutment on the tail 13.
  • the diameter of the tail 13 and its length of introduction inside the spring makes it possible to limit the movements of the fixing parts 3, 4 and in particular the movements of flexion-extension and lateral inflection.
  • the means for limiting the movements 12 comprise means making it possible to adjust the limits of the movements of flexion-extension, traction-compression and lateral inflection.
  • the tail 13 is mounted movable axially inside the helical spring 2 in order to allow the limits of movement of the fixing parts 3 and 4 to be adjusted.
  • the tail 13 is mounted on a end part according to a screw-nut type connection, accessible from the end of the fixing part in order to allow adjustment of the movements.
  • the tubular element 7, in which the helical spring 2 is arranged can be extended on either side, by a rod 20 each connected to a fixing part 3, 4.
  • Such a helical spring 2 thus constitutes a modular element which can be easily adapted on an osteosynthesis rod or even several osteosynthesis rods.
  • FIGS. 5 and 6 illustrate an exemplary embodiment of an osteosynthesis device 1 comprising two elastically deformable connection systems 2 in accordance with the preceding description.
  • the osteosynthesis device 1 is in the form of a tubular element 7 ′ which is in the form of a tube, for example of circular cross section with an internal bore 1 ⁇ .
  • the tubular element 7 ′ is provided with two connection systems or spring 2 each extending over a localized area B of the tubular element 7 ′, taking into account the longitudinal axis of said element.
  • the localized zones B of the tubular element 7 ′ are connected to each other by a junction zone J.
  • Each localized zone B provided with the spring 2 extends to the neighboring free end of the tubular element 7 ′, by a terminal zone T constituting a fixing part 3 or 4.
  • the terminal zones T and the junction zone J have substantially identical lengths.
  • the osteosynthesis device 1 also comprises means for limiting the movements 12 constituted by a limiting finger associated with at least one and in the example illustrated, with each elastically deformable connection system 2.
  • each finger 12 is mounted from the free end of the tubular element 7 '.
  • Each finger has a shoulder head 131 bearing on a free end of the tubular element 7 'and has an external diameter substantially equal to the external diameter of the tubular element 7', so as to extend in the extension of the 'tubular element 7'.
  • the shouldered head 13 ⁇ is provided with a chamfer 13 2 for connection with the tubular element 7 '.
  • the shouldered head 13 ⁇ is fixed in any suitable manner and for example by welding on the free end of the tubular element 7 '.
  • the shouldered head 13 ⁇ is connected to the tail 13 'by a junction body 13 3 extending in contact with the bore 7 ⁇ over a length corresponding at most to the terminal fixing zone T.
  • the tail 13' thus extends with a play, inside the bore 7 ⁇ of the tubular element 7 'over a length at least equal to the length of the localized zone B forming the helical spring 2.
  • the shank 13 ′ extends over the entire length of the localized zone B, projecting on either side of the latter, and having a diameter less than the diameter of the bore 1 ⁇ of the spring 2.
  • the finger 12 as described in relation to FIGS. 5 and 6 can be fitted to an osteosynthesis device comprising a single elastically deformable connection system 2. It appears from the foregoing description that the osteosynthesis device according to the invention has a reduced bulk since it fits directly into the form of an osteosynthesis connecting rod. In addition, such an elastically deformable connection system 2 has a simple manufacture while offering freedom of multidirectional movements.
  • the invention is not limited to the examples described and shown since various modifications can be made without departing from its scope.

Abstract

The invention relates to an osteosynthesis device for the vertebral column, comprising at least one elastically-deformable connecting system (2) which is connected on either side to at least first (3) and second (4) fixing parts which are designed to be fixed to the vertebrae by means of bone-anchoring elements. According to the invention, the device takes the form of a tubular element (7, 7') in which the elastically-deformable connecting system (2) is provided by a helical spring having a determined stiffness in order to exert a return force for movements involving flexion/extension, traction/compression and lateral bending of the fixing parts.

Description

DISPOSITIF DE LIAISON INTERVERTEBRALE A MOUVEMENTS MULTIDIRECTIONNELS CONTROLES La présente invention concerne le domaine des dispositifs d'ostéosyn thèse destinés notamment au traitement de défauts ou d'états pathologiques de la colonne vertébrale ou des vertèbres. L'objet de l'invention concerne plus précisément un dispositif de stabilisation intervertébrale permettant de maintenir en position relative convenable au moins deux vertèbres en vue de corriger chez un patient par exemple, un tassement des vertèbres, une scoliose, une lordose, une cyphose ou une instabilité intervertébrale. Dans le domaine d'application de l'ostéosynthèse du rachis, il existe de nombreux dispositifs d'ostéosynthèse comportant chacun un système de liaison relié de part et d'autre, à des parties de fixation adaptées pour être fixées sur des vertèbres par l'intermédiaire d'éléments d'ancrage osseux. Il est connu une première catégorie de dispositif d'ostéosynthèse comportant un système de liaison rigide relié de part et d'autre, aux parties de fixation sur les vertèbres. Un tel dispositif rigide de stabilisation conduit à un report des contraintes mécaniques sur les articulations intervertébrales adjacentes à celles stabilisées. Pour remédier à ce problème, il a été proposé une deuxième catégorie de dispositif d'ostéosynthèse comportant un système de liaison déformable élastiquement relié de part et d'autre, aux parties de fixation sur les vertèbres. D'une manière générale, un tel dispositif de stabilisation intervertébrale dit dynamique comporte un système déformable élastiquement propre à réagir à un allongement et à une compression axiale. Un tel dispositif de stabilisation est capable d'amortir le mouvement en compression comme celui en traction autorisant ainsi un mouvement physiologique des segments vertébraux. Certains dispositifs connus sont adaptés également pour amortir les mouvements en flexion-extension dans le plan antéro- postérieur et les mouvements en flexion latérale. Il apparaît toutefois que les solutions antérieures connues ne permettent pas un débattement multidirectionnel et présente un encombrement relativement important conduisant en particulier à une difficulté pour placer un tel dispositif dans une position non contrainte. L'objet de l'invention vise donc à remédier aux inconvénients de l'état de la technique, en proposant un dispositif dynamique de liaison intervertébrale présentant un encombrement réduit tout en étant capable d'amortir et de contrôler les mouvements de compression-traction, de flexion-extension et d'inflexion latérale. Pour atteindre un tel objectif, l'objet de l'invention concerne un dispositif d'ostéosynthèse pour colonne vertébrale comportant au moins un système de liaison déformable élastiquement relié de part et d'autre, à au moins une première et une deuxième parties de fixation adaptées pour être fixées sur des vertèbres par l'intermédiaire d'éléments d'ancrage osseux. Conformément à l'invention, le dispositif est réalisé sous la forme d'un élément tubulaire dans lequel le système de liaison déformable élastiquement est réalisé par un ressort hélicoïdal présentant une raideur déterminée pour exercer un effort de rappel pour des mouvements de flexion- extension, de traction-compression et d'inflexion latérale des parties de fixation. Le dispositif d'ostéosynthèse selon l'invention présente ainsi un encombrement réduit et une conception simple tout en offrant un débattement multidirectionnel compatible avec les mouvements des vertèbres instrumentés. Selon une variante de réalisation, l'élément tubulaire comporte deux systèmes de liaison déformable élastiquement aménagés sur deux zones localisées qui d'une part, sont reliées entre elles par une zone de jonction et, d'autre part sont prolongées chacune par une zone terminale de fixation. De préférence, les zones terminales et de jonction possèdent des longueurs sensiblement identiques. Selon une caractéristique avantageuse de réalisation, chaque système de liaison déformable élastiquement est réalisé par au moins une découpe en forme d'hélice aménagée dans l'élément tubulaire afin de réaliser le ressort hélicoïdal. De préférence, le ressort hélicoïdal est réalisé par au moins une découpe en forme d'hélice formant au moins une spire de section droite transversale parallélépipédique. Selon une variante préférée de réalisation, le dispositif d'ostéosynthèse selon l'invention comporte des moyens de limitation des mouvements de flexion- extension, de traction-compression et d'inflexion latérale entre les parties de fixation, montés à l'intérieur du ressort et en étant supportés par au moins une partie de fixation. De préférence, les moyens de limitation des mouvements comportent des moyens de réglage des limites des mouvements de flexion-extension, de traction- compression et d'inflexion latérale. Par exemple, les moyens de limitation de mouvements sont réalisés par une queue s'étendant axialement avec un jeu à l'intérieur du ressort hélicoïdal. Avantageusement, la queue est montée mobile axialement à l'intérieur du ressort hélicoïdal afin de permettre de régler les limites des mouvements des parties de fixation. Selon un autre exemple de réalisation, la queue fait partie d'un doigt monté à partir de l'extrémité libre de l'élément tubulaire. Avantageusement, un doigt est monté à partir de chaque extrémité libre de l'élément tubulaire. De préférence, un doigt est formé par une tête épaulée en appui sur une extrémité libre de l'élément tubulaire, cette tête épaulée étant raccordée à la queue par un corps de jonction s'étendant à l'intérieur de l'élément tubulaire, au plus sur la longueur de la zone terminale de fixation. Par exemple, la queue s'étend avec jeu à l'intérieur de l'élément tubulaire sur au moins toute la longueur de la zone localisée formant ressort hélicoïdal. Avantageusement, la tête épaulée est pourvue d'un chanfrein de raccordement avec l'élément tubulaire. Selon une autre variante de réalisation, le ressort hélicoïdal est prolongé de part et d'autre par une tige reliée à une partie de fixation. Diverses autres caractéristiques ressortent de la description faite ci-dessous en référence aux dessins annexés qui montrent, à titre d'exemples non limitatifs, des formes de réalisation de l'objet de l'invention. La Figure 1 est une vue en perspective d'un premier exemple de réalisation d'un dispositif d'ostéosynthèse conforme à l'invention. La Figure 2 est une vue en coupe-élévation d'un dispositif d'ostéosynthèse tel qu'illustré à la Fig. 1. La Figure 3 est une vue en coupe élévation montrant une variante de réalisation d'un dispositif d'ostéosynthèse conforme à l'invention. La Figure 4 est une vue en perspective illustrant un autre exemple de réalisation d'un dispositif d'ostéosynthèse conforme à l'invention. La Figure 5 est une vue externe d'un autre exemple de réalisation d'un dispositif d'ostéosynthèse conforme à l'invention. La Figure 6 est une vue en coupe longitudinale prise sensiblement selon les NI-NI de la Fig. 5. Tel que cela ressort plus précisément des Fig. 1 et 2, l'objet de l'invention concerne un dispositif d'ostéosynthèse 1 pour la colonne vertébrale comportant au moins un système de liaison déformable élastiquement 2 relié de part et d'autre, à au moins une première partie de fixation 3 et à une deuxième partie de fixation 4. Ces parties de fixation 3 et 4 sont adaptées pour être fixées sur des vertèbres par l'intermédiaire d'éléments d'ancrage osseux de tout type tels que par exemple des vis pédiculaires ou des crochets. Conformément à l'invention, le système de liaison déformable élastiquement 2 est réalisé par un ressort hélicoïdal présentant une raideur déterminée pour exercer un effort de rappel pour autoriser des mouvements multidirectionnels des parties de fixation 3, 4. Les mouvements des parties de fixation 3 et 4 peuvent être décomposés de façon élémentaire de sorte que le ressort hélicoïdal 2 présente une raideur déterminée pour exercer un effort de rappel pour des mouvements de flexion- extension, de traction-compression et d'inflexion latérale des parties de fixation 3 et 4. Bien entendu après implantation du dispositif d'ostéosynthèse 1 selon invention, les mouvements du rachis imposé au dispositif correspondent à la ou à plusieurs de ces mouvements dits élémentaires combinés ou non entre eux. Selon une variante préférée de réalisation, le ressort hélicoïdal 2 est réalisé par un élément tubulaire 7 dans lequel est aménagé au moins une entaille ou découpe 9 en forme d'hélice. Dans l'exemple illustré à la figure 2, l'élément tubulaire présente une découpe hélicoïdale 9 permettant de former au moins une spire 10 de section droite transversale parallélépipédique. Bien entendu, il peut être envisagé de réaliser une ou plusieurs découpes ou entailles 9 en forme de secteur d'hélice de longueur adaptée à la raideur souhaitée. Selon une variante préférée de réalisation, le dispositif d'ostéosynthèse 1 comporte des moyens 12 de limitation des mouvements de flexion-extension, de traction-compression et d'inflexion latérale entre les parties de fixation 3 et 4. Ces moyens de limitation 12 sont supportés par au moins une partie de fixation 3, 4. De tels moyens de limitation 12 permettent de contrôler l'amplitude des mouvements susceptibles d'être réalisés en traction-compression, en flexion-extension ou selon une inflexion latérale. Dans un exemple préféré de réalisation illustré plus particulièrement à la Fig. 3, les moyens de limitation des mouvements 12 sont réalisés par une tige, une quille ou une queue 13 s'étendant axialement avec un jeu, à l'intérieur du ressort hélicoïdal 2 en étant reliée par exemple à la partie de la fixation 4. Il doit être compris que le dimensionnement de cette queue 13 permet de contrôler les mouvements entre les parties de fixation 3 et 4 dans la mesure où la partie de fixation 3 libre par rapport à la queue 13 vient en butée sur la queue 13. Ainsi, le diamètre de la queue 13 et sa longueur d'introduction à l'intérieur du ressort permet de limiter les mouvements des parties de fixation 3, 4 et notamment les mouvements de flexion-extension et d'inflexion latérale. Selon une caractéristique avantageuse de réalisation, les moyens de limitation des mouvements 12 comportent des moyens permettant de régler les limites des mouvements de flexion-extension, de traction-compression et d'inflexion latérale. Selon une variante préférée de réalisation, la queue 13 est montée mobile axialement à l'intérieur du ressort hélicoïdal 2 afin de permettre de régler les limites des mouvements des parties de fixation 3 et 4. Selon cet exemple, la queue 13 est montée sur une partie d'extrémité selon une liaison du type vis-écrou, accessible à partir de l'extrémité de la partie de fixation afin de permettre un réglage des mouvements. Selon une caractéristique de réalisation, l'élément tubulaire 7, dans lequel est aménagé le ressort hélicoïdal 2, peut être prolongé de part et d'autre, par une tige 20 reliée chacune à une partie de fixation 3, 4. Un tel ressort hélicoïdal 2 constitue ainsi un élément modulaire pouvant être adapté facilement sur une tige d'ostéosynthèse voire plusieurs tiges d'ostéosynthèse. De même, il peut être prévu d'équiper comme cela ressort de la figure 4, un système d'ostéosynthèse 1 de plusieurs systèmes de liaison déformable 2. Les Fig. 5 et 6 illustrent un exemple de réalisation d'un dispositif d'ostéosynthèse 1 comportant deux systèmes de liaison déformable élastiquement 2 conformes à la description qui précède. Selon cet exemple de réalisation, le dispositif d'ostéosynthèse 1 se présente sous la forme d'un élément tubulaire 7' se présentant sous la forme d'un tube, par exemple de section droite transversale circulaire avec un alésage interne 1\. Dans l'exemple illustré, l'élément tubulaire 7' est pourvu de deux systèmes de liaison ou ressort 2 s'étendant chacun sur une zone localisée B de l'élément tubulaire 7', prise en considération de l'axe longitudinal dudit élément. Les zones localisées B de l'élément tubulaire 7' sont reliées entre elles par une zone de jonction J. Chaque zone localisée B pourvue du ressort 2 se prolonge jusqu'à l'extrémité libre voisine de l'élément tubulaire 7', par une zone terminale T constituant une partie de fixation 3 ou 4. Selon une caractéristique préférée de réalisation, les zones terminales T et la zone de jonction J possèdent des longueurs sensiblement identiques. Avantageusement, le dispositif d'ostéosynthèse 1 comporte également des moyens de limitation des mouvements 12 constitués par un doigt de limitation associé à au moins un et dans l'exemple illustré, à chaque système de liaison déformable élastiquement 2. Tel que cela ressort plus précisément de la Fig. 6, chaque doigt 12 est monté à partir de l'extrémité libre de l'élément tubulaire 7'. Chaque doigt comporte une tête épaulée 131 en appui sur une extrémité libre de l'élément tubulaire 7' et présente un diamètre externe sensiblement égal au diamètre externe de l'élément tubulaire 7', de manière à venir s'étendre dans le prolongement de l'élément tubulaire 7'. De préférence, la tête épaulée 13ι est pourvue d'un chanfrein 132 de raccordement avec l'élément tubulaire 7'. La tête épaulée 13τ est fixée de toute manière appropriée et par exemple par soudure sur l'extrémité libre de l'élément tubulaire 7'. La tête épaulée 13ι est raccordée à la queue 13' par un corps de jonction 133 s'étendant en contact avec l'alésage 7ι sur une longueur correspondant au plus à la zone terminale de fixation T. La queue 13' s'étend ainsi avec un jeu, à l'intérieur de l'alésage 7ι de l'élément tubulaire 7' sur une longueur au moins égale à la longueur de la zone localisée B formant le ressort hélicoïdal 2. En effet et tel que cela ressort clairement de la Fig. 6, la queue 13' s'étend sur toute la longueur de la zone localisée B en dépassant de part et d'autre de cette dernière, et en présentant un diamètre inférieur au diamètre de l'alésage 1\ du ressort 2. Bien entendu, le doigt 12 tel que décrit en relation des Fig. 5 et 6 peut équiper un dispositif d'ostéosynthèse comportant un unique système de liaison déformable élastiquement 2. Il ressort de la description qui précède que le dispositif d'ostéosynthèse selon invention présente un encombrement réduit dans la mesure où il s'inscrit directement dans la forme d'une tige de liaison d'ostéosynthèse. De plus un tel système de liaison déformable élastiquement 2 présente une fabrication simple tout en offrant une liberté de mouvements multidirectionnels. L'invention n'est pas limitée aux exemples décrits et représentés car diverses modifications peuvent y être apportées sans sortir de son cadre. The present invention relates to the field of osteosynthesis devices intended in particular for the treatment of defects or pathological conditions of the spine or vertebrae. The object of the invention relates more precisely to an intervertebral stabilization device making it possible to maintain in suitable relative position at least two vertebrae with a view to correcting in a patient, for example, a compacting of the vertebrae, a scoliosis, a lordosis, a kyphosis or intervertebral instability. In the field of application of osteosynthesis of the spine, there are numerous osteosynthesis devices each comprising a connection system connected on either side to fixing parts adapted to be fixed on vertebrae by the through bone anchors. A first category of osteosynthesis device is known, comprising a rigid connection system connected on either side to the fixing parts on the vertebrae. Such a rigid stabilization device leads to a transfer of mechanical stresses on the intervertebral joints adjacent to those stabilized. To remedy this problem, a second category of osteosynthesis device has been proposed, comprising an elastically deformable connection system connected on either side to the fixing parts on the vertebrae. In general, such a so-called dynamic intervertebral stabilization device comprises a deformable system which is elastically able to react to elongation and to axial compression. Such a stabilization device is capable of damping the movement in compression as well as that in traction, thus allowing physiological movement of the vertebral segments. Certain known devices are also suitable for damping movements in flexion-extension in the anteroposterior plane and movements in lateral flexion. However, it appears that the known prior solutions do not allow multidirectional travel and has a relatively large size, leading in particular to a difficulty in placing such a device in an unconstrained position. The object of the invention therefore aims to remedy the drawbacks of the state of the art, by proposing a dynamic intervertebral connection device having a reduced bulk while being capable of damping and controlling the compression-traction movements, flexion-extension and lateral inflection. To achieve such an objective, the object of the invention relates to an osteosynthesis device for a spinal column comprising at least one elastically deformable connection system connected on either side to at least first and second fixing parts. adapted to be fixed on vertebrae by means of bone anchoring elements. In accordance with the invention, the device is produced in the form of a tubular element in which the elastically deformable connection system is produced by a helical spring having a determined stiffness to exert a restoring force for flexion-extension movements, traction-compression and lateral inflection of the fixing parts. The osteosynthesis device according to the invention thus presents a reduced bulk and a simple design while offering a multidirectional clearance compatible with the movements of the instrumented vertebrae. According to an alternative embodiment, the tubular element comprises two deformable connection systems elastically arranged on two localized zones which on the one hand, are connected to each other by a junction zone and, on the other hand are each extended by a terminal zone of fixation. Preferably, the terminal and junction zones have substantially identical lengths. According to an advantageous characteristic of embodiment, each elastically deformable connection system is produced by at least one cut in the form of a helix arranged in the tubular element in order to produce the helical spring. Preferably, the helical spring is produced by at least one helical cutout forming at least one turn of parallelepipedal cross section. According to a preferred variant embodiment, the osteosynthesis device according to the invention comprises means for limiting the flexion-extension, traction-compression and lateral inflection movements between the fixing parts, mounted inside the spring and being supported by at least one fixing part. Preferably, the movement limitation means comprise means for adjusting the limits of the flexion-extension, traction-compression and lateral inflection movements. For example, the movement limitation means are produced by a tail extending axially with a clearance inside the helical spring. Advantageously, the tail is mounted axially movable inside the helical spring in order to allow the limits of the movements of the fixing parts to be adjusted. According to another exemplary embodiment, the tail is part of a finger mounted from the free end of the tubular element. Advantageously, a finger is mounted from each free end of the tubular element. Preferably, a finger is formed by a shouldered head resting on a free end of the tubular element, this shouldered head being connected to the tail by a junction body extending inside the tubular element, at the more along the length of the terminal attachment zone. For example, the tail extends with play inside the tubular element over at least the entire length of the localized zone forming a helical spring. Advantageously, the shouldered head is provided with a chamfer for connection with the tubular element. According to another alternative embodiment, the helical spring is extended on both sides by a rod connected to a fixing part. Various other characteristics will emerge from the description given below with reference to the appended drawings which show, by way of nonlimiting examples, embodiments of the subject of the invention. Figure 1 is a perspective view of a first embodiment of an osteosynthesis device according to the invention. Figure 2 is a sectional elevation view of an osteosynthesis device as illustrated in FIG. 1. Figure 3 is an elevational sectional view showing an alternative embodiment of an osteosynthesis device according to the invention. Figure 4 is a perspective view illustrating another embodiment of an osteosynthesis device according to the invention. Figure 5 is an external view of another embodiment of an osteosynthesis device according to the invention. FIG. 6 is a view in longitudinal section taken substantially according to the NI-NI of FIG. 5. As can be seen more precisely from FIGS. 1 and 2, the subject of the invention relates to an osteosynthesis device 1 for the spine comprising at least one elastically deformable connection system 2 connected on either side to at least one first fixing part 3 and to a second fixing part 4. These fixing parts 3 and 4 are adapted to be fixed on vertebrae by means of bone anchoring elements of any type such as for example pedicle screws or hooks. According to the invention, the elastically deformable connection system 2 is produced by a helical spring having a determined stiffness to exert a restoring force to allow multidirectional movements of the fixing parts 3, 4. The movements of the fixing parts 3 and 4 can be decomposed in an elementary manner so that the helical spring 2 has a determined stiffness to exert a restoring force for movements of flexion-extension, traction-compression and lateral inflection of the fixing parts 3 and 4. Good heard after implantation of the osteosynthesis device 1 according to the invention, the movements of the spine imposed on the device correspond to the one or more of these so-called elementary movements combined or not. According to a preferred alternative embodiment, the helical spring 2 is produced by a tubular element 7 in which is arranged at least one notch or cutout 9 in the form of a helix. In the example illustrated in FIG. 2, the tubular element has a helical cutout 9 making it possible to form at least one turn 10 of parallelepipedal cross section. Of course, it can be envisaged to make one or more cuts or notches 9 in the form of a helix sector of length adapted to the desired stiffness. According to a preferred alternative embodiment, the osteosynthesis device 1 comprises means 12 for limiting the flexion-extension, traction-compression and lateral inflection movements between the fixing parts 3 and 4. These limitation means 12 are supported by at least one fixing part 3, 4. Such limiting means 12 make it possible to control the amplitude of the movements capable of being carried out in traction-compression, in flexion-extension or according to a lateral inflection. In a preferred embodiment illustrated more particularly in FIG. 3, the movement limitation means 12 are produced by a rod, a keel or a tail 13 extending axially with a clearance, inside the helical spring 2, being connected for example to the part of the fixing 4. It should be understood that the dimensioning of this tail 13 makes it possible to control the movements between the fixing parts 3 and 4 insofar as the free fixing part 3 relative to the tail 13 comes into abutment on the tail 13. Thus, the diameter of the tail 13 and its length of introduction inside the spring makes it possible to limit the movements of the fixing parts 3, 4 and in particular the movements of flexion-extension and lateral inflection. According to an advantageous characteristic of embodiment, the means for limiting the movements 12 comprise means making it possible to adjust the limits of the movements of flexion-extension, traction-compression and lateral inflection. According to a preferred embodiment, the tail 13 is mounted movable axially inside the helical spring 2 in order to allow the limits of movement of the fixing parts 3 and 4 to be adjusted. According to this example, the tail 13 is mounted on a end part according to a screw-nut type connection, accessible from the end of the fixing part in order to allow adjustment of the movements. According to an embodiment characteristic, the tubular element 7, in which the helical spring 2 is arranged, can be extended on either side, by a rod 20 each connected to a fixing part 3, 4. Such a helical spring 2 thus constitutes a modular element which can be easily adapted on an osteosynthesis rod or even several osteosynthesis rods. Likewise, provision may be made to equip as This emerges from FIG. 4, an osteosynthesis system 1 of several deformable connection systems 2. FIGS. 5 and 6 illustrate an exemplary embodiment of an osteosynthesis device 1 comprising two elastically deformable connection systems 2 in accordance with the preceding description. According to this exemplary embodiment, the osteosynthesis device 1 is in the form of a tubular element 7 ′ which is in the form of a tube, for example of circular cross section with an internal bore 1 \ . In the example illustrated, the tubular element 7 ′ is provided with two connection systems or spring 2 each extending over a localized area B of the tubular element 7 ′, taking into account the longitudinal axis of said element. The localized zones B of the tubular element 7 ′ are connected to each other by a junction zone J. Each localized zone B provided with the spring 2 extends to the neighboring free end of the tubular element 7 ′, by a terminal zone T constituting a fixing part 3 or 4. According to a preferred embodiment characteristic, the terminal zones T and the junction zone J have substantially identical lengths. Advantageously, the osteosynthesis device 1 also comprises means for limiting the movements 12 constituted by a limiting finger associated with at least one and in the example illustrated, with each elastically deformable connection system 2. As can be seen more precisely of Fig. 6, each finger 12 is mounted from the free end of the tubular element 7 '. Each finger has a shoulder head 131 bearing on a free end of the tubular element 7 'and has an external diameter substantially equal to the external diameter of the tubular element 7', so as to extend in the extension of the 'tubular element 7'. Preferably, the shouldered head 13ι is provided with a chamfer 13 2 for connection with the tubular element 7 '. The shouldered head 13τ is fixed in any suitable manner and for example by welding on the free end of the tubular element 7 '. The shouldered head 13ι is connected to the tail 13 'by a junction body 13 3 extending in contact with the bore 7ι over a length corresponding at most to the terminal fixing zone T. The tail 13' thus extends with a play, inside the bore 7ι of the tubular element 7 'over a length at least equal to the length of the localized zone B forming the helical spring 2. In fact, and as is clear from FIG. 6, the shank 13 ′ extends over the entire length of the localized zone B, projecting on either side of the latter, and having a diameter less than the diameter of the bore 1 \ of the spring 2. Of course , the finger 12 as described in relation to FIGS. 5 and 6 can be fitted to an osteosynthesis device comprising a single elastically deformable connection system 2. It appears from the foregoing description that the osteosynthesis device according to the invention has a reduced bulk since it fits directly into the form of an osteosynthesis connecting rod. In addition, such an elastically deformable connection system 2 has a simple manufacture while offering freedom of multidirectional movements. The invention is not limited to the examples described and shown since various modifications can be made without departing from its scope.

Claims

REVENDICATIONS 1 - Dispositif d'ostéosynthèse pour colonne vertébrale comportant au moins un système de liaison déformable élastiquement (2) relié de part et d'autre, à au moins une première (3) et une deuxième (4) parties de fixation adaptées pour être fixées sur des vertèbres par l'intermédiaire d'éléments d'ancrage osseux, caractérisé en ce qu'il est réalisé sous la forme d'un élément tubulaire (7, 7') dans lequel le système de liaison déformable élastiquement (2) est réalisé par un ressort hélicoïdal présentant une raideur déterminée pour exercer un effort de rappel pour des mouvements de flexion-extension, de traction-compression et d'inflexion latérale des parties de fixation. 2 - Dispositif d'ostéosynthèse selon la revendication 1 , caractérisé en ce que l'élément tubulaire (7') comporte deux systèmes de liaison déformable élastiquement (2) aménagés sur deux zones localisées (B) qui d'une part, sont reliées entre elles par une zone de jonction (J) et, d'autre part sont prolongées chacune par une zone terminale de fixation (T). 3 - Dispositif d'ostéosynthèse selon la revendication 2, caractérisé en ce que les zones terminales (T) et de jonction (B) possèdent des longueurs sensiblement identiques. 4 - Dispositif d'ostéosynthèse selon la revendication 1 ou 2, caractérisé en ce que chaque système de liaison déformable élastiquement (2) est réalisé par au moins une découpe (9) en forme d'hélice aménagée dans l'élément tubulaire afin de réaliser le ressort hélicoïdal. 5 - Dispositif d'ostéosynthèse selon la revendication 4, caractérisé en ce que le ressort hélicoïdal (2) est réalisé par au moins une découpe en forme d'hélice formant au moins une spire (10) de section droite transversale parallélepipédique. 6 - Dispositif d'ostéosynthèse selon l'une des revendications 1 à 5, caractérisé en ce qu'il comporte des moyens (12) de limitation des mouvements de flexion-extension, de traction-compression et d'inflexion latérale entre les parties de fixation, montés à l'intérieur du ressort et en étant supportés par au moins une partie de fixation (3, 4). 7 - Dispositif d'ostéosynthèse selon la revendication 6, caractérisé en ce que les moyens de limitation des mouvements (12) comportent des moyens de réglage des limites des mouvements de flexion-extension, de traction-compression et d'inflexion latérale. 8 - Dispositif d'ostéosynthèse selon la revendication 6 ou 7, caractérisé en ce que les moyens de limitation de mouvements (12) sont réalisés par une queue (13, 13') s'étendant axialement avec un jeu à l'intérieur du ressort hélicoïdal (2). 9 - Dispositif d'ostéosynthèse selon les revendications 7 et 8, caractérisé en ce que la queue (13, 13') est montée mobile axialement à l'intérieur du ressort hélicoïdal (2) afin de permettre de régler les limites des mouvements des parties de fixation (3, 4). 10 - Dispositif d'ostéosynthèse selon l'une des revendications 3 à 9, caractérisé en ce que le ressort hélicoïdal (2) est prolongé de part et d'autre par une tige (20) reliée à une partie de fixation (3, 4). 11 - Dispositif d'ostéosynthèse selon les revendications 2 et 8, caractérisé en ce que la queue (13') fait partie d'un doigt monté à partir de l'extrémité libre de l'élément tubulaire (7'). 12 - Dispositif d'ostéosynthèse selon la revendication 11, caractérisé en ce qu'un doigt est monté à partir de chaque extrémité libre de l'élément tubulaire (7'). 13 - Dispositif d'ostéosynthèse selon la revendication 11 ou 12, caractérisé en ce qu'un doigt est formé par une tête épaulée (13ι) en appui sur une extrémité libre de l'élément tubulaire (7'), cette tête épaulée (13ι) étant raccordée à la queue (13') par un corps de jonction (133) s'étendant à l'intérieur de l'élément tubulaire (7'), au plus sur la longueur de la zone terminale de fixation. 14 - Dispositif d'ostéosynthèse selon la revendication 12 ou 13, caractérisé en ce que la queue (13') s'étend avec jeu à l'intérieur de l'élément tubulaire (7') sur au moins toute la longueur de la zone localisée (B) formant ressort hélicoïdal. 15 - Dispositif d'ostéosynthèse selon la revendication 13, caractérisé en ce que la tête épaulée (13ι) est pourvue d'un chanfrein (132) de raccordement avec l'élément tubulaire (7'). CLAIMS 1 - Osteosynthesis device for spine comprising at least one elastically deformable connection system (2) connected on either side, to at least a first (3) and a second (4) fixing parts adapted to be fixed on vertebrae by means of bone anchoring elements, characterized in that it is produced in the form of a tubular element (7, 7 ') in which the elastically deformable connection system (2) is produced by a helical spring having a determined stiffness to exert a restoring force for flexion-extension, traction-compression and lateral inflection movements of the fixing parts. 2 - Osteosynthesis device according to claim 1, characterized in that the tubular element (7 ') comprises two elastically deformable connection systems (2) arranged on two localized zones (B) which on the one hand, are connected between they by a junction zone (J) and, on the other hand are each extended by a terminal fixing zone (T). 3 - Osteosynthesis device according to claim 2, characterized in that the terminal (T) and junction (B) zones have substantially identical lengths. 4 - Osteosynthesis device according to claim 1 or 2, characterized in that each elastically deformable connection system (2) is produced by at least one cutout (9) in the form of a helix arranged in the tubular element in order to produce the coil spring. 5 - Osteosynthesis device according to claim 4, characterized in that the helical spring (2) is produced by at least one helical cutout forming at least one turn (10) of parallelepipedal cross section. 6 - Osteosynthesis device according to one of claims 1 to 5, characterized in that it comprises means (12) for limiting the movements of flexion-extension, traction-compression and lateral inflection between the parts of fixing, mounted inside the spring and being supported by at least one fixing part (3, 4). 7 - Osteosynthesis device according to claim 6, characterized in that the movement limitation means (12) comprise adjustment means limits of flexion-extension, traction-compression and lateral inflection movements. 8 - Osteosynthesis device according to claim 6 or 7, characterized in that the movement limitation means (12) are produced by a shank (13, 13 ') extending axially with a clearance inside the spring helical (2). 9 - Osteosynthesis device according to Claims 7 and 8, characterized in that the tail (13, 13 ') is mounted movable axially inside the helical spring (2) in order to allow the limits of the movements of the parts to be adjusted. fixing (3, 4). 10 - Osteosynthesis device according to one of claims 3 to 9, characterized in that the helical spring (2) is extended on either side by a rod (20) connected to a fixing part (3, 4 ). 11 - Osteosynthesis device according to claims 2 and 8, characterized in that the tail (13 ') is part of a finger mounted from the free end of the tubular element (7'). 12 - Osteosynthesis device according to claim 11, characterized in that a finger is mounted from each free end of the tubular element (7 '). 13 - Osteosynthesis device according to claim 11 or 12, characterized in that a finger is formed by a shouldered head (13ι) bearing on a free end of the tubular element (7 '), this shouldered head (13ι ) being connected to the tail (13 ') by a junction body (13 3 ) extending inside the tubular element (7'), at most along the length of the terminal fixing zone. 14 - Osteosynthesis device according to claim 12 or 13, characterized in that the tail (13 ') extends with play inside the tubular element (7') over at least the entire length of the zone located (B) forming a helical spring. 15 - Osteosynthesis device according to claim 13, characterized in that the shouldered head (13ι) is provided with a chamfer (13 2 ) for connection with the tubular element (7 ').
PCT/FR2005/000766 2004-03-30 2005-03-30 Intervertebral connecting device with controlled multi-directional movements WO2005094704A1 (en)

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FR2868285A1 (en) 2005-10-07
FR2868285B1 (en) 2006-11-24

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