WO2007016673A2

WO2007016673A2 - Total artificial disc

Info

Publication number: WO2007016673A2
Application number: PCT/US2006/030267
Authority: WO
Inventors: Madhavan Pisharodi
Original assignee: Perumala Corporation
Priority date: 2005-08-02
Filing date: 2006-08-02
Publication date: 2007-02-08
Also published as: US20060282165A1; WO2007016673A3; US20070043441A1; US8480742B2

Abstract

An artificial disc prosthesis (10) having load-bearing characteristics that mimic those of the normal, healthy intervertebral disc so as to provide resist flexion and axial compression of the spine in a way that preserves normal spinal function. The disc prosthesis includes three main components, a frame (12) , a cushion (14) molded over the frame, and a sac (16) containing a hydrogel for maintaining disc height that is confined within a cavity in the cushion. Disc height is changed by increasing and/or decreasing the amount of hydrogel in the sac in accordance with the particular needs of the patient into which the artificial disc is implanted. Also provided is a frame for an artificial intervertebral disc that allows the axis of rotation of the spine to shift in a manner that replicates, or mimics, the normal function of the intervertebral disc.

Description

TOTAL ARTIFICIAL DISC

The present invention relates to an artificial disc that does not include a joint or significant sliding portions but maintains spinal flexibility, and the cushioning effect of the disc, after surgical replacement of an intervertebral disc. In more detail, the present invention relates to an artificial disc for surgical replacement of an intervertebral disc that retains the properties of cushioning and resistance to flexure of the spine, as well as allowing other normal range of motions, that characterize the healthy intervertebral disc.

The injured, deformed, diseased, and/or degenerated human spine is a source of great pain in many patients, and there are many approaches to management, treatment, and/or prevention of that pain, including surgical intervention. One particularly vexing source of spinal pain and/or dysfunction is the damaged intervertebral disc. Healthy intervertebral discs are a necessity to pain-free, normal spinal function, yet disc function is all too frequently impaired by, for instance, disease or injury. The anatomy of the intervertebral disc correlates with the biomechanical function of the disc. The three major components of the disc that are responsible for the function of the disc are the nucleus pulposus, annulus fibrosus, and cartilagenous endplate. The nucleus pulposus is the centrally located, gelatinous network of fibrous strands, surrounded by a mucoprotein gel, that prevents buckling of the annulus and maintains the height of the disc (and therefore, provides the cushioning effect and resistance to spinal flexure that are so important to spinal function) through osmotic pressure differentials. The water content of the disc changes in accordance with the load on the spine, water being driven out of the pulposus under heavy load. The annulus fibrosus encapsulates the disc, resisting both tension and compression loads and bearing axial loads. The vertebral endplates are cartilagenous in nature and "sandwich" the other components of the disc, distributing load over the entire disc and providing stability during normal spinal movements. The three elements work in cooperative fashion to facilitate disc function, and impairment of any of the elements compromises the functions of the other elements.

The two main surgical treatments of the intervertebral disc include total disc and nuclear replacement, but unfortunately, both treatments represent a number of compromises that simply do not provide normal disc function. The total artificial disc prosthesis is a total prosthetic replacement of the annulus fibrosus and nucleus pulposus with an endplate that interfaces with the patient's own vertebral endplates. Capturing and securing the total disc prosthesis to the host vertebral endplates can be a challenge because of the asymmetrical and cyclic loads placed upon the spine that can place excessive stresses on both the host bone and the interface between the prosthesis and the endplates, resulting in early loss of fixation. Many presently available total disc prostheses are designed to mimic the function of normal joints, but in that aspect, they are non-physiological in the sense that the normal spine does not have actual joints or sliding functions, but does have an inherent shock absorbing function. This lack of cushioning and shock absorbing function may be the contributing factor for the settling of the prosthesis into the vertebral body. For a summary of some of the disadvantages and limitations of known disc replacements, reference may be made to CM. Bono and S.R. Garfϊn, History and Evolution of Disc Replacement, The Spine Journal, Vol. 4, pp. 145S- 150S (2004) and E.G. Santos, et al, Disc Arthroplasty: Lessons Learned from Total Joint Arthroplasty, The Spine Journal, Vol. 4, pp. 182S-189S (2004).

Nuclear replacement is intended to replace a damaged nucleus pulposus with a device for restoring disc height while maintaining the kinematics of the gel comprising the healthy, intact nucleus pulposus. Although less invasive, implant extrusion and migration of the implant are frequent complications of nuclear replacement surgery. Some of the disadvantages and limitations of known devices for disc replacement are summarized in CM. Bono and S.R. Garfin, History and Evolution of Disc Replacement, The Spine Journal, Vol. 4, pp. 145S-150S (2004) and in A.N. Sieber and J.P. Kostuik, Concepts in Nuclear Replacement, The Spine Journal, Vol. 4, pp. 322S-324S (2004).

It is, therefore, an object of the present invention to provide a total artificial intervertebral disc that overcomes the disadvantages and limitations of prior devices comprising a cushion, a frame comprised of first and second plates having the cushion positioned therebetween and a bridge connecting the plates, and ears formed on the plates for selectively affixing the frame to the adjacent vertebrae when the frame, having the cushion positioned therebetween, is inserted into the space between adjacent vertebrae. It is another object of the present invention to provide an artificial intervertebral disc comprising a frame, a cushion molded over the frame, and a screw passing through the frame and the cushion. An anchor is mounted to the screw for selectively engaging the vertebrae adjacent the intervertebral disc space when the frame, having the cushion molded thereover, is inserted into the space between the vertebrae and the screw is turned, thereby resisting anterior-posterior movement relative to the adjacent vertebrae. Another object of the present invention is to provide a total artificial disc that maintains the normal range of motion of the spine and provides a cushioning function that approximates the normal function of the intervertebral disc under compression load.

Another object of the present invention is to provide a total artificial disc that is comprised of three main components that together function to provide the cushioning provided by cooperation of the three components of the normal intervertebral disc.

Another object of the present invention is to provide an artificial disc in which the axis of rotation translates in anterior-posterior and side-to-side directions a manner approximating normal disc function.

Another object of the present invention is to provide a total artificial disc that is adapted for use in adjacent segments of the spine.

Another object of the present invention is to provide a frame for an intervertebral disc prosthesis comprised of spaced apart plates, a bridge connecting the plates, a "U"- shaped ear extending at approximately a right angle from the first plate and having a hole formed therein, and a "Y"-shaped ear extending at approximately a right angle from the second plate having holes formed in both forks of the Y-shaped ear.

Other objects, and the many advantages of the present invention, will be made clear to those skilled in the art in the following detailed description of several embodiments of the present invention and the drawings appended hereto. Those skilled in the art will recognize, however, that the embodiments of the invention described herein are only examples provided for the purpose of describing the making and using of the present invention and that they are not the only embodiments of artificial discs that are constructed in accordance with the teachings of the present invention.

The present invention addresses the above-described problems by providing an artificial intervertebral disc comprising a cushion, a frame comprised of first and second plates having the cushion positioned therebetween with a bridge connecting the plates, and ears formed on the plates for selectively affixing the frame to the adjacent vertebrae when the frame, having the cushion positioned therebetween, is inserted into the disc space.

In a second aspect, the present invention provides an artificial intervertebral disc comprising a frame having a cushion molded over the frame. A screw passes through the frame and at least a portion of the cushion. An anchor is mounted to the screw for selectively engaging the adjacent vertebrae when the frame, having the cushion molded thereover, is inserted into the space between two vertebrae and the screw is turned.

In another aspect, the present invention provides a frame for an intervertebral disc prosthesis comprised of spaced apart plates, a bridge connecting the plates, a "U"-shaped ear extending at approximately a right angle from the first plate and having a hole formed therein, and a "Y"-shaped ear extending at approximately a right angle from the second plate and having holes formed in both forks of the Y-shaped ear.

Referring now to the figures, Figure 1 shows a perspective view of one embodiment of an artificial intervertebral disc constructed in accordance with the teachings of the present invention.

Figure 2 is a side elevational view of the artificial disc of Fig. 1.

Figures 3 A and 3B are perspective and front elevational views of the frame of the artificial disc of Fig. 1 before the cushion is molded over the frame.

Figure 4 is a top plan view of an alternative embodiment of an artificial disc constructed in accordance with the teachings of the present invention.

Figure 5 shows a perspective view of a second embodiment of an artificial intervertebral disc constructed in accordance with the teachings of the present invention.

Figure 6 is a front elevational view of the artificial disc of Fig. 5.

Figure 7 is an exploded, perspective view of the artificial disc of Fig. 5 showing the manner in which the disc is assembled before implantation in the intervertebral disc space.

Figure 8 is a perspective view of a telescoping tube for bridging the two plates comprising the frame of the artificial disc of Fig. 5.

Figure 9 is an exploded, perspective view of a third embodiment of an artificial disc constructed in accordance with the teachings of the present invention showing the assembly of the disc before implantation in the intervertebral disc space. In more detail, Figs. 1 and 2 show a first artificial disc constructed in accordance with the teachings of the present invention generally at reference numeral 10. Artificial disc 10 is comprised of three components, each described in detail below, a frame 12, cushion 14 molded over frame 12, and sac 16 contained within a cavity 18 formed in cushion 14. A fourth component, comprised of screw 20 and anchor 22, is also shown in Fig. 1. Those skilled in the art will recognize from the following description that, with appropriate changes in size and configuration, the artificial disc of the present invention can also be utilized to advantage for total disc replacement in the cervical spine.

Frame 12 is better illustrated in Figs. 3 A - 3B, and by reference to those figures, it can be seen that frame 12 is comprised of two spaced apart plates 24 connected by a bridge 26. hi the embodiment shown in Figs. 1 - 4, the plates 24 are formed as arms, the bridge 26 connecting the two arms, or plates, 24 at one end. One or both of the ends 25 of the plates 24 opposite bridge 26 are provided with ears 28 having holes 30 formed therein for receiving a screw (not shown in Fig. 3) for securing frame 12 to the bodies of the vertebrae (not shown) adjacent the intervertebral disc space into which artificial disc 10 is inserted, hi the embodiment shown, both ends of plates 24 are provided with ears 28, the ear 28A on the end of one plate 24A being shaped in the form of an inverted "U," and the ear 28B on the end of plate 24B being shaped in the form of an inverted "Y" and having two holes 30 formed therein, the portion of ear 28B between the holes 30 being cutout at 32 to form the "fork" of the "Y"-shaped ear 28B. This arrangement of "U"- and "Y"-shaped ears 28A, 28B allows the use of artificial disc 10 in successive segments of the spinal column. When secured to the body of the adjacent vertebra, the "U"-shaped ear 28A of one artificial disc extends into the cutout portion 32 of the "Y"-shaped ear 28B secured to the body of that same vertebra. As best shown in Fig. 3B, the bridge 26 of frame 12 is provided with a hole 34 for a purpose to be made clear below. hi the embodiment shown in Figs. 1 - 4, frame 12 is comprised of a material that tends to return to its original shape after the frame is subjected to either a compression or tension load, hi other words, when the disc 10 is inserted into the intervertebral disc space, it is subjected to both compression and tension loads as the spine flexes and as the patient moves during his/her normal daily routine, and when subjected to compression and tension loads, the frame deforms. Under compression, the ends 25 of the plates 24 opposite bridge 26 tend to move closer to each other and when in tension, the ends 25 of the plates 24 opposite bridge 26 tend to move further apart; in other words, the plates 24 of frame 12 deviate from their original spaced apart position (in the embodiment shown, the two plates are substantially parallel, but those skilled in the art who have the benefit of this disclosure will recognize that the invention is not limited to a frame having parallel plates) when under compression or tension force. When the respective compression or tension force is relieved, the frame 12 tends to return to its original shape, i.e., the ends 25 of plates 24 opposite bridge 26 return to their original spaced relationship, and the plates assume their original, spaced apart relationship. When subjected to loads in this manner, frame 12 acts as both a "backbone" and as a spring to help both bear compression loads and relieve tension loads in a manner that mimics normal disc function. Note also that when artificial disc 10 is inserted into the intervertebral disc space, the bridge 26 of frame 12 is positioned posteriorally relative to the ends 25 of plates 24. The spring function of frame 12 is advantageous because, as the patient bends forward, the ends 25 of plates 24 opposite bridge 26 are subjected to compression loads, and the further the patient bends, the more the material comprising frame 12 tends to resist the compression load, providing the spring function discussed above. Further, biomechanical studies of normal, healthy spines have shown that the axis of rotation (the weight-bearing center of the intervertebral disc) translates anteriorally and posteriorally as the spine flexes, and the variable resistance provided by this configuration and placement of frame 12 in the intervertebral disc space helps provide this normal front-to-back shift in the axis of rotation, so that the total artificial disc of the present invention replicates that shifting in the axis of rotation. Similarly, the spring function allows the axis of rotation to shift from side-to-side. Materials characterized by a spring- like function when formed into the frame 12 include, but are not limited to stainless steel, titanium and titanium alloys, cobalt-chrome (Co-Cr) alloys, cobalt-chromium- molybdenum (Co-Cr-Mo), carbon fiber, and medical grade (inert) polymeric plastics such as polyethylene, and any other biocompatible material, all as known in the art.

As noted above, cushion 14 is molded over frame 12 (best shown in Fig. 2), and from that description of the structural relationship of frame 12 and cushion 14, it can be surmised that cushion 12 is molded from a resilient, polymeric material. Although not limited to these materials, in one embodiment, cushion 14 is molded from a biocompatible, viscoelastic polymer such as silicone, a methane such as a polycarbonate urethane, polyurethane, or any other biocompatible material. As best shown in Fig. I₅ the cushion 14 is molded in a shape that approximates the shape of the normal intervertebral disc; by reference to Fig. 2, it can be seen that the top and bottom surfaces 36 of cushion 14 are arched so that cushion 14 is thicker in the center than at its periphery. This shape of cushion 14 is referred to as being biconvex, e.g., both the top and bottom of cushion 14 are convex in both the anterior-posterior and side-to-side directions. As described below, plates 24 may also be arched and cushion 14 formed in substantially rectangular shape to achieve this same result of approximating the shape of the intervertebral disc space.

Although not a required feature of the invention, in the embodiment shown, the surfaces 36 of cushion 14 are provided with structure for resisting movement of disc 10 relative to the adjacent vertebrae in the form of texture or grooves (indicated generally by reference numeral 37) to facilitate ingrowth of bone onto the surfaces 36. In one embodiment, the surfaces 36 of cushion 14 are covered with a porous or roughened titanium coating and perhaps even a layer of calcium phosphate for this purpose; other suitable coatings/surfaces, including titanium wire mesh, plasma-sprayed titanium, porous cobalt-chromium and bioactive materials such as hydroxyapatite and the aforementioned calcium phosphate and other biocompatible materials, are known in the art. As noted above, the central portion of cushion 14 is provided with a cavity 18 having a sac 16 contained therein. Although the cavity 18 shown in the figures is kidney- shaped so as to approximate the shape of the nucleus pulposus of a normal intervertebral disc, those skilled in the art will recognize that the cavity need not be shaped in this shape and that, depending upon the particular pathology prompting disc replacement, it may even be advantageous to shape the cavity 18 differently in contemplation of varying kinematic characteristics. The sac 16 is at least partially filled with a hydrogel such as a polyvinyl alcohol (PVA), synthetic silk-elastin copolymers, polymethyl- or polyethylmethacrylate, polyethylene or polyacrylonitrile that absorbs water and increases in volume upon absorption of water, thereby functioning to maintain disc height in a manner similar to the healthy disc. To facilitate absorption of water, sac 16 is comprised of a material that is permeable to water and the cushion 14 of artificial disc 10 may be provided with a plurality of holes or channels (not shown) for allowing water to pass through the material comprising cushion 14 to access the hydrogel in sac 16. Materials that are used to advantage as the sac 16 include woven polyethylene, woven and non- woven biocompatible synthetic fibers and other materials known in the art. Because sac 16 is contained within cavity 18, the strength of the material comprising sac 16 is not as important as the ability of that material to contain the hydrogel and pass water in a manner that mimics the absorption of water by the healthy nucleus pulposus.

As best shown in Fig. 2, the disc 10 of the present invention is provided with ports 38 through which hydrogel is added or removed from sac 16 in cavity 18. Ports 38 are comprised of channels extending from sac 16 to the periphery of cushion 14 and are preferably located adjacent the ears 28 of frame 12 since the disc 10 is implanted ventrally and the ears 28 therefore face the surgeon when implanted, allowing access to ports 38 for injection of hydrogel as needed to confer the desired amount of initial disc height to the implanted artificial disc. Once the desired disc height is obtained, the ports 38 are capped or plugged to prevent extrusion of the hydrogel within sac 16.

As is also apparent in Figs. 1 and 2, the screw 20 extends from the periphery of cushion 14 through cushion 14 in an anterior-posterior direction. Anchor^' 22 is mounted to screw 20 at a location that allows anchor 22 to reside in a cavity 40 formed in cushion 14 until the screw 20 is rotated to extend anchor 22 out of cavity 40 into contact with the cortical end plates of the adjacent vertebrae. The ends of anchor 22 are formed as points 42 to dig into the bone of the adjacent vertebrae, resisting extrusion or shifting of the disc 10 relative to the vertebrae. To provide additional rigidity to this anchoring arrangement, the screw passes through and is journaled in the above-described hole 34 in the bridge 26 of frame 12 and the screw 20 is capped by a rivet 44 (see Fig. 1) or similar structure on the periphery of cushion 14 opposite ears 28. Those skilled in the art will recognize that the cavity 40 in which anchor 22 resides before rotation of screw 20 need not be separate from the cavity 18 containing sac 16. However, to protect sac 16 from physical damage as a result of the rotation of screw 20 and/or extension of anchor 22, it is preferred that the two cavities be separated by the material comprising cushion 14. Referring also to Figs. 1 and 2, it can be seen that cushion 14 is provided with a band 46 that encircles the periphery of cushion 14. In addition to the physical strength conferred by this band, acting to confine the material comprising cushion 14 to resist extreme compression loads, band 46 cooperates with the hole 34 in the bridge 26 of frame 12 to provide an additional bearing point for the screw 20 and rivet 44.

Referring now to Fig. 4, a perspective view of a second embodiment of the artificial disc of the present invention is shown at reference numeral 48. Disc 48 is similar to disc 10 but is provided with a plurality of shock absorbing cells 50 throughout the material comprising cushion 14. In one embodiment, the shock absorbing cells 50 are comprised of a spring confined within a sac that is likewise confined within the cavity of the material comprising cushion 14 so as to restrict the motion of the spring confined therein to upward and downward, and not side-to-side, motion. This arrangement of the shock absorbing cells helps provide variable resistance to the compression force exerted by side-to-side flexion of the spinal column. Those skilled in the art will recognize from this disclosure that the distribution of the shock absorbing cells 50 in cushion 14 may be changed in accordance with the particular pathology addressed by implantation of the artificial disc of the present invention. It may, for instance, be advantageous to locate more cells 50 on one side of the portion of the cushion 14 than the other if the patient's spinal column is deformed (congenitally or as a result of degeneration or injury) so as to provide extra resistance to compression loads on one side of the spinal column.

Those skilled in the art will recognize that disc 48 is characterized by three different levels, or sources, of resistance to compression loads, thereby providing the cushioning function lacking in currently available disc prostheses. The first contribution to the resistance to compression loads is provided by the material comprising cushion 14, the second contribution is from the hydrogel contained within sac 16, and the third contribution is provided by the shock absorbing cells 50. The contribution provided by each component is capable of being adjusted by use of different volumes of hydrogel, different sizes and shapes of cushion 14, and the number, type, and location of shock absorbing cells 50 to optimize the function of the artificial disc for each particular patient.

In yet another embodiment (not shown), the amount of resistance to compression force provided by shock absorbing cells 50 is adjustable in response to either the amount of compression on said cushion or in response to an external input. The adjustability is provided in a number of ways. In one embodiment, resistance to compression is adjusted by an electrical motor incorporated into each of cells 50. The motor responds to an external input that can be provided in the form of a pulsed magnetic, radio, or other signal received by an antenna located in cells 50 that causes extension of a ram to extend the spring in each cell to provide additional resistance to compression loads. Alternatively, an electrical signal is generated by a piezo-electric wire embedded in or supported by the band 46 encircling the periphery of the cushion 14 or the band 46 is itself comprised of a piezo-electric material. Upon compression of the material comprising cushion 14, the periphery of cushion 14 has a tendency to increase in diameter, and that increase generates an electrical signal in the piezo-electric wire that increases the resistance to compression load provided by the cells in the same manner as in response to an external input. In a second embodiment, rather than a motor, each shock absorbing cell 50 is provided with a spring comprised of a material that reacts to changes in magnetic, electrical, or thermal fields to increase or decrease the compression/tension characteristics of the spring. A similar effect can be achieved by the use of biomaterials that respond to changes in magnetic, electrical, or even thermal fields. Depending upon the particular biomaterial, it is not even necessary to confine the material within a sac forming the cell 50; instead, the cell 50 may consist of a hole or blind pocket in the material comprising cushion 14 filled with a material that responds to changes in magnetic, electrical, or thermal fields to increase or decrease the resistance to compression load. Referring now to Figs. 5 - 9, fourth and fifth embodiments of the artificial disc of the present invention are likewise comprised of the three components described in connection with the embodiments shown in Figs. 1 - 4, a frame 12, cushion 14, and sac 16 contained within cavity 18 formed in cushion 14, each of which mimics the function of the corresponding components of the normal disc. Because the embodiments shown in Figs. 5 - 9 share common components with the embodiments shown in Figs. 1 - 4, the same reference numerals are used in describing the common components.

In the embodiment 52 shown in Figs. 5 - 8, the plates 24 comprising frame 12 are formed in saucer-shaped configuration (best shown in Fig. 6) which is complementary to the shape of the end plates of the bodies of the adjacent intervertebral discs (as described above in connection with the biconvex shape of the cushion 14) rather than as the elongate arms shown in Figs. 1 - 4. The bridge 26 connecting the two plates 24 of frame 12 of disc 52 takes the form of a telescoping tube 54, the ends of which are provided with keys 56 secured in complimentary-shaped slots (not numbered) in plates 24. The ends of the two. concentric cylinders 54A, 54B comprising telescoping tube 54 can also be secured to plates 24 by welding, mechanical connection (such as rivets), medical-grade adhesive, or other manner known in the art.

Although the telescoping tube 54 can act as a spring to resist compression by compression of an inert gas or liquid contained in the hollow interior of the concentric cylinders 54A, 54B comprising tube 54 (while also allowing limited relative motion between first and second plates 24), as best shown in Fig. 7, tube 54 resides in a hole formed in cushion 14, and cushion 14, which is sandwiched between first and second plates 24, provides resistance to compression loads on the spinal column. Because the plates 24 of disc 52 approximate the shape of and bear against the bodies of the adjacent vertebrae, cushion 14 is formed in a generally rectangular shape so as to fit within the space between first and second plates 24. The curvature of the above-described saucer- shaped configuration of plates 24 helps confine the cushion 14 between the two plates 24 and provides varying resistance to compression depending upon the degree of flexion of the spine, thereby mimicking the function of the normal spine in the same manner described above in connection with the embodiment of the artificial disc of the present invention shown in Figs. 1 - 4. Because the plates 24 of the artificial disc shown in Figs. 5 - 8 bear against the bodies of the adjacent vertebrae (rather than cushion 14 in the embodiment shown in Figs. 1 - 4), the outer surfaces of plates 24 are provided with structure for resisting movement of disc 52 relative to the adjacent vertebrae. As shown in Figs. 5 - 8, this structure for resisting relative movement takes the form of a plurality of prongs 58 formed on plates 24 for biting into the bodies of the adjacent vertebrae, but those skilled in the art will recognize that the surfaces of the plates 24 could also be provided with grooves and/or coatings of the type described above for promoting ingrowth of bone in place of, or in addition to, prongs 58. Similarly, because the hydrogel-filled sac 16 contained in cushion 14 expands and contracts with ingress and egress of water to mimic the function of the normal disc, plates 24 are provided with a plurality of channels 60 for passage of water to the cushion 14. In the embodiment shown, the channels 60 are coincident with the prongs 58, but those skilled in the art will recognize that channels 60 can be located anywhere on the surface of the plates 24 and need not be coincident with the prongs 58.

Referring now to Fig. 9, a fifth embodiment of the artificial disc of the present invention is indicated generally at reference numeral 62. Because this fifth embodiment 62 is likewise similar in construction to the other embodiments shown herein, the same reference numerals are again used to designate like components. The difference between the embodiment 52 (Figs. 5 - 8) and the embodiment 62 (Fig. 9) is that the telescoping tube 54 of embodiment 62 is provided with a spring 64 confined between the two concentric cylinders 54A, 54B for providing additional resistance to compression load Those skilled in the art who have the benefit of this disclosure will recognize that certain changes can be made to the component parts of the apparatus of the present invention without changing the manner in which those parts function and/or interact to achieve their intended result. By way of example, those skilled in the art who have the benefit of this disclosure will recognize that the amount of resistance to compression and/or tension load provided by the frame 12 depends on such factors as the dimension of the plates 24 and the location of the bridge 26 close to the edge of the plates 24 (so as to provide a long lever arm) and the material comprising the frame 12 and that although a frame with a certain level of resistance to compression/tension load may be appropriate for one patient, an intervertebral disc including a frame with a different level of resistance to compression/tension load may be better suited for implantation in another patient. It will also be apparent to those skilled in the art that the same result can be obtained by inserting a block (not shown) having a hole therethrough into the frame 12 against bridge 26 to effectively shorten the length of each of the lever arms formed by plates 24 comprising frame 12. It will also be recognized by those skilled in the art that to obtain desirable load resistance properties, it may be advantageous to make the cushion 14 of a combination of materials, with an embedded layer of material having a second set of resilience and/or load-bearing characteristics, or as a laminated "sandwich" of polyurethane and other material(s), each material adding a unique component to the load bearing characteristics of the cushion 14. All such changes, and others that will be clear to those skilled in the art from this description of these several embodiments of the invention, are intended to fall within the scope of the following, non-limiting claims.

Claims

WHAT IS CLAIMED IS:

1. An artificial intervertebral disc comprising: a cushion; a frame comprised of first and second plates having said cushion positioned therebetween with a bridge connecting said plates; and ears formed on said plates for selectively affixing said frame to the adjacent vertebrae when said frame, having said cushion positioned therebetween, is inserted into the space between two adjacent vertebrae.

2. The artificial intervertebral disc of claim 1 wherein said cushion is provided with a cavity having a sac therein, said sac containing a hydrogel.

3. The artificial intervertebral disc of claim 2 wherein said sac is comprised of a material that is permeable to water.

4. The artificial intervertebral disc of either of claims 2 or 3 additionally comprising an opening through said cushion for changing the amount of hydrogel within said sac.

5. The artificial intervertebral disc of claim 1 wherein said bridge connects said first and second plates at one end.

6. The artificial intervertebral disc of claim 5 wherein said frame is comprised of a resilient material so that the ends of the plates opposite the bridge move toward and apart from each other in response to changes in load.

7. The artificial intervertebral disc of claim 5 wherein said ears extend at approximately a right angle relative to said plates and are provided with a hole therethrough for receiving a screw for securing the frame to the body of an adjacent vertebra.

8. The artificial intervertebral disc of claim 5 wherein said first plate is provided with an ear extending at approximately a right angle and having a hole therethrough for receiving a screw for securing the frame to the body of an adjacent vertebra and the second said plate is provided with an ear extending at approximately a right angle and having two spaced apart holes therethrough for receiving screws for securing the frame to the body of a second adjacent vertebra, the portion of the ear between the holes of the ear of said second plate being cut out.

9. The artificial intervertebral disc of claim 1 additionally comprising a screw passing through said frame and at least a portion of said cushion, and an anchor mounted to said screw and passing through a hole in the bridge of said frame.

10. The artificial intervertebral disc of claim 9 wherein said screw passes through a hole in said frame.

11. The artificial intervertebral disc of either of claims 9 or 10 wherein said anchor resides in a cavity formed in said cushion until said screw is rotated to cause said anchor to project out of the cavity to engage the adjacent vertebrae.

12. The artificial intervertebral disc of claim 1 additionally comprising a band extending around the periphery of said cushion.

13. The artificial intervertebral disc of claim 1 additionally comprising a plurality of shock absorbing cells situated in said cushion.

14. The artificial intervertebral disc of claim 13 wherein said shock absorbing cells are adjustable in response to either the amount of compression on said cushion or in response to external input.

15. The artificial intervertebral disc of claim 1 wherein said cushion is comprised of polyurethane.

16. The artificial intervertebral disc of claim 15 wherein the amount of hydrogel added to said sac is adjusted to provide the portion of said cushion having said sac positioned therein with different load-bearing characteristics than the portion of said cushion surrounding said sac.

17. The artificial intervertebral disc of claim 1 wherein said first and second plates are provided with structure for reducing movement of said plate relative to an adjacent vertebra when inserted into an intervertebral disc space.

18. The artificial intervertebral disc of claim 1 wherein the bridge of said frame comprises a telescoping cylinder.

19. A frame comprised of spaced apart, substantially parallel plates, a bridge connecting said plates, a "U"-shaped ear extending at approximately a right angle from one of said plates having a hole formed therein, and a "Y"-shaped ear extending at approximately a right angle from the second of said plates having holes formed in both forks of the Y-shaped ear

20. The frame of claim 20 wherein said frame is comprised of a material that tends to return to its original shape after said frame is subjected to either compression or tension load.

21. The frame of claim 21 wherein the material comprising said frame is selected from one of the group consisting of surgical stainless steel, titanium, and a medical grade polymer.

22. The frame of either of claims 19 or 20 wherein said plates are biconvex.

23. An artificial intervertebral disc comprising: a frame; a cushion molded over said frame; a screw passing through said frame and a portion of said cushion; and an anchor mounted to said screw for selectively engaging the adjacent vertebrae when said frame, having said cushion molded thereover, is inserted into the space between two adjacent vertebrae and said screw is turned.

24. The artificial intervertebral disc of claim 23 wherein said cushion is provided with central cavity having a sac therein, said sac containing a hydrogel.

25. The artificial intervertebral disc of claim 23 wherein said frame comprises first and second spaced apart arms connected at one end by a bridge.

26. The artificial intervertebral disc of claim 25 wherein said frame is comprised of a resilient material so that the ends of the arms opposite the bridge move toward and apart from each other in response to changes in load.

27. The artificial intervertebral disc of claim 25 wherein the end of one or both of the arms of said frame opposite the bridge is provided with an ear extending at approximately a right angle relative to the arm and having a hole therethrough for receiving a screw for securing the frame to the body of an adjacent vertebra.

28. An artificial intervertebral disc comprising: first and second plates; a bridge connecting said first and second plates; a cushion sandwiched between said first and second plates, said cushion being comprised of a resilient material that resists compression loads on said first and second plates, and having said bridge extending through a hole formed therein.

29. The artificial intervertebral disc of claim 28 wherein said cushion is provided with central cavity having a sac therein, said sac containing a hydrogel.

30. The artificial intervertebral disc of claim 29 wherein said sac is comprised of a material that is permeable to water.

31. The artificial intervertebral disc of claim 29 additionally comprising an opening through said cushion for changing the amount of hydrogel within said sac.

32. The artificial intervertebral disc of claim 28 additionally comprising a band extending around the periphery of said cushion.

33. The artificial intervertebral disc of claim 29 additionally comprising a plurality of shock absorbing cells situated in said cushion.

34. The artificial intervertebral disc of claim 33 wherein said shock absorbing cells are adjustable in response to either the amount of compression on said cushion or in response to external input.

35. The artificial intervertebral disc of claim 28 wherein said cushion is comprised of polyurethane.

36. The artificial intervertebral disc of claim 28 wherein said first and second plates are provided with structure for resisting movement of said plates relative to the adjacent vertebrae when inserted into the intervertebral disc space.