CN100425214C

CN100425214C - Methods and instruments for interbody fusion

Info

Publication number: CN100425214C
Application number: CNB2004100286166A
Authority: CN
Inventors: T·A·兹德布里克; E·F·雷三世; L·M·博伊德
Original assignee: SDGI Holdings Inc
Current assignee: SDGI Holdings Inc
Priority date: 1995-03-27
Filing date: 1996-03-26
Publication date: 2008-10-15
Anticipated expiration: 2016-03-26
Also published as: TR199600243A2; CN1701772A; ZA962368B; MX9601079A; AU4829496A; AU705930B2

Abstract

The invention relates to a driving tool for embedding the body fusion device to the clearance between the adjacent vertebras. The fusion device is provided with a body which is provided with a cylinder outer surface cut by a flat side wall arranged relatively. The outer surface is provided with an outside thread. The tool comprises a lathy axle and a pair of corresponding clamps connected with one end of the axle through an articulated piece. The clamp is separated from each other. Every clamp is provided with a pair of inward surfaces contacting the flat side wall arranged relatively to the fusion device and a pair of outward surfaces coherent to the outer surface of the cylinder of the fusion device.

Description

The driven tool of fusing device is used to implant

The application submitted on March 26th, 1996, and application number is 96105961.3, denomination of invention is divided an application for the application of " being used to recover the interbody fusion devices and the method for spinal column normal anatomy form ".

Technical field

The present invention relates to a kind of artificial implantation that is used for being placed into the space that the intervertebral intervertebral disc that will damage stays after taking out.Specifically, the present invention relates to a kind of implant that can be convenient to arthrodesis between adjacent vertebrae or spinal fusion, can also keep or recover to be in simultaneously the normal anatomy of spine form on the specific vertebral.

Background technology

In the past few years, the amount of the spinal operation that carries out increases steadily in order to get rid of the factor that causes low back pain.Modal situation is that the pain of lower back portion is caused by intervertebral disk injury between adjacent vertebrae or pathological changes.Various degeneration may be given prominence to or take place to these dishes, and both of these case has all destroyed the function on the anatomy of intervertebral disc.The most popular surgical method of handling this class situation is two vertebras that merge round the pathological interspinal dish.As a rule, be the whole intervertebral disc except that fibrous ring all to be taken out by diskectomy.Owing to taken out the intervertebral disc that has damaged, just some thing must be put into and to coil in the internal clearance, otherwise this gap will atrophy, causes along the damage of the nerve of spinal extension.

In order to prevent the atrophy of this dish internal clearance, just must fill this gap, so that two adjacent vertebras are merged with the substitute of bone or bone.In the technology in early days, just simply bone material is put, normally be put into the rear portion of vertebra, utilize a plate or a bar to come stabilizing spine across the pathological changes vertebra between the adjacent vertebra.Adopt such technology, when formed merge after, the parts that are used to keep the stability of spine portion have just become fifth wheel.Moreover, usually not only time-consuming but also complicated by the needed surgical operation of vertebra level that implantation bar or plate are stablized between incorporating period.

So propose again, the better way that solves the stability of having taken out the gap behind the intervertebral disc is: vertebra is merged between their end plates separately, preferably do not need to use front card or back card/back board.People have carried out a large amount of effort and have developed a kind of acceptable dish internal clearance implant that can be used for replacing the intervertebral disc that damages can keep the stability of the dish internal clearance between the adjacent vertebrae again at least before forming complete arthrodesis.These " interbody fusion devices " have various ways.For example, a kind of form that adopts cylindrical implant in several more popular designs.4961740 and No. 5055104 United States Patent (USP)s of No. 4501269 United States Patent (USP)s of Bagby, No. 4878915 United States Patent (USP)s of Brantigan, Ray and No. 5015247 United States Patent (USP)s of Michelson have been described this class implant.As described in the patent of Ray, Brantigan and Michelson, in these cylindrical implants, screw thread is carved with in cylindrical outside, so that insert interbody fusion devices.Another kind of scheme is that some fusion implant will be knocked in dish internal clearance and the vertebral endplate.The 4743256th, 4834757 and No. 5192327 patents of the U.S. of Brantigan have been described such device.

In all these patents of enumerating in the above, the cross section of implant all is constant on whole length, and all is right circular cylinder shape generally.The somebody has developed other implant that is used for the body endomixis that does not have constant cross-section.For example, No. 4714469 patent of the U.S. of McKenna showed a kind of hemispheric implant that has the elongated protuberance that extends in the vertebral endplate.No. 4714469 patent of the U.S. of Kuntz showed a kind of bullet-headed prosthese that can optimize the frictional fit between this prosthese and the adjacent vertebral body.At last, the implant in No. 4936848 patent of the U.S. of Babgy is spheric, and this implant preferably is placed between the vertebral body of adjacent vertebrae.

Interbody fusion devices can be divided into two kinds of fundamental types substantially, promptly solid implant and the implant with the structure that allows osteogenesis.The 4878915th, 4743256,4349921 and No. 4714469 patents of the U.S. have been described several solid implants.Remaining patent discussed above has the permission bone and passes some technical characterictic of implant growth.Have found that utilization can promote the device of bone self-sow can realize faster and more stable arthrodesis.The device that the patent of Michelson is described is the representative of the hollow implant of this class, uses earlier from the bone of body before with this class implant insertion dish internal clearance usually and fills it.This implant has some circular holes that are communicated with the hollow lumen of this implant, forms a path for tissue growth thus between the substitute of vertebral endplate and bone in implant or bone.When preparation dish internal clearance, end plate is reduced, so that to the bone blood supply, thereby help the growth of this tissue.In fusion process, the metal structure that is provided by the implant of Michelson has played help to opening and the stability of keeping motor segment to be merged.In addition, in case form arthrodesis, implant itself plays a kind of effect of holder to solid diaphysis.

In existing many interbody fusion devices, still there are some difficulties.Although having realized that the hollow implant of growing in the substitute that makes bone that bone can be in implant or bone is to realize a kind of best-of-breed technology device of merging, but most existing devices are difficult to realize this fusion, are to be difficult to realize this fusion under the help that does not have some additional stabilising arrangement (as bar or plate) at least.In addition, these the device in have some structurally solid inadequately, can not bear the heavy load and the curvature movement that are applied to the most continually on the Fused vertebral (being the vertebra in lower lumbar spine district).

Need provide a kind of osteogenesis ability of can optimizing to have enough intensity again, before forming arthrodesis, can support the hollow interbody fusion devices of spinal column segment always.The inventor have been found that for the opening of osteogenesis prevent the stress protection be embedded in the implant from playing an important role aspect the body bone.In other words, if the size in osteogenesis hole or shape are improper,, have been found that this load is to guarantee that quick and complete fusion is necessary just can not bear certain load from the body bone.In this case, simple fibrous tissue may be reuptaked or develop into to the bone that is embedded in the implant, rather than the bone fusant, and this will cause the imbalance on the structure collectivity.On the other hand, the osteogenesis hole must not be greatly to making housing not have enough supporting forces, can not avoiding being trapped in the degree in the adjacent vertebrae.

Another problem that above-mentioned existing device does not solve relates to the problem of the normal anatomy form of the spinal column segment of keeping or recovering to merge.Nature, in case intervertebral disc is taken out, the normal lordosis of spinal column or back convex arc degree have just disappeared.In existing device, the demand of recovering this radian has been left in the basket.For example, the U.S. of Babgy No. 4501269 patent is representative, and in BAK device commercially available, SpineTech, adjacent vertebral body is with the cylindrical reamer reaming that extraordinary implant is housed.In some cases, before reaming, set up normal radian earlier, and then insert implant.Fig. 1 shows this structure, and Fig. 1 has shown that columniform implant is inserted into and installs the degree of depth in the vertebra of the adjacent substantial health of the dish internal clearance of implant.Yet owing to taken out the load-bearing bone in the vertebra, owing to the general rear portion reaming that is difficult to by the following waist section of lordosis maximum, this method to the excessive reaming in rear portion is not generally generally accepted again.Adopting this implant in most cases, do not doing the effort that recovers the lordosis radian, therefore, along with vertebra be stabilized in implant around, this columniform implant causes the protruding distortion in back easily.This phenomenon makes the spinal column disequilibrium, thereby usually causes undergoing surgery again.

Because therefore these defectives of existing device still need a kind of osteogenesis ability of can optimizing and can keep its intensity and stable interbody fusion devices again.Also need to make this implant can keep or recover to lay the normal anatomy of spine form of the section of implant in addition.This implant must have to be enough to support and to bear result from the intensity that is in the supraspinal heavy load on the level of laying implant, should keep stable simultaneously in whole process.

Summary of the invention

At the still an open question that existing device carries over, the present invention has designed a kind of hollow threaded interbody fusion devices, can be used for recovering the normal angular relationship between adjacent vertebrae.Specifically, this device has an elongated main body, and this main body is tapered along its whole length substantially, and has a hollow inner chamber, and the external diameter of this main body is greater than the gap between the adjacent vertebrae.This main body has an outer surface, and described outer surface has that some are oppositely arranged, tapered cylindrical part and a pair of flat side surface that be oppositely arranged, tapered between above-mentioned cylindrical part.Therefore, it seems from an end, this fusing device just as if a columniform main body, the side of this main body is that the string along the main body external diameter is cut into planar.On columniform part, have screw thread, so that make this main body insert in a controlled manner and join on the end plate of adjacent vertebrae.

In another aspect of this invention, outer surface is tapered with certain angle along its length, and in one embodiment, this angle is consistent with the normal segmental lordosis of lower lumbar spine.The opening that also has some blood vessels that on flat side surface, form on the outer surface, and the elongated osteogenesis groove of the pair of opposing that on columniform part, forms.The transverse width of osteogenesis groove is preferably about half of effective width of the cylindrical part in the scope of defining slot.

The invention provides a kind of driven tool that is used for fusing device is inserted into the dish internal clearance.In an example, driven tool comprises an axle, and an end of axle has a pair of tapered clamp respect to one another.This is connected on the axle by a twisting seam clamp, and described twisting seam opens clamp so that fusing device is clamped between them.Driven tool also has a sleeve round the coaxial setting of described axle, and this sleeve can slide along axle, and extruding twisting seam, thereby this is pushed away together to clamp is past, so that clamp fusing device.Perhaps, can adopt a kind of intramedullary expansion elastic collet chuck, closely support fusing device during insertion internally.

In aspect of driven tool, tapered clamp has an outer surface, and the shape of this outer surface is identical with the shape of the tapered cylindrical part of fusing device.Clamp also have one flat towards the inboard, towards surface corresponding to the flat side surface of fusing device.Therefore, when clamp was pressed to fusing device, the surface towards the inboard of clamp contacted with the flat side surface of fusing device, and the outer surface of clamp and fusing device are combined into a complete taper shape, so that in the mode that is screwed into fusing device is inserted.The part that several protrusions can also be arranged on the surface of inboard of clamp is in order to engage with hole in the fusing device, so that this device is driven in and rotates in the dish internal clearance.

In another aspect of this invention, provide a kind of fusing device has been implanted to method between the adjacent vertebrae.In one approach, be to insert from the place ahead, this method comprises expansion dish internal clearance and get out the step in hole that diameter equals the bottom diameter of fusing device on the end plate of adjacent vertebrae.Insert a sleeve, constitute the service aisle of the implantation fusing device step of boring step and back.Implant is combined with driven tool, be inserted in the sleeve and be screwed into then in the ready hole.The insertion depth of taper fusing device has determined the separately angle that adjacent vertebrae reaches.

In another kind of inventive method, prepare the insertion point in the wings, that is,, and in vertebral endplate, bore an inner diameter hole from rear expansion dish internal clearance.Also constitute the service aisle of boring and inserting step with a sleeve.Fusing device is inserted in the good hole of brill, makes its flat sidewall towards adjacent vertebra.Rotate this device then, make the external screw thread that is positioned on its cylindrical part cut and be engaged on the adjacent vertebra.In addition, because fusing device is taper, the outer surface of the taper of this device will make adjacent vertebra separate certain angle, thereby recover normal lordosis anatomic form.

Description of drawings

Fig. 1 is the sagittal side view of the fusing device in the prior art;

Fig. 2 is the enlarged perspective according to the interbody fusion devices of one embodiment of the present of invention;

Fig. 3 is the sectional view that cuts open the interbody fusion devices shown in Figure 2 of getting, watching along the direction of arrow along the 3-3 line;

Fig. 4 is the end view of the front end of interbody fusion devices shown in Figure 2;

Fig. 5 is the top view of interbody fusion devices shown in Figure 2;

Fig. 6 is the A-P side view when the place ahead of spinal column is watched, and represents the situation when two interbody fusion devices shown in Figure 2 are implanted in the body internal clearance between L4 and L5;

Fig. 7 is the sagittal view that is implanted in the interbody fusion devices between L4 and the L5 shown in Figure 6;

Fig. 8 is the perspective view according to another embodiment of interbody fusion devices of the present invention;

Fig. 9 is the top view according to the implantation driver of another aspect of the present invention;

Figure 10 is an end of the implanting driver enlarged perspective when being engaged on the interbody fusion devices shown in Figure 2;

Figure 11 is the sectional view that amplify the part that is engaged on the implantation driver on the interbody fusion devices shown in Figure 10;

Figure 12 is suitable for the sectional view that amplifies with the part of the implantation driver of another embodiment of interbody fusion devices shown in Figure 10 engagement;

Four steps of the method for Figure 13 (a)-13 (d) expression fusing device that implants (device for example shown in Figure 2) according to a further aspect in the invention;

Implant four steps of another kind of method of fusing device (device for example shown in Figure 2) of Figure 14 (a)-14 (d) expression.

The specific embodiment

For principle of the present invention is better understood, the several embodiment shown in and adopt concrete language to describe the present invention below with reference to accompanying drawings.However, be to be understood that, this does not also mean that qualification to scope of the present invention, and those skilled in the art in the invention will reckon with the variation of device shown in the drawings very naturally and further improve, and the further application of the principle of the present invention that is wherein comprised.

Fig. 2-5 illustrates interbody fusion devices 10 according to an aspect of the present invention.This device is made of a kind of hard cone body 11, and main body 11 is preferably made by material a kind of biocompatibility or inert.For example, main body 11 can have the suitable material that is suitable for above-mentioned strength characteristics by the rustless steel of medical grade or titanium or other and makes.This device also can be by the porous material of biocompatibility, and for example the porous tantalum that is provided by Implex Corp is made.For ease of reference, device 10 has a front end 12 and a rear end 13, and the anatomical position when they are implanted in the dish internal clearance with device 10 is corresponding.Cone body 11 has defined a hollow inside 15, and inner 15 are surrounded by main wall 16, and its front end 13 is by end wall 17 sealing (see figure 3)s.Hollow inside 15 is made into the shape of the substitute that can admit autotransplantation bone or bone, can promote between the adjacent vertebrae and the firm fusion in the whole dish internal clearance.

According to the present invention, interbody fusion devices 10 is screwed devices, can be screwed in the end plate between adjacent vertebrae.In one embodiment of the invention, vertebra shape main body 11 defines the one group of external screw thread 18 that is interrupted and the complete screw thread 19 of a front end that is positioned at this implant.Complete screw thread 19 serves as this implant is screwed into place " starting " screw thread on the vertebral endplate of dish in the internal

clearance.Screw thread

18 and 19 can have several shape as known in the art, so that be screwed in the vertebra.For example, these screw threads can have the cross section of leg-of-mutton cross section or truncated triangles.The height of screw thread is 1.0mm (.039in) preferably, so that enough engagement forces are provided in vertebra, fusing device 10 can not coiled outside the internal clearance by suffered the shifting onto than top load of spinal column.In some specific embodiments, pitch is 2.3mm (0.091in) or 3.0mm (0.118in), the quantity that this depends on the place vertebral of the device 10 that will implant and implant is kept the required thread engagement in location.

In one aspect of the invention, the outer wall 16 of cone body 11, particularly main body comprises the sidewall 22 of the truncation of pair of parallel, and Fig. 4 clearly show that this a pair of parallel side wall 22.This oppose side wall is preferably flat, so that this fusing device is inserted between the end plate of adjacent vertebrae, and form a zone for the bone fusion.This sidewall to truncation extends to the complete screw thread 19 that is positioned at rear end 13 from the front end 12 that installs always.Like this, owing to have this sidewall 22 to truncation, the end of device 10 is incomplete circle, and these circular both sides are gone along a flat-sawn of this circle.In a specific embodiment, the point diameter of interbody fusion devices 10 is 16.0mm (0.630in).In this specific embodiment, the sidewall 22 of truncation is to form along a pair of about parallel chords line at a distance of 12.0mm (0.472in), and therefore, the circular arc portion of being clipped in the both sides of this device is approximately relative with 90 ° angle.This paper will describe benefit and the advantage that the sidewall 22 by the truncation of fusing device 10 brings in more detail.

The cone body 11 of device 10 comprises the opening 24 and 25 of the formation blood vessel that a pair of sidewall 22 that passes through each truncation is determined.When fusing device is implanted in the dish internal clearance, opening 24 and 25 will be arranged or towards sagittal plane along side direction.This will be used to form a path to opening, so that can form blood vessel between bone implant in the hollow lumen 15 and tissue on every side.In addition, some bone also may be by these

opening growths.Opening

24 and 25 size can guarantee to provide optimal path for forming blood vessel, can be retained in a large amount of structures in the cone body 11 again, to bear the bigger axial load of the dish internal clearance that runs through between adjacent vertebrae.

Cone body 11 has also been determined the osteogenesis groove 27 that some are oppositely arranged, all these grooves all with the sidewall 22 of truncation at an angle of 90.When device 10 when implanted, these grooves 27 are preferably directly adjacent with vertebral endplate.More particularly, when the

screw thread

18 and 19 of device when being screwed in the vertebral endplate, vertebra will partly extend in the groove 27 with bone implant in the hollow lumen 15 that is contained in device 10 and contact.Fig. 5 clearly show that in order to ensure complete arthrodesis and solid spinal fusion, osteogenesis groove 27 is made into the shape that maximum open can be provided for osteogenesis.The transverse width of these grooves is preferably approaching with the effective width of the threaded portion of main body.Have found that, adopt the existing device of many small gap can not promote bone material fast and solid arthrodesis.These little slits also usually cause the formation of pseudarthrosis and the growth of fibrous tissue on the contrary.Because osteogenesis groove 27 of the present invention is directly facing to vertebra, they are not on the position that must bear bigger load of device.The substitute is, the sidewall 22 of truncation will bear by means of intermittent screw thread 18 by between two end plates of vertebra and run through the most load of coiling internal clearance.

In further feature, on the front end 12 of main body 16, a pair of radially relative recess 29 can be arranged, this shape to recess 29 makes them to match with implantation driven tool as herein described.In addition, on the end wall 17 of the rear end 13 of implant, also can have a parts (not shown) that cooperates with instrument.For example, as this paper will further describe, can open a hexagonal groove and admit a hexagonal driven tool.

A key character of interbody fusion devices of the present invention is, main body 11 is tapered or conical, and in other words, the external diameter of the front end 12 of this device is greater than the external diameter of its rear end 13.As shown in Figure 3, main wall 16 is tapered with angle A round the center line CL of device 10.Tapered main wall 16 helps to recover the normal relative angle between the adjacent vertebrae.For example, at waist, angle A helps to recover to be positioned at the normal lordosis angle and the flexibility of the spinal column at this position.In a concrete example, angle A is 8.794 °.These parts are understood that implant can have the part of some non-tapers, as long as can not influence the taper main functions.

The cone angle A of implant combines with the front end of fusing device 10 and the external diameter of rear end, has determined the amount of the angular divergence that will form between adjacent vertebrae when implant is placed into or is screwed in its residing position.Fig. 6 and Fig. 7 clearly show that this feature, and this two width of cloth illustrates the preferred structure that adopts a pair of fusing device 10.In illustrated structure, device 10 is placed between lower lumbar spine L4 and the L5, and

screw thread

18 and 19 is screwed among the end plate E of two vertebras.As shown in Figure 7, when device 10 when being screwed among the end plate E, its pivot P along the direction of arrow E towards vertebral advances.Nominally pivot P is the counterrotating center between the adjacent vertebrae of motor segment.Along with taper fusing device 10 further advances towards pivot P along the direction of arrow I, adjacent vertebrae L4 and L5 scatter towards the direction of arrow S angledly.The insertion depth of fusing device 10 will determine the final segmental lordosis L that reaches between adjacent two vertebras.

In device several specific embodiments of 10, the external diameter of front end 12 or the diameter of thread crest can be 16,18 or 20mm, and the total length of device is 26mm.Device size is by the level of the vertebra that will implant this device and the angle decision that must reach.

In another aspect of this invention, as shown in Figure 6, the size of device 10 makes two such cylinder-shaped bodies 11 can be implanted in the dish gap.So just can or put into another kind of bone integrating materials between these two devices 10 on every side.This characteristic has also promoted the fusion in the whole dish internal clearance, and device can be fixed between the adjacent vertebra more massively, prevents that the higher load on this this specific vertebral of device quilt from extruding.

In fusing device specific embodiment, the opening 24 that forms blood vessel is rectangular generally in vivo, and it is of a size of 6.0mm (0.236in) and takes advantage of 7.0mm (0.276in).Equally, the opening 25 that forms blood vessel is also rectangular, its be of a size of 4.0mm (0,157in) take advantage of 5.0mm (0.197in).Nature, this opening is smaller, because it is positioned at the less rear end 13 of device 10.Osteogenesis groove 27 also is orthogonal, and it is long to be 20.0mm (0.787in), and wide is 6.0mm (0.236in).Have found that forming the opening 24,25 of blood vessel and these sizes of groove 27 is best to osteogenesis and vascularization.In addition, the size of these openings is very not big, and they have taken into account the structural integrity of device, and perhaps they make the bone integrating materials that is contained in the hollow lumen 15 can more easily be discharged from implantation process.

As shown in Figure 7, when device was positioned between L4 and the L5 vertebra, the

opening

24 and 25 that forms blood vessel contacted with the tissue that blood vessel is enriched in the formation around the vertebra in the side.And as shown in Figure 6, therefore osteogenesis groove 27 contacts with vertebral endplate E towards axially.

In another embodiment of the present invention shown in Figure 8, interbody fusion devices 30 is made of the main body 31 of a taper.The same with the fusing device 10 among the embodiment of front, main body 34 defines a hollow lumen 33.But, in this embodiment, do not have the opening that forms blood vessel on the sidewall 38 of truncation.And the osteogenesis groove 34 of relative both sides that is positioned at device 10 is smaller.The intermittent screw thread 36 that this means the outside that is positioned at device 30 extends a longer segment distance round implant.If adopt porous material (for example tantalum) to form and be fixed to auxiliary surface on the adjacent bone, then can adopt such design for tissue growth.The interbody fusion devices 30 of embodiment shown in Figure 8 can also be applied to some vertebral, on these levels, and the risk maximum that device is extruded.Therefore, prevent extruding of this class by the contact amount that increases screw thread.Before inserting, in the hollow lumen 15 of device 10, fill up bone or substitute earlier, so that provide convenience for such prestrain.

According to an aspect of the present invention, can utilize implantation driver 50 shown in Figure 9 that interbody fusion devices 10 is implanted.Implanting driver 50 is made of an axle 51 and the axle sleeve 52 round this concentric setting.One end of axle has some clamps 54, is used for clamping interbody fusion devices 10 so that with its implantation.Clamp has a tapered outer surface 55 and a flat inner surface 56, is suitable for cooperating with the sidewall 22 of the truncation of interbody fusion devices.The outer surface 55 of taper is consistent with the root of intermittent screw thread 18 footpath, so clamp 54 fills up the whole cylindrical shape of main wall 16 basically.Because outer surface 55 will be connected across the hole of screw thread that has been arranged in opening of vertebral endplate, so the conical outer surface 55 of clamp has promoted being screwed into of interbody fusion devices 10.

Each clamp all has interlocking latch 58 and the driving projection 59 that stretches out from inner surface 56.Figure 11 clearly show that these functions of components.See Fig. 9 earlier, have a twisting seam 62 that supports a pair of clamp 54 on the axle 51.Twisting seam 62 has such shape: it make clamp be in one disperse the state of the natural deflection enough opened, taper interbody fusion devices 10 can be received between the clamp.Axle 51 defines a tapering part 63 between twisting seam 62 and each clamp 54.This tapering part and cone tank 67 couplings that are positioned on the inwall of axle sleeve 52.Therefore, when just axle sleeve 52 during towards the direction reach of clamp 54, cone tank 67 is leaning on tapering part 63, thus sealing or extrusion twisting seam 62.By this way, clamp 54 is subjected to making their thrust close to each other, and will clamp at the interbody fusion devices between two clamps under the effect of pressure.

Axle 51 and axle sleeve 52 have threaded interface 65, make axle sleeve 52 can be screwed to axle along the length direction of axle and go up or back out from axle.Specifically, threaded interface 65 comprise be positioned at axle on 51 external screw thread and be positioned at female thread on the axle sleeve 52, described internal and external screw thread has identical pitch, so axle sleeve can be easily move and moves down from implanting driver.Axle 51 also has a pair of latch 69, and they move after with axle sleeve 52 and are limited in the scope, and this scope only is to make clamp 54 independently go out one section moving range that enough distances are required in order to admit interbody fusion devices 10.

Figure 10 and 11 shows the use of implanting driver.As shown in figure 10, the outer surface 55 of clamp 54 is in basically on the position that the root with intermittent screw thread 18 directly flushes.As shown in figure 11, two latch 58 can be arranged to the opening 24 of the formation blood vessel on the sidewall 22 that is arranged in each truncation.In the same way, drive the recess that holds driven tool 29 engagements on projection 59 and the front end 12 that is positioned at cone body 11.Interlocking latch 58 and driving projection 59 combine, and interbody fusion devices 10 is clamped tightly, thereby this device can be screwed into place having attacked in opening silk or not tapping in vertebrae.

Figure 12 shows another embodiment that implants driver.Driver 90 comprises an axle 91, and its length is enough to guarantee that it extends the dish internal clearance outside the patient body.A head that defines a pair of clamp respect to one another 93 links to each other with the end of axle 91, and the shape of each clamp makes them to flush with the sidewall 22 of the flat truncation of fusing device 10.The same with two clamps 54 of foregoing implantation driver 50, the outer surface of clamp 53 is cylindrical, so that consistent with the cylindrical thread part of device.

Driver 50 is different with implanting, and the driver 90 among the embodiment shown in Figure 12 utilizes a distensible elastic collet chuck assembly to hold fusing device 10 tightly so that be inserted in the health.Specifically, head 92 defines an elastic collet chuck 94, and elastic collet chuck 94 has one through wherein center trepanning 95.One end of elastic collet chuck 94 is annular lip 96, and annular lip 96 has the diameter of the internal diameter of the end 12 that is slightly smaller than fusing device 10 at least at first.An expander axle 97 slidably runs through described trepanning, and has the end 98 of an increasing, and end 98 is near annular lip 96 and just extended outside the annular lip 96.The end 98 of the increasing of expander axle 97 is less at the diameter of its initiating terminal, and it can be slided in trepanning 95, and from this initiating terminal, the diameter of end 98 is enlarged to the diameter greater than described trepanning gradually.

Implant driver 90 and comprise an extracting tool axle 99, described axle 99 is arranged in the hole 100 that is limited by axle 91 in the mode that can slide.The latch well 101 that has a locking hub 102 on the end with expander axle 97 to engage in the end of extracting tool axle 99.Extracting tool axle 99 extends outside the end of axle 91, holds for the surgeon.When extracting tool axle 99 was pulled out, it just was pulled outwardly expander axle 97 from the annular lip 96 of sleeve 94, thereby the end of widening 98 little by little is bonded in the trepanning 95.Along with end 98 further moves forward in the trepanning 95, annular lip 97 is extended to second a bigger diameter from initial diameter, is enough to hold tightly the inner chamber of fusing device 10.Implant driver and engages with fusing device by this way by making, device 10 can be inserted in the field of operation, then, the reaming axle can be pushed into outside the trepanning with the release enlarged portion, thus fusing device is unclamped.

The present invention has designed two kinds of methods of implanting interbody fusion devices 10.At first, Figure 13 (a)-13 (d) shows the place ahead insertion.In preliminary step, need fix suitable, the starting point of bilateral preferably of implanting fusing device.In the first step of this place ahead insertion, earlier a dilator 75 is placed between two end plate E of vertebra with the dish gap between expansion L4 and the L5.(certainly, should be appreciated that this step also can be used for other vertebral).In second step shown in Figure 13 (b), with a sleeve 76 be placed into the dish gap around.Can design the shape of sleeve 76 by known method, it can be engaged reliably with the front portion of vertebral body, so that securely but be temporarily to make sleeve 76 location.In fact, in the implantation of this peritoneoscope (laproscopic) formula, what sleeve 76 play a part is a service aisle.In this step shown in Figure 13 (b), a known drill bit 77 is inserted in the sleeve, with this drill bit drilling bore hole in these two adjacent vertebras.Also can tapping in these holes, so that fusing device is screwed into, although this step is not requisite.

In the next procedure shown in Figure 13 (c), clamp fusing device 10 with implanting driver 50, and it is inserted in the sleeve 76, touch opening on the bone up to starting screw thread 19.Then, can fusing device 10 be screwed into out having attacked in hole silk or not tapping in vertebral endplate with implanting driver 50.Should be appreciated that, in this step, also can utilize other suitable driven tool,, engage with the driven tool groove 29 of the front end 12 that is positioned at device 10 as the device of screw drive type.As previously described, the insertion degree of fusing device 10 has determined to be added in lordotic amount on this vertebra level or that this vertebra level is recovered.In last step, will implant driver and take out, make fusing device 10 stay original position.As seen, in case implanted, the end wall 17 of sealing is just towards the rear end of this vertebra.The hollow lumen 15 that is positioned at front end is opened wide, but necessary words can close it with metal or plastic material.

In second kind of inventive method, Figure 14 (a)-14 (d) shows the rear insertion.Two steps in the front of rear insertion are similar to the place ahead insertion, different just, dilator 75, sleeve 76 and drill bit 77 are to put into the zone of laying implant from behind.This insertion may need vertebra is peeled off or removed so that admit sleeve 76.In the 3rd step of this method, fusing device 10 is inserted in the dish gap of expansion by sleeve 76.Should be appreciated that, only need the dish gap is expanded to certain degree that this degree is to admit the implant that has directly in the face of the sidewall 22 of the truncation of vertebral endplate E necessary.Therefore, shown in Figure 14 (c), osteogenesis groove 27 is towards side direction, rather than towards laterally, consistent with the implantation position of its expection.Can utilize a kind of suitable driven tool 80 that fusing device 10 is stretched out by sleeve 76, and enter into the dish internal clearance.In one embodiment, driven tool 80 has a protuberance 81, and its shape is coincide with the recess of opening on the end wall 17 of the rear end 13 of fusing device 10.Also can utilize the external screw thread (not shown) will install 10 is fixed on the driver 80.

In case fusing device 10 pushed in the dish internal clearance and with respect to the pivot P of vertebra arrived the suitable degree of depth, just can utilize driven tool 80 to rotate this implant along the direction of the middle arrow R indication of Figure 14 (c).Along with the rotation of driven tool 80, itself also rotates device, makes intermittent screw thread 18 begin to be cut into the vertebra that is arranged in end plate E place.By this way, implanting the same dispersion direction along arrow S indication in Figure 14 (c) of cam of image separates adjacent vertebra.Just can be with implant locking in vertebra, owing to only need once to rotate so it is a kind of comparatively easy insertion method to some degree that this cam-type is inserted.On the contrary, screw-type insertion Technology Need previously discussed will install and be threaded into continuously on its position.

Adopt any in these two kinds of technology, can utilize X-ray or other suitable technique to check the position of fusing device 10, thereby set up the angular relationship between the vertebra with respect to adjacent with it vertebra.Perhaps, can pre-determine preferred implant insertion depth, and when putting into implant between the vertebra from this degree of depth of patient's external test.

As seen, interbody fusion devices 10 of the present invention, implantation driver 50 and method of the present invention have significant advantage than existing device and technology.Specifically, fusing device 10 is threaded hollow inserts, and the bone that has excavated to greatest extent between adjacent vertebrae merges potential, has kept the globality of implant itself simultaneously.Should be appreciated that spinal column will bear sizable load at it on axially, before reaching solid fusion, this load all must be born by fusing device 10 at least.Device 10 also has the parts of feeder vessels formation and tissue growth, and these parts have quickened fusion speed, have improved the intensity of the sclerotin that is fused into.Another significant aspect is, the conical in shape of implant makes the surgeon can recover and keep suitable radian between the vertebral body or relative angle.This just can be avoided occurring the serious problems relevant with existing device of product distortion, this class of spinal column disequilibrium.Another advantage of device of the present invention and implantation driver is to utilize the insertion method of a kind of abdominal cavity mirror both can also can be inserted into from the rear portion from the front portion.According to vertebral, two kinds of insertion methods all are desirable, and therefore, importantly, implant will be suitable for inserting from this both direction.Forwardly in the insertion, the insertion that utilizes screw-in technology (contrasting with knocking in) to come control device is in the wings in the insertion, with the insertion that slips into and the method for cam-type is come control device.

Although utilized the description displaying of accompanying drawing and front and set forth the present invention; but these accompanying drawings and description only are illustrative rather than determinate; be to be understood that; the front shows just and has described preferred embodiment that all changes and the improvement that fall into design scope of the present invention all should be protected.For example, install 10 situations that are used for spinal column although just disclose, structure of the present invention and method also can be used in other joint space, for example ankle joint, carpal joint and subtalar joint.In addition, although device shown 10 all is taper in a preferred embodiment, add that on resulting device part non-taper or inverted cone still falls into scope of the present invention in its whole length range.

Claims

1. driven tool, be used for interbody fusion devices is implanted to gap between the adjacent vertebrae, described fusing device has a main body, described main body has the cylindrical outer surface that straight side walls that a quilt is oppositely arranged disconnects, have external screw thread on the described outer surface, described driven tool comprises:

An elongated axle; And

A pair of by an end that be connected, the respect to one another clamp of articulated elements with described axle, described clamp departs from out each other;

In the described clamp each all have a pair of be formed the inside surface that can contact with the straight side walls that is oppositely arranged of fusing device and a pair of be formed can with the corresponding to outside surface of the cylindrical outer surface of fusing device.

2. driven tool as claimed in claim 1, fusing device wherein has out the opening on straight side surface, wherein, the described inside surface of each described clamp all has a pin that stretches out from this surface, when inner surface contacts with described flat side surface, described pin will extend in one of lip-deep a plurality of openings of flat side of fusing device when described.

3. driven tool as claimed in claim 1, it is characterized in that, described driven tool also comprises an axle sleeve that is provided with coaxially round described axle, described axle sleeve can slide on described axle, thereby push described articulated elements, so that described clamp is pushed away closely each other, thus, described clamp will clamp at the fusing device between the described clamp.

4. driven tool as claimed in claim 3, it is characterized in that described axle sleeve is by means of being threaded on the described axle, therefore, when described axle sleeve was rotated round the threads engage place, described axle sleeve can axially move along the length direction of described axle.

5. driven tool as claimed in claim 3 is characterized in that:

Described clamp has a conical surface adjacent with described articulated elements; And

The groove that a taper is arranged on the inner surface of described axle sleeve, the groove of described taper and described conical surface complementation, therefore, when described axle sleeve moves axially when pushing described articulated elements towards described clamp, described cone tank also moves along described conical surface thereupon.

6. driven tool as claimed in claim 1, wherein said fusing device has the recess of splitting in the one end that is oppositely arranged, wherein, described clamp has some from the described driving projection of stretching to inner surface, and described driving projection can mesh with the recess that is oppositely arranged in the fusing device.

7. driven tool, be used for interbody fusion devices is implanted to gap between the adjacent vertebrae, described fusing device is hollow, this fusing device has a main body, described main body has the cylindrical outer surface that straight side walls that a cylindrical form interior surface and quilt be oppositely arranged disconnects, have external screw thread on the described outer surface, described driven tool comprises:

An elongated axle; And

Be connected, the clamp respect to one another of one end of a pair of and described axle, described clamp depart from out each other so that the straight side walls that is oppositely arranged of fusing device is received between them; And

A distensible elastic collet chuck assembly that links to each other with described elongated axle, described distensible elastic collet chuck assembly has such part, and this part can be little of first enlarged-diameter to, second diameter bigger, that make its inner chamber that can hold fusing device that makes its inner chamber that can place oneself in the midst of this hollow fusing device from one.

8. driven tool as claimed in claim 7 is characterized in that described distensible elastic collet chuck assembly comprises:

A head that becomes one with described a pair of relative clamp, described head have one through the adjacent with described clamp of wherein a centre bore and an end that is positioned at described centre bore and be positioned at the annular lip of described clamp inboard; And

An expander axle that slidably is arranged among the described centre bore, described expander axle has an end, when described expander axle is placed in the described centre bore, this end is little of make its first enlarged-diameter to that can slide bigger second diameter adjacent with described annular lip described centre bore from one

Thus, when described expander axle was retracted in the described centre bore, the end of described expansion made described annular lip little by little be expanded to degree with the engagement of the inner chamber of fusing device.