KR100423626B1 - Devices for spinal surgery in the human body and spine stretchers - Google Patents

Abstract

The present invention relates to an apparatus and method for inserting a spinal implant, wherein the intervertebral space is first switched and then a hollow sleeve with teeth at one end is driven into the spine adjacent to the disk space. The drill then passes through a hollow sleeve removal disc and bone arranged to receive a spinal implant that is inserted through the sleeve. In addition, according to the implant insertion apparatus and method of the present invention, the intervertebral space is first switched to restore the normal angular relationship of the spine adjacent to the disc space. An elongated outer sleeve with an elongated portion capable of retaining the converted vertebrae in the normal angular relationship is then driven into the vertebrae adjacent to the disk space. The drill then passes through a hollow sleeve removal disc and bone provided to receive the spinal column implant inserted through the sleeve.

Description

Devices for spinal surgery in the human body and spine stretchers

The present invention relates to an artificial fusion implant installed in an intervertebral space remaining after removal of a damaged spinal disk, and more particularly, to an apparatus and method for inserting an implant.

In order to stabilize the injured spine segment for a long time, fusion (working joining two or more bones together via the bone bridge of the joined bone) may be performed. As is well known to those skilled in the art, in interbody fusion, in order to restore a more normal spatial relationship, the disc is partially cut and bone is placed in the space previously occupied by the disc material (between adjacent vertebrae) Safety by mechanical support, and by long-term permanent cross-bonding of the bones between the vertebrae. In the case of fusion in the disk space, the bones to be fixed are prepared by breaking or cutting the hardened outer plate (end plate) of the bone, and intervening bone grafts are provided with more vascular structures, reticular tissues (sponges). It is necessary to bring the bone into contact with the bone and to restore the implant to both the bone making and the opposing vertebrae caused and controlled by the "fracture" so that the bone becomes one continuous segment.

It is an object of the present invention to provide an insert, insertion device and method which inserts an implant into the intervertebral disc space remaining after removing the disc material and permanently excludes all movement of the disc at that location. In order to achieve this object, the device of the present invention occupies a disc internal space, is self-stable without being hard and pushed out, stable to adjacent spinal vertebrae to exclude local movement, and to ensure the durability of the composite. It can contribute essentially to the fusion of the vertebrae and the bones of the vertebrae.

Nowadays, after a damaged disc is removed, bones or other things are not placed in the remaining space. If nothing is placed in this space, it may lead to collapse of the space, which may result in nerve damage, or the space may be filled with scar tissue and eventually undergo reherniation. However, using bone to fill the space requires additional surgery to obtain bone from the patient and the bone can only be used in limited form in the most useful form, otherwise it is quite dangerous due to the lack of living bone cells. The supply is limited because it poses the risk of infection and is often obtained from victims of traffic accidents. In addition, regardless of the source of the bone, the bone is structurally limited and there is no means to stabilize bone movement or stabilize the adjacent vertebrae.

a. Prior Art Implants

Considerable attempts have been made to develop acceptable disc prostheses (artificial discs). Such devices have been used to replace damaged disks, to restore the height of internal spaces, and to restore normal movement of their spinal joints. None of these devices have proven medically acceptable. This group of prosthetic or prosthetic disc replacements differ from the present invention because they seek to maintain the movement of the spine. Such prior arts include US Pat. No. 3,867,728 to Stubbstad, which discloses flexible disk implants; U.S. Patent No. 4,349,921 to Kuntz, which discloses a flexible disk replacement having a pile surface protrusion to prevent the device from being out of position; US Pat. No. 4,309,777 to Patil, which discloses a motion retaining implant having a spiked outer surface to prevent dislocation and containing a series of springs to extend the vertebrae away from each other; US Pat. No. 3,875,595 to Froning, which discloses a motion retaining bladder type disc replacement having two opposing stub-shaped protrusions to prevent out of position; Patent No. 2,372,622 to Passio (France), which discloses a motion retaining implant comprising complementary opposing convex and concave surfaces.

In summary, these devices are similar to the present invention in that they are installed in the intervertebral space after removing the damaged disk. While these prior art devices seek to preserve the movement of the spine, the devices of the present invention are completely different because they want to permanently exclude all movement of the spinal segment.

The second related field of the prior art relates to a device used to replace a spine that is essentially completely removed. Such removal is generally necessary in severe vertebral fractures or in tumors and is not involved in the treatment of disc disease. The device of the present invention is installed in disk space, but another spinal device could not be installed in disk space if at least one vertebra has already been removed so that no "disk space" remains. In addition, these devices are limited in that they attempt to function as temporary structural members that mechanically replace the removed vertebrae (but not replace the discs), and are osteogenic to achieve joint fusion across the vertebrae. It does not contribute substantially to the supply of material. Thus, unlike the present invention, which provides a source of bone formation, this group of devices uses conventional techniques and therefore must be accompanied by additional surgery that involves a bone fusion process. Devices of this group constitute vertebrae struts rather than disc replacements, such prior arts being described in U.S. Patent Nos. 4,533,273 to WU, which discloses a turnbuckle type vertebra; US Pat. No. 4,401,112 to Rezaian, which discloses a turnbuckle-type lumbar support with added long stabilizing staples connecting damaged vertebral bodies; U.S. Patent No. 4,554,914 of Kapp, which discloses a spike that extends with a screw mechanism that acts as an anchor for the acrylic cement that is used to remove the entire vertebra and extend to the remaining gap to replace the missing bone (bone). Howa; US Pat. No. 4,636,217 to Ogilvie, which discloses an intervertebral crutch device that can be inserted after at least one spine has been removed and consists of a device for fastening screws into the vertebrae above and below the removed vertebrae.

In summary, these second groups of devices are vertebral replacement crutches, do not inherently participate in bone fusion, can be inserted only in limited circumstances where the entire vertebrae are removed by this method, and are not designed for the treatment of disc disease or It differs from the device of the present invention in that it is not intended to be used for such treatment.

The third field of the prior art associated with the present invention includes all devices designed to be applied to the vertebral surface. Such devices include all types of plates, crutches and rods that are attached by hooks, wires and screws. These devices differ from the devices of the present invention in that they are not inserted into the disk space and in addition are not used endogenously in supplying bone forming material for fusion.

Thus, if one wishes to permanently fix the spine, additional surgery consisting of spinal fusion performed using conventional means or supplemental methylmethacrylate cement is required. Such devices, applied to the spine but not in disk space, are US patents of Stephens, which discloses a "U" shaped metal rod attached to the back element of the spine by wires to stabilize the spine over multiple segments. 4,604,995; Maximum support load on the patient's own disc, installed rearward along the lumbar spine so that the pressure on the spine's tail position is blocked by full flexion and held in place by the shape of the spine column itself. U.S. Patent No. 2,677,369 to Knowles, which discloses a metal spinal column device that changes the diameter of the device.

Other devices are simple variations in the use of rods (e.g. Harrington, Luck, Cottrell-Duboset, Zilke), wires or cables (dewyers), plates and screws (steppies), or crutches (dun, nolis). to be.

In summary, none of these devices can be designed or used in disk space. Moreover, these devices do not replace damaged disks and are not involved in bone fusion inherently.

The relevant technical field under consideration relates to devices which are designed to remove damaged discs and install them in the intervertebral space and to exclude further movements at that location.

Such a device is described in US Pat. No. 4,501,269 to Bagby, which discloses an insertable device and a restricted instrument. The method used is as follows. When a hole is drilled transversely across the junction and a hollow metal basket of larger diameter than the hole strikes the hole, the hollow metal basket is filled with debris of the bone created by the perforation.

Although the present invention (apparatus, apparatus and method) appears to be somewhat similar to Beck's patent, there is little or no similarity and the difference is very significant. These differences are as follows.

1. Safety -The present invention provides a system of instruments that is fully protected such that all adjacent biostructures (eg large blood vessels, nerve structures) are fully protected. This mechanism of the present invention also prevents overpenetration by a drill. Such infiltration of the cervical spine may result in, for example, completely incapacitating the patient or causing death. In the thoracic spine may lead to complete paralysis. In the lumbar spine, it may cause paralysis or invade the aorta, vena cava, or iliac vessels, resulting in life-threatening consequences.

The device of the present invention is screwed without trauma into a suitable position, while the device of Beckby is hit in place by contrast. Becky's device must be hit if the implant is significantly larger than the perforated hole. This is very dangerous and strikes just above the spinal column, which is very sensitive to percussive injury. In addition, the device of the present invention is capable of inserting away from the spinal column and nerves, for example in the lumbar spine, while the device of the Beckyby must always strike directly towards the spinal column.

In addition, Becky's device is hit by a flexible hole with considerable resistance, and because there is no specific structural feature to fix it, if the device protrudes strongly, it poses a significant risk to the patient and the failure of treatment. Easy to cause. The device of the present invention is firmly screwed in place without trauma and has a locking thread specifically designed to prevent accidental positional deviation. Certain implant location deviations, such as might have been caused by proximity to the spinal column, spinal nerves, and blood vessels in a Veby device, may result in disaster.

2. Wide Applicability- The device of Beckby can only be inserted from the front of the spinal column, but in contrast, the device of the present invention can be inserted from the rear (dorsal) in the lumbar spine and used for cervical, thoracic and lumbar spine. This is because the purpose of these devices is for the treatment of disc disease, although more than about 99% of all spinal surgery for the treatment of disc disease is performed from the rear, which can easily utilize the present invention, the device of Bekbai can do so. It is very important in that it is not.

3. Disc removal —The device of Beckby requires complete removal of the disc prior to the drilling step, whereas the device of the present invention prepares the spinal end plate in a single step, eliminating the difficult separation process of the disc.

4. Time required -The present invention does not take much time to remove the disk before initiating the fusion, thus saving time than the apparatus of the back up. In addition, the process is carried out through the system of the guide mechanism according to the present invention, it does not take time to constantly install and replace the soft tissue retractor through the process.

5. Safety of the implant—Out of the implant position is a major cause of device damage (resulting in treatment failure) and may result in involuntary or death of the patient. As described above, the Becky devices lack any specific means of achieving safety and are highly positioned by the tendency of two elongated vertebrae to return to their initial position, which squeezes the device because it is hit to achieve vertebral elongation. Easy to escape However, the device of the present invention is screwed in place. Since there is no screw release force between the vertebrae, the compression force alone does not allow the implant to leave the position. The implant is inherently stable in structure. In addition, the threads of the present invention are very particular in that they are periodically interrupted to prevent the tail end of each tab from being blunted and twisted to prevent subsequent screw release. For the removal of implants having such "locking threads" it is necessary to use a special extractor. The safety of the device of the present invention is further improved compared to the Veby device with the “bone ingrowth” surface being tissue treated. Surface texturing increases the friction on the fit and allows the implant itself to grow directly in the vertebral bone into the casing.

6. Spinal Column Safety -The present invention not only is stable on its own, but also provides stability between adjacent vertebrae in at least three ways that are not possible with Becky's device. Firstly, the Becky device is installed transversely across the central junction, so that the vertebrae do not oscillate back and forth on this round cylindrical axis, similar to the cylindrical board used for the seesaw.

Second, because the Becky device lacks certain special design features to resist sliding, it moves substantially as a third body allowing translation of the vertebrae relative to the device and to each other.

Third, certain devices can provide stability as long as they are properly positioned. However, as with a Becky device, the Becky insert may be out of position due to the instability of the spine to be treated, resulting in further instability of the spine. In contrast, the device of the present invention is inherently stable and will ensure stabilization of adjacent vertebrae.

7. Disintegration of the Internal Space -Although both the present invention and Beckby's device may be manufactured to withstand the compressive forces within the internal space, nevertheless the internal space may not be loaded with human load from the stomach as the insert is settled in the vertebral bone. May collapse. This is related to the load per unit area. Again, the invention is superior to Becky's apparatus in at least four respects.

First, the present invention provides a fairly large surface area for distributing the load. Secondly, the device of Beckby is installed in the center, but the device of the present invention is installed in both directions when the bone is more cortical and stronger outside toward the rim. Third, the present invention supports the load with the "I" beam effect, while the device of Beckby is not. Fourth, not only the pressure causing the collapse of the bone adjacent to the implant, but also the corrosion of the bone caused by the movement of the implant in contact with the bone under pressure. As mentioned in item 6 above, the present invention provides considerable resistance to such movements, thus excluding the possibility of corrosion and collapse of the interior space.

8. Properties of Bone Intergrowth Surfaces —The present invention utilizes known conventional surface treatment techniques to induce bones to grow directly from the vertebrae into the casing material of the implant itself. Beckby's device does not have similar features.

9. Fusion Mass -Beckby's device requires removing the disc and then drilling a hole between adjacent vertebrae. The generated fragments of bone are introduced into the device. The device of the present invention takes pure bone preparation marrow from the iliac crest and then uses a special press to compress the bone forming material to a very high density until the material itself is substantially extruded from all cells of the implant. Cores allow for strong injection into the implant.

10. Achievement of Fusion—The fusion rate in the spine is directly related to the exposed intravascular bone suspension area, the quality and amount of available fusion mass, and a nearly uniform range of stability achieved by all other factors. There is this. Next, the fusion success rate of the present invention is optimal vertebral stability (# 5), optimal spine stability (# 6), bone ingrowth surface treatment (# 8), good fusion mass (# 9), and high surface area The bone surface area (# 7) will be better compared to the Becky device.

Reference is made to methods for producing materials according to the recent prior art which can be considered in connection with the present invention and thus to "internal bone growth" and to patents which disclose them.

Such patents include US Pat. Nos. 4,636,526 (Dorman), 4,634,720 (Dorman), 4,542,539 (Loewe), 4,405,319 (Cosentino), 4,439,152 (Smile), 4,168,326 (Bromer), Nos. 4,535,485 (Ashman), 3,987,499 (Skavach), 3,605,123 (Han), 4,655,777 (Dun), 4,645,503 (Lean), 4,547,390 (Ashman), 4,608,052 (Van) Kampen), 4,698,375 (Dorman), 4,661,536 (Dorman), 3,952,334 (Bochols), 3,905,047 (Long), 4,693,721 (Dutchey), 4,070,514 (Entry), etc. .

However, although the implant of the present invention uses the bone ingrowth method, it is also used in conventional techniques.

b. Prior Art Apparatus and Methods

Described below are the technical history of prior art devices and methods for inserting spinal implants.

In 1956, Ralph Cloward developed the methods and instruments disclosed to prepare and secure the cervical spine's lordosis (front). Cloward was surgically removed from the disc to be fixed and then installed a rigid drill guide mechanism with a pro formed of a large scaffold and a linear rod and the alignment was maintained to facilitate stretching the bone adjacent to the disc space by inserting the peg into the adjacent vertebrae. As the large scaffold was positioned relative to the front of the spine, it also served as a fixed reference point controlling the depth of puncture. The tubular drill guide mechanism installed prior to drilling was completely removed. Cylindrical bone dowels that are considerably larger in diameter than the holes formed were blown into the holes already formed. Claude's instrument method is designed and limited to use only from the front and in the region of the cervical spine. The hole was placed at the centerline, precluding the use of the instrument from the back, where the spinal column is obstructed.

Since the bone implant to be inserted in Clawward's method is necessarily larger in diameter than the perforated hole, the bone implant could not be inserted through a drill guide mechanism. This necessitates the removal of the drill guide mechanism, thereby leaving the implant inserted in a state that is not completely protected. Claward's method and apparatus were unsuitable for application from the back side.

In addition, it is not possible to continuously protect the elaborate neural structures for the instrument, as well as the bone and cartilage fragments generated by the Claward method during the surgical procedure making them unsuitable for application from the rear. In addition, the drill guiding mechanism disclosed by Claw Ward could not be installed from the rear in the spinal canal because the scaffold squeezed the nerves. Modifying the claw's drill guiding mechanism by removing the scaffold completely renders the instrument unusable, as it lacks safety and cannot control the depth of accommodation.

In spite of this, Wilterberger (Wilterberger and Bial Abbott's "Intervertebral Space Fusion with Lumbar Discs Used in Lumbar Disc Surgery" (1957, Bone Bulletin Surgical Bulletin, Volume 39A, pp. 234-292)) Punching disc space into the lumbar spine between nerve bases from the back and inserting a button-type plywood stack into the space Wilterberger introduces circular perforation and fusion fusion into the concept of claws. Although it provided rear access to the lumbar spine, it did not provide an improved method and was criticized for not making the process stable enough to use the instrument.

Crock (1981 Clinical Orthopedic Surgery: Intra-body Lumbar Fusion-Instructions for Use and Medical Technology, Vol. 165, pp. 165-163) describes techniques and instruments for lumbar fusion in the human body from the outside. Where two side-by-side large holes were drilled across the disc space from the intrinsically unprotected outer surface to the inner surface, and then hit at least partially cylindrical implants larger than the holes into the holes.

A review of the prior art has shown a number of significant difficulties in perforating the preparation of end plates in connection with methods and tools for performing intra-vertebral fusion.

Most spinal surgery is performed from the back in the lumbar spine, and reviewing the prior art generally exposes significant difficulties with respect to the spine, particularly with respect to the back access to the lumbar spine. These difficulties include:

1. Difficult to protect surrounding tissues throughout the surgical procedure, especially before perforation and after implantation;

2. difficult to receive debris, bone and cartilage that occurs during surgery;

3. Failure to optimize the contact of cylindrical drill holes and bone grafts, making them difficult to fit due to mismatches in diameter;

4. Failure to determine the optimal drill size before drilling;

5. failing to determine the optimum amount of stretching before drilling;

6. The amount to be stretched cannot be optimized to restore normal spatial relationships between adjacent vertebrae;

7. does not form sufficient working space in the spinal canal (between nerve base and dural sac) to make surgery safe;

8. Because of the small tolerances from the rear, there should be no scaffold on the drill guide mechanism, and the perforation will not be reliably parallel to the spinal end plate;

9. It is not possible to remove bones equally from opposite vertebral bone surfaces;

10. This includes the inability to position the dual drill holes side by side in the spinal canal.

Summary of the Invention

The present invention includes a series of artificial implants whose purpose is to cut out damaged discs and then directly perform bone fusion across the intervertebral space. Such implants are structurally load-bearing devices that are harder than bones and can withstand the considerable forces that occur in the intervertebral space. The device of the present invention has a large number of large cells and orifices, which are subjected to loads of fixation-promoting materials, such as natural bones, to affect adjacent vertebrae so that the bonds of the bones and implants are joined together. The implant casing may be tissue treated or any known technique to achieve a “bone ingrowth surface” to further enhance the stability and promote fusion of the implant.

The device of the present invention is shaped and designed to promote its own safety in the intervertebral space, to prevent the device from being out of position, and to stabilize adjacent spinal segments.

The device and method of the present invention for preparing the vertebrae for insertion of the implant allows for safe and rapid removal of the disc, preparation of the vertebrae, performance of fusion, and internal stabilization of the spinal segment.

The present invention provides a method for performing intravertebral fusion using a new instrument, wherein a protective tubular member or paired tubular member is installed before the perforated portion of the surgical procedure and held in place until the implant is fully inserted. Can be.

For example, with respect to the posterior approach to the lumbar spine, two drawers are used to separate two adjacent vertebrae by a desired distance. A hollow outer sleeve with teeth formed at one end is pressed against the adjacent vertebra on one side to secure the vertebra in place when the drawer is removed. A small diameter hollow inner sleeve is introduced into the outer sleeve, and a drill with a drill stop drills the hole through the hollow inner sleeve to the desired depth. The implant is then inserted into this hole.

The present invention provides an apparatus and method for inserting a spinal implant from the front, back and sides of the spine. The apparatus and methods of the present invention provide a stretcher apparatus configured to restore and maintain the normal angular relationship of the vertebral vertebrae known as lordosis or kyphosis before completing the fusion process. The present invention also provides an expandable outer sleeve which is a combination drawing machine used to perform the surgical procedure of the present invention, which outer sleeve is used to perform the surgical procedure of the present invention. The combined drawer and outer sleeve may also be formed to maintain normal angular relationship of the vertebrae during the surgical procedure. The present invention also provides a stretcher outer sleeve combination that may be used to perform the surgical procedure of the present invention from the side of the spinal column to protect large blood vessels and nerve structures that may be damaged during the surgical procedure. In summary, the instruments and methods of the present invention provide for total nuclear discectomy, intrabody fusion, and intervertebral fusion as a single surgical procedure.

Discussion of the Instrumentation

The apparatus and method of the present invention provide the following advantages.

1. The present invention provides for the safe protection of surrounding tissues. The outer sleeve protects the delicate soft tissue structures, nerves, blood vessels and organs outside the passages of various sharp surgical instruments and implants. In addition, the device of the present invention occupies the smallest possible area to prevent elongation associated with manual contraction, simultaneously shrinks and shields surrounding tissue throughout the circumferential direction, and passive support in that it consists only of a flexible curved surface. Improve retractor

2. The present invention provides safe protection against the risk of overpenetration of the instrument or implant.

3. The present invention protects the surgical site from debris that occurs during the procedure.

4. The method of the present invention is safe because it directly protects soft tissues and absolutely protects from direct injury due to over-infiltration. This makes the use of powerful instruments more effective and effective.

5. The present invention keeps the spine firmly fixed throughout the surgical procedure.

6. The present invention aligns and fixes the spine throughout the surgical procedure.

7. The present invention shrinks and fixes the spine throughout the surgical procedure.

8. The present invention allows all instruments introduced through the outer sleeve to be equally centered coaxially through the disk space and the parallel end plates.

9. The present invention facilitates implant insertion by preventing high compressive forces that tend to collapse space. If this compressive force is not checked, it is likely to interfere with the introduction and progression of the implant and to cause stripping.

10. The present invention maintains the entire spine securely during the surgical procedure, thereby prolonging the scope and time of surgery, and likewise extending the duration and scope of use of the spinal implants in the human body.

11. The present invention specifically increases the ability to use large implants.

12. In the present invention, the distal ends of all the intrusion mechanisms have blunt surfaces.

13. In the present invention, all instruments are stopped at a predetermined depth to prevent overpenetration.

14. In the present invention, the structure of the outer sleeve meets the spatial constraints of the particular surgical site.

15. In the present invention, the structure of the second or inner sleeve allows a difference in size between the inner diameter of the outer sleeve and the outer diameter of the drill itself. This difference is necessary to accommodate the depth of engagement of the thread formed in the circumferential direction of the stretch and implant.

16. In the present invention, a specially designed drill bit having a recess in the central shaft can safely collect the puncture product, which can be removed without disturbing the outer sleeve by removing a single unit of the inner sleeve and the drill bit. Can be.

17. In the present invention, a cylindrical hole is formed in two adjacent vertebrae across the disc space, and the bone graft is removed by removing a core of bone that is slightly smaller than the inner diameter of the implant cavity but is longer in length. Trephine is provided that is specifically designed to collect.

18. In the present invention, a specially designed press presses a long core of naturally occurring bone into the implant and extrudes it through the implant.

19. In the present invention, a specially designed driver extractor attached to an implant allows insertion or removal without detachment from the implant, except when the surgeon carefully releases it. .

20. In the present invention, pre-stretching increases the working space.

21. In the present invention, the stretching machine is an automatic aligner that acts as a direction detector.

22. In the present invention, the drawer is concentrated itself between opposing vertebral surfaces which then serve as a centering post for removing bone.

23. In the present invention, pre-stretching ensures equal removal of bone from adjacent vertebral surfaces.

24. In the present invention, pre-drawing ensures that the device exactly matches the perforated holes.

25. In the present invention, pre-stretching causes the perforation to be performed parallel to the vertebral end plate.

26. In the present invention, pre-stretching makes it possible to determine the optimal stretch before drilling.

27. In the present invention, pre-stretching makes it possible to determine the correct prosthetic size before drilling.

28. In the present invention, pre-stretching facilitates the insertion of the device by reducing the compressive loads (which inhibit transplantation) occurring across the interior space.

29. In the present invention, pre-stretching reduces the risk of shaving bone during insertion.

30. In the present invention, pre-stretching provides the necessary parallel placement, spacing and parallelism prior to critical drilling.

31. In the present invention, pre-stretching provides complete stabilization of the vertebrae opposite the disk space through the surgical procedure.

32. In the present invention, pre-stretching is easier to insert implants, since the compression load between opposing vertebrae remains checked so that the device itself does not have to be pressurized enough to insert the vertebrae.

33. In the present invention, pre-stretching may be of sufficient size to allow multiple implants to be used for their intended purpose, thereby allowing for more effective insertion of the implant and without maintaining pre-stretching. There is no need for a significant portion to be used for the purpose of separating the opposite vertebrae.

34. The present invention allows the use of implants having sharp threads or surface protrusions, as there is no risk to surrounding tissue.

35. The invention is also sufficiently preloaded, such as when the implant is provided for surgery, and may also be loaded with materials of the surgeon's choice at the time of surgery.

36. The present invention can load a spinal implant outside of the spinal canal prior to inserting the implant.

37. The present invention provides a stretcher for restoring the physiological amount of spinal prognosis / spinocytosis up to any predetermined level of the spine.

38. The stretcher of the present invention provides for repair of sagittal spinal alignment and partial correction of scoliosis.

39. The present invention provides an expandable outer sleeve such that the combined stretching machine and outer sleeve partially restore the spine to three-dimensional alignment.

Purpose of the Invention

It is an object of the present invention to provide an improved method of performing intervertebral disc ablation, fusion and internal stabilization of the spine simultaneously and in a single process.

Another object of the present invention is to provide an improved method for performing faster and safer intervertebral disc ablation, fusion and internal stabilization of the spine than with conventional methods.

It is another object of the present invention to provide an improved method of performing intervertebral disc ablation, fusion, and internal stabilization of the spinal cord to provide an improved surgical spinal implant.

It is another object of the present invention to facilitate the performance of combined discectomy, fusion and internal spinal stabilization by providing intervertebral resection that provides an improved system of surgical instruments, and fusion and internal stabilization of the spinal cord.

Another object of the present invention is to provide an improved method of performing intervertebral discectomy, fusion and internal stabilization of the spine.

Still another object of the present invention is a device for spinal fusion in the human body which is faster, safer and more effective than the prior art methods, which can be performed from the rear in the lower lumbar spine as well as effectively from the front in the cervical, thoracic and lumbar spine and To provide a way.

It is another object of the present invention to provide a means for inserting a spinal implant between adjacent vertebrae while optimally setting the vertebral spacing and maintaining alignment.

Still another object of the present invention is an apparatus for maintaining and restoring a normal angular relationship between adjacent vertebrae of the spine, partially modifying and treating spinal vision, scoliosis, and / or scoliosis, total nuclear discectomy, Intra-body spinal fusion and vertebral fusion are provided as a single surgical procedure to provide a mechanism for partially internal fixation of the spine.

It is another object of the present invention to provide a combined outer sleeve and stretcher for inserting a spinal implant between adjacent vertebrae while maintaining optimal spacing, positioning and alignment of the vertebrae.

Yet another object of the present invention is to provide a stretcher capable of restoring and maintaining normal angular relationships between adjacent vertebrae, which may be inserted in the disk space between two adjacent blood vessels.

It is yet another object of the present invention to provide an apparatus and method for vertebral fusion in the human body which is faster, safer and more effective than the prior art methods and which can be effectively performed on the cervical, thoracic and lumbar vertebrae.

These and other objects of the present invention will become apparent from a review of the following detailed description and the accompanying drawings.

1 is a side view of an elongate drawing machine of the present invention inserted into an intervertebral space;

2 is a side view of a stretcher assembly usable with respect to the spine,

3 is a perspective view of a short stretching machine having a large holding force of FIG.

3A is a side view of the short stretching machine having a large holding force of FIG. 3;

3b is a side view of another short stretching machine latched forward in the circumferential direction;

3c is a plan view of another short drawing machine of FIG.

3d is a perspective view showing another embodiment of a short drawing machine,

3E is a top view of another drawing machine of FIG. 3D,

3F is a side view of another rectangular short stretcher with a jagged surface,

4 shows a spine segment (two vertebrae and intervening) with a short stretcher in place, with a portion of the upper vertebrae and discs cut off to show the short stretcher on one side of the spine, with the long stretcher installed on the opposite side Perspective view of the disc),

5 is a side view of the outer sleeve installed on the elongate drawing machine and ready to set up to receive the drive cap;

6 is a side view of an elongated stretcher outer seat and drive cap properly fitting the outer sleeve into two adjacent vertebrae;

7A is a side view of a cervical vertebral outer sleeve installed on an elongate stretcher in front of the disk space;

7B is a bottom view of the single outer sleeve of FIG. 7A,

7C is a bottom view of the double outer sleeve,

7D is a side view of the proximal end of FIG. 7C;

7E is a bottom view of the dual drive cap for driving two stretchers,

FIG. 7F is a side view showing the double outer sleeve of FIGS. 7C and 7D and the stretcher and double cap of FIG. 7E seated corresponding to the vertebrae;

8 is a side view of the outer sleeve of FIG. 7A centered with an elongate stretcher and fully seated in the front of the cervical spine,

9 is a perspective view of a drawer puller;

10 is a side view of an adjacent puller that engages the extraction ring of an elongate stretcher shown in phantom on the distal end of the outer sleeve;

10a is a partial side view of an adjacent puller coupled to an elongated drawer immediately before extraction;

10B is a rear view of the adjacent outer sleeve and short stretcher, shown in dotted lines in place with respect to the vertebrae, discs, and nerves;

11A shows a side view of a drill and an inner sleeve in an outer sleeve that drills across the intervertebral space and partially cuts a cylindrical arc from an adjacent vertebra;

FIG. 11B is a side elevation view of the intervertebral space by another “trepine method” showing the drawer, trepine, inner sleeve and outer sleeve in place; FIG.

FIG. 11C is similar to FIG. 11A but shows a modified drill form in which the extended proximal end of the drill is oscillated and auto-centered; FIG.

11D is a side perspective view of a mechanism for removing and then drilling an arc of a bone from a vertebrae;

12 is a side perspective view of a surgical tab,

FIG. 13 is a partial cross-sectional view showing an outer sleeve and a surgical tab threaded sufficiently in space;

14A is a side view of the bone harvesting trepine and motor adapter,

14B is a perspective view of the implanted bone loading device;

14c is a perspective view of a corkscrew to release and remove the instrument;

15 is a perspective view of the bone loading device at the time of surgery,

16 is a partial cross-sectional perspective view of an implant drive mechanism for engaging a spinal implant;

17 is a partial cross-sectional view of a spinal implant seated sufficiently in the intervertebral space by a drive mechanism device positioned in place in the outer sleeve;

18 is a side view of the lumbar spinal cord showing the final result of spinal implant insertion via the posterior root;

19 is a side view of the posterior long spinal column stretcher inserted from the rear of the spinal cord between adjacent vertebrae to restore and maintain only the spinal column of the spinal cord;

20 shows repair and maintenance of vertebral lordosis of the spine, with the outer sleeve and cap partially shown in dashed lines, with an outer sleeve inserted between adjacent vertebrae to engage the vertebra and properly seated on a stretcher that is only long from the back. Side view of a long stretcher only in the spinal column from the back for

FIG. 21 is a view of a spinal implant inserted through an outer sleeve between two adjacent vertebrae of the spinal column, showing that lordosis is repaired and maintained and that a portion of the bone has been removed from each vertebra to receive a spinal fusion implant. Drawing,

FIG. 22 is a side view of a spinal implant inserted between two adjacent vertebrae of the spine such that the prefrontal disease is repaired

Fig. 23 is a side view of the stretcher short only in the spinal column from the rear of the present invention;

FIG. 24 is a plan view along line 24-24 of FIG. 23 of a short stretcher of the spinal column from the back of the present invention;

25 is a side view of the spinal column only elongator from the back of the present invention inserted between two adjacent vertebrae from the back of the spine to repair and maintain only spinal column;

Figure 26 is a perspective view of the expandable outer sleeve of the present invention having an elongated member for insertion into the disk space and engaging means for engaging the adjacent vertebrae of the spine;

27 is a side view of the expandable outer sleeve of FIG. 26 inserted between adjacent vertebrae of the spine;

28 is an illustration of another embodiment of the expandable outer sleeve of FIG. 26 without using a joining means for joining adjacent vertebrae;

FIG. 29 is a perspective view of the vertebral columnar extended outer sleeve from the back of the present invention having an irregularly extended member for restoring and maintaining only the spinal column of the spine and a coupling member for engaging the vertebra; FIG.

FIG. 30 is a side view of the rearward expandable outer sleeve of FIG. 29 inserted between adjacent vertebrae from the back of the spine to repair and maintain only spinal column;

31 is a perspective view of the front vertebral column only expandable outer sleeve of the present invention with an extended member to restore and maintain only the spinal column of the spine from the back of the spine;

FIG. 32 is a side view of another embodiment of the vertebral vertebra only front extended outer sleeve of FIG. 31 without using a coupling means for vertebral engagement inserted between adjacent vertebrae from the front of the spine; FIG.

33 is a perspective view of a double expandable outer sleeve with irregular extensions decreasing in height in the direction of insertion;

34 is a bottom view of the footrest of the double expandable outer sleeve of FIG. 33;

35 is a perspective view of a double expandable outer sleeve with irregular extensions decreasing in height in the insertion direction;

36 is a front view of the device of the present invention installed on two elongate stretchers with peg inserted into the vertebrae for use in installing an intra-body spinal implant having one or more flat sides;

37 is a bottom view of the footrest of the device according to the invention for use in installing an intra-body spinal implant having one or more flat sides;

FIG. 38 is a cross sectional view taken along line 38-38 of FIG. 36 of a device used to insert an intra-body spine having one or more flat sides;

FIG. 39 is a device of the invention for use in mounting an intra-body spinal implant having one or more flat sides, with a peg partially inserted into the vertebrae;

FIG. 40 is a device according to the invention for use in mounting an intra-body spinal implant having one or more flat sides, illustrating the steps of a method for puncturing a hole into the vertebra and engaging the adjacent vertebra of the spinal column. Drawing showing that,

FIG. 41 illustrates the steps of a method for inserting a second intra-body spinal implant with one or more flat sides into two adjacent vertebrae, with one implant pre-installed in place.

The detailed description that follows will be described in connection with the application to the lumbar spine through the rear approach. In its simplest form, the method of the present invention comprises the following steps. The patient is laid on the spinal column to fix the stretching and alignment of the disk space. The posterior exposure is then performed on both sides, either partially or without discectomy. A drawing machine is used to draw the disk space and a hollow outer sleeve is fitted to one of these drawers. The distal end of the outer sleeve is provided with engaging means such as teeth for engaging two adjacent vertebrae. The outer sleeve is introduced into the vertebra and then the drawing machine is removed. A hollow inner sleeve is then inserted into the outer sleeve and a stopped drill is used to prepare the opposing vertebral surface. The drill and inner sleeve are removed as a single unit. Tap space if required. The prepared spinal implant is then inserted through the outer sleeve using a stop insert. Then remove the instrument and repeat the process on the opposite side of the spine.

Detailed description of the preferred embodiment

Step 1a. Before surgery, in order to select the optimal implant size and to determine the desired stretch, appropriately sized translucent implant templates are placed on the AP, lateral and coaxial images of the internal space in which fusion is to be performed. Overlap

Step 1b. It is desirable to lay the patient on a spinal surgery table that will induce stretching and vertebral alignment.

Step 2. In a preferred embodiment, standard bilateral (partial) discectomy is performed and the periphery of the vertebral body adjacent to the interior space is removed. In a variant, the disk material does not need to be removed. In a preferred embodiment, the internal space performs a pair of semihemilaminotomies on both sides, cuts the inner surface of the face joint adjacent to the spinal canal, and retains the interspinous ligaments between the bone and the vertebrae. Exposed.

Step 3. Starting on the first side, the dural sac and transverse nerve base at this level contract on average, and then a long stretcher is inserted and impinges on the posterior vertebral body adjacent to the space. Next, the elongate drawer with the distal end of increasing diameter is inserted sequentially until optimal drawing is achieved. The optimal stretching not only restores the normal height of the space, but also prevents the possibility of a balanced and collapse of the space. This space collapse causes the soft tissue structures to be pressed at equal pressure to the vertebral segments, including the outer casing of the disc (annular fibrous), the various ligaments and capsule structures, as well as the muscle and other soft tissue structures, when spacing the vertebral bodies. This balanced stretching not only partially restores the height of the space, but also provides significant safety as the space prevents further stretching or collapse.

In a preferred embodiment, as the desired stretching is achieved, the use of the rigid elongate stretching machine is terminated, and a releasable dedicated stretching machine is installed in conformity with the stereo and / or radiograph. After the drawable drawer is released, the short drawer remains in place and the very low profile head is adjacent the canal floor but is safely located away from the neural structure. Short drawers may use the short drawers of various embodiments while varying the degree of resistance to movement so that they can remain in place until their removal is necessary. In a preferred embodiment of the process, attention is then directed towards the opposite side of the spinal cord.

Step 4. A long drawing machine is inserted on the opposite side of the same inner space, the diameter of its working end being identical to the diameter of the short drawing machine already installed in place. However, if it is determined that the second side needs to be further stretched to achieve optimum safety due to the asymmetric collapse of the interior space, a short drawer suitable for this may be installed on the second side. The short drawer will then be removed from the first side and replaced with a longer long drawer to balance the interior space.

In another embodiment, the entire surgical procedure is performed on one side of the spine using only a long stretcher before repeating the process on the opposite side of the spine. This method can be performed according to the remaining steps, as already described in the preferred embodiment, but this is best done using trepine. Trepine allows the long drawer to be held in place, thereby allowing interspace stretching provided in the first method by a short drawer. This modification method requires the use of trepine on a long stretcher instead of a reamer and is called the "trepine method". This will be described in detail later.

Step 5. By means of a short drawer in place on the first side of the spine, a long drawer in place on the second side of the spine, a dura sac and a transversely retracted transverse nerve, the outer sleeve is installed on the long drawer and furthermore an impact cap And using a melt to strike firmly to the optimum depth. The long drawer is then removed.

Step 6. The inner sleeve is then installed in the outer sleeve, and the inner space is then bored, such as a drill, end mill, dilator, or trepine, to drill, enlarge and cut the bone to be removed for both sides. means) as well as the remaining intervening disc material to prepare on the side. In a preferred method, using a specially designed endmill-drill, the endmill-drill and the inner sleeve will be removed as a unit, safely transported from the bone and caught disk debris from the spinal canal into the unit.

Step 7. If necessary, a thread forming tool with penetration limiting means for adjusting the insertion depth is inserted through the outer sleeve, if necessary.

Step 8. The prepared implant is then inserted using a special drive mechanism unit. The implant may be coated and / or made and / or loaded with a material suitable for bone fusion that may promote bone growth and / or fusion. However, in a preferred embodiment, the implant is treated with bone promoting and inducing materials, but loaded with materials suitable for fusion.

Although natural and artificial materials are included within the scope of the present invention, preferred embodiments relate to the use of bone in a patient by the following method. Hollow trepine is used to harvest the core of the bone from the back of the iliac humerus adjacent to the sacroiliac joint. This core of bone has an outer diameter slightly smaller than the inner diameter of the spinal implant to be loaded and is longer in length than the spinal implant. Using an instrument designed for this purpose, the core of bone is injected from trepine into the central cavity of the implant. This causes too much bone material in the implant to compress the bone material through an opening in communication with the outer surface of the implant.

Step 9. Using the drive instrument extractor, the prepared implant is screwed into the prepared internal space. The instrument is removed from the side of the spine and concentrated towards the first side of the spine. The small retractor moves the dural sac and transverse nerve bases to some degree and protects them so that the short stretcher unit retained can be seen directly. Without removing the short drawer, it is assembled to its shaft portion to reconstruct itself into a long drawer. With the implanted implant acting as a stretcher on the opposite side, the long stretcher is used to guide the outer sleeve downward when blown as described in step 5.

Steps 6 and 7 are then repeated to complete the surgical procedure. Enema and suture the affected area in a defined manner.

Representative Examples of Preferred Methods

MRI scans of the patient's front, back, lateral and coaxial images by transparent superposition of different sized implants allow accurate template diameter and length to be accurately assessed through the template prior to surgery, as well as premorbid height Evaluate the exact amount of stretching required to recover. Then, the patient is properly positioned and partial intervertebral discectomy is performed on both sides by paired halves.

For the purposes of this example, it is assumed that the correct implant is determined to be 18 mm and 26 mm in length by preoperative evaluation. In addition, the stretching required to recover the height of the inner space will be about 10 mm. While the dural and transverse nerve bases are moderately shrunk and protected, a long stretcher with an outer diameter, i.e., 18 mm, having a diameter of about 8 mm at the working end will be inserted while the barrel portion corresponding to the implant to be inserted will be inserted. Direct observation has shown that this is slightly smaller than optimal, with its tubular portion having an outer diameter of 18 mm, but with a dedicated drawer having its working end having an outer diameter of 10 mm. Confirming ideal stretching by direct observation and / or x-ray imaging, the dedicated stretching machine is dismantled, the barrel and head portions are removed, the short stretching portion is kept deeply inserted and its flange head is held against the tube floor. It may be parallel and deeply inserted into the neural structure. The dural sac and neural structures can be safely returned to their normal position, which is located on the surface of the flanged portion of the short stretching machine.

Now discuss the opposite side. The dural sac and nerve base contract to a moderate extent on the second side, and an elongate stretcher with a barrel section of 18 mm diameter and a working end of 10 mm will be inserted into the interior space and run horizontally with the bone if necessary. Any osteophyte thus moved by striking is removed in advance, allowing the shoulder of the barrel to lie flat against the back of the abutment body. The dural sac and nerve base are still retracted, but the outer sleeve is installed on an elongated stretcher and fitted to the optimal depth using a drive cap and a mallet.

In a preferred embodiment, the elongate stretcher is removed and the inner sleeve is inserted into the outer sleeve. Since the purpose of the inner sleeve is to support the drill and allow the size of the implant to be larger than the size of the drill, the implant is insertable through the outer sleeve, thus the outer diameter of the inner sleeve is 18 mm and its inner diameter is 16.6 mm . This allows to fit in the outer sleeve, allowing the introduction of a drill bit whose diameter is 18.1 mm and a diameter of 16.5 mm.

Following the drilling process, the drill and the inner sleeve are removed as a single unit with cartilaginous and bone fragments hanging on it. The penetration depth of the drill is preset and limited by the fixed rigid column of the outer sleeve. In this embodiment, the inner space will be prepared to a depth of 28 mm in anticipation of drilling at least 2 mm further into the 26 mm long implant. If tabs are used, the major and minor diameters of the implant to be inserted will be adjusted, and the depth of penetration will be controlled by the drill. The spinal implant will be prepared for insertion using trepine to collect the core of the posterior iliac bone having a length of at least 30 mm and a diameter of about 14.5 mm.

Using a bone loading device, the core of this bone is strongly injected into the inner chamber of the spinal implant, which is capped. The fully loaded implant will be attached to the front end of the cap end, ie the insertion drive below the outer sleeve, and will be screwed into place at the depth of penetration by the insertion drive mechanism. The dural sac and nerve base are reduced and protected, and the outer sleeve is removed. This completes the fusion process on the side, and as described above, the surgical process will be repeated on the other first side of the same interior space.

Transformation method

A variant and extremely useful method is the "trepine method". This has the advantage that instead of using a hollow tubular cutter called trepine for the use of the drill in step 5 of the preferred embodiment, it can be used in conjunction with the preferred embodiment. In addition, this precludes the need to install a short drawer and maintains stretching at the site of bone removal, despite allowing it to be performed efficiently from start to finish on one side before starting the surgical procedure on the opposite side.

The "trepine method" is described below.

Exposing the space on at least one side, the dural sac and nerve base contract. The elongate stretcher differs from the solid stretcher of the preferred embodiment in that the barrel portion is of a finer diameter than the spinal implant. As in the preferred embodiment, the outer sleeve has a slightly larger inner diameter than the implant to be inserted. Thus, at this time, the first inner sleeve is inserted into the outer sleeve to form a difference between the outer diameter of the elongate stretching machine and the outer diameter of the outer sleeve. The outer sleeve and the first inner sleeve are thus assembled so that they are mounted on the elongate drawing machine, and the outer sleeve is optimally seated using the impact cap. The cap and the first inner sleeve are removed, but the long stretcher and outer sleeve remain in place.

The elongate drawer maintains optimal drawing and the outer sleeve holds the vertebrae together to prevent any movement of the vertebrae, and a hollow tubular cutter known as trepine is inserted over the elongate drawer and its barrel portion is inserted into the outer sleeve. . The trepine stopped at the appropriate depth is used to equally cut the bone from the opposing vertebral endplates.

In a variant, the second inner sleeve may be installed in the outer sleeve or in the second sleeve before installing the trepine on the elongate stretching machine. The second inner sleeve has an inner diameter larger than that of the elongate stretching machine and has an outer diameter smaller than the inner diameter of the outer sleeve. This improves the safety of trepine, but is produced in the form of a long flute that obliquely runs longitudinally along the outer surface of the drawing machine with respect to the barrel to accommodate bone and cartilage fragments that occur during the cutting process. Need to be.

After using trepine to the appropriate depth by these methods, the trepine, elongate drawing machine and the second inner sleeve are all removed if desired. Since trepine cuts two arcs in the bone, but does not extend their width, a shaft mechanism with a vertical cut at its working end is inserted in parallel into the disk space and cuts the base of the two longitudinal cutting arcs. The motion is transmitted through the arc, removed through the outer sleeve and released. This inner space may optionally be tapped and the implant inserted as a preferred method. As mentioned above, the "trepine method" may or may not use a short drawer on the opposite side.

Application of the method in other parts of the spine

The following method is a preferred embodiment for performing intra-body spinal fusion from the rear in the thoracic and lumbar spine. It is also suitable in the cervical spine where it is possible to install two implants side by side from the front over the width of the vertebra and enough to protrude the length of the implant into the vertebra at least a few millimeters away.

The internal space to be fixed is properly exposed and the soft tissues and vital structures are reduced and protected on both sides. If the width of the internal space is visible from the back, it is possible without the neural structure associated with the back of the spine. The center line is displayed in front of the interior space. The disc is removed using a first knife and, if necessary, using curettes and rongeurs. In a variant, the disc remains intact during the puncture phase of the surgical procedure. However, in a preferred embodiment of the surgical procedure, large stretches of nucleus and annulus are removed from the front surface, and elongated stretchers whose diameters of their working ends gradually increase into the inner space at the point between the midline and the lateral range of the spine. Is inserted.

A double outer sleeve with a common footrest and retaining peg is inserted over a long stretching machine installed alone and on a second stretching machine or on both stretching machines if it is preinstalled. The double outer sleeve is firmly seated in the front of the spine. Any spurs that interfere with the horizontal fit of the scaffold to the front of the spine should be removed before inserting the long stretcher. When the outer sleeve is fitted optimally, one of the elongated drawers is removed and the inner sleeve and drill bit are inserted in the removed position. The outer diameter of the drill bit is equal to the minor diameter of the implant to be inserted. The thickness of the inner sleeve is basically as much as the difference between the major and minor diameters of the screwed implant.

A stationary drill is used to prepare opposing vertebral surfaces and to remove any disc material. If desired, the stop tab may be inserted through the outer sleeve or into the inner space to form a thread. A properly prepared implant is inserted into the insertion drive mechanism and then introduced through the space through the outer sleeve until its penetration depth is limited by a stop on the insertion drive mechanism. By the implant itself in any position to act as a stretcher, the long stretcher is removed from the opposite side and the process is repeated. If both implants are firmly in place, the outer sleeve may be removed. Diffuse head formation of the implant may be adjusted while observing directly.

Detailed Description of Methods and Apparatus of Preferred Embodiments

In a preferred embodiment, the discs D between adjacent vertebrae V are accessed via paired half vertebral resections on both sides of the adjacent vertebrae. In a preferred embodiment, the surface prickly ligaments, the internal prickly ligaments, a portion or the majority of the spines or flakes are retained at the cut plane junction. However, although less preferred, these structures may be removed.

In a preferred method, partial nuclear intervertebral discectomy on both sides is performed through both side openings formed through the back side of the annular fibrous. Although not preferred, the disc can be cut later and resected with the vertebral bone during the drilling process. Starting on the first side, the dual nerve base retractor is installed such that the dural and lower nerve bases are moderately contracted to allow access from the back side to two adjacent vertebral bodies and one side of the intervening disc.

Referring to FIG. 1, preferably after removal of a portion of the nuclear disc material, the elongate stretcher 100 is inserted into the intervertebral space while directly observing. The disk penetration 102 is basically cylindrical with an annular shear 103 and a shoulder 104. In the shoulder 104, the penetration 102 extends from the barrel 106. The penetrating portion 102 spaces the vertebral body to facilitate the introduction of the mechanism. Subsequently, an elongated drawing machine having a penetrating portion 102 of increasing diameter is inserted. When the diameter of the penetrating portion 102 becomes optimal, the vertebrae V are pressed to be sufficiently matched to both sides, so that they are parallel to each other as well as to the penetrating portion 102. At this time, any residual protrusion of the posterior vertebral body adjacent to the posterior disk, which has not been removed before, strikes the crown 110 with the hammer flat surface 109 and drives the shoulder 104 relative to the periphery of the vertebrae V. Leveled with the vertebral body by a forced shock such as. Since the drawing is optimally made with respect to the pressure of the vertebral end plate against the penetration 102, the elongated stretching machine 100 is placed completely perpendicular to the plane of the rear body and is arranged completely parallel to the vertebral end plate, thereby performing Allow for optimal alignment of the surgical procedure.

Although the penetrating portion 102 may be used in various diameters, all the penetrating portions may have a constant length smaller than a predetermined depth of the inner space. This combination with the circumferential shoulder 104 is so large that it is difficult to fit into the interior space, thus preventing the risk of overpenetration. The barrel 106 is of the same diameter as the outer diameter of the device to be implanted. The recess 108 under the crown 110 allows the elongate stretcher 100 to be coupled to the extractor unit shown in FIG. 9.

2, in a preferred embodiment, a variable elongate stretcher 113 is used on the first side of the spine. The variable elongated stretcher 113 has a tub member 152 that can be separated from the short stretcher 120. Although initially stretched by a solid elongate stretcher, it is also possible to use a long elongate that can be suitably adapted to draw optimally. The variable elongate stretching machine 113 is composed of a tubular member 152 having a short stretching machine 113 and a protruding portion 134 having a rectangular end portion. Short stretcher 120 has an increased diameter head 128, a rectangular groove 118, and an internal threaded opening 114. The cylinder member 152 has an inner shaft 111 terminated with a large hexagonal crown 115 and a portion 112 having a reduced diameter. The detent portion 117 is provided on the flat surface of the crown 115. The other end of the shaft 111 has an end screw 116 that screwed correspondingly to the screw opening 114. The shaft 111 is prevented from being removed from the barrel member 152 by a set pin 119 that passes in a convenient manner through the wall of the barrel member 152. The short stretching machine 120 is removably attached to the cylinder member 152 via the coupling of the rectangular male groove 118 and the female coupling member 143. This coupling is achieved by engaging the crown 110 with the inner shaft 111 formed with the end screw 116 acting as a thread and driving them using the handle 135. The end screw acting as a thread is screwed into the male rectangular groove 118 of the short drawer 120.

The handle 135 has an open socket 138 for fitting around the crown 115 and has a hexagonal portion of reduced diameter to allow rotation of the end screw 116 threaded with the shaft 111. Join 112. The detent ball 150 on the inner side of the socket 138 engages and supports the detent 117 in the crown 115.

2, 3 and 3A-3F, the short stretcher 120 is to provide a high degree of safety when temporarily placed to prevent inadvertent movement during surgery on the second side. It is designed. To this end, the embodiment of the short stretcher 120 shown in FIGS. 3 and 3A includes a pair of sharp caps 126 embedded in opposing vertebral bodies and an omnidirectional latch 124 to further prevent rearward movement. It is provided. 3B and 3C, which illustrate a preferred embodiment, are side and top views of another embodiment of a stretcher portion having a circumferential omnidirectional latch 124, although the stretcher portion to be inserted between the vertebrae is necessarily cylindrical.

3D and 3E, another embodiment of a short drawer is shown. It has a more rectangular structure with an omnidirectional latch and without the sharp peg 126 of FIG. Figure 3f shows the wave shape to increase the interference with the bone surface and to prevent positional movement to add safety to the unit. To this end, the working ends of both the long and short drawers may have various shapes depending on the purpose, and the end of the shape with or without pruning 126 as well as the irregularities of the surface may be used. 120 may be made more resistant to movement.

Once the first side of the spine is ideally stretched, the dedicated stretcher is detached, leaving the short stretcher 120 in place at the safe depth of the vertebral canal bottom and dural sac and nerve base.

Referring to FIG. 4, the surgeon moves to the other side of the spine at the same disc (D) level and moderately contracts the dural sac and nerve base to expose the disc on its side. The elongate stretching machine is then inserted sequentially into the disk space until the diameter of the stretching machine is at least as large as the diameter of the first side. Since the inner space is slightly asymmetrical, if a larger diameter drawer is required on the second side for ideal stretching as compared to the first side, a shorter stretcher with a larger diameter is fitted on the second side, and surgery is directed to the first side. Will be returned. In this case, the short drawer of the first side will be removed and the long drawer 100 corresponding to the increase in the diameter of the short drawer 120 already installed will be fed. In both cases, surgery continues on one side where a long stretcher is installed. In this regard, by using a device such as the Michelson Orthopedic Support Frame of U.S. Patent No. 4,481,943, issued November 13, 1984, the surgery uses a drawer or simply installs an accurate long drawer on the first side. In order to do this, surgery is not performed and the procedure is performed on the side before moving to the opposite side. These variables are within the scope of the present invention.

Referring to FIG. 5, the elongate stretcher 100 acts as an alignment rod for the centering post and the hollow outer sleeve 140. The alignment rod is fitted over the elongate stretching machine 100, indicated by dashed line 101. The front portion of the outer sleeve 140 is metal and has a sharp tooth 142 that can be inserted into two adjacent vertebrae V and firmly support them. The circumferential sharp teeth 142 interfere with the flat planar area 152 which serves to prevent further insertion of the sharp teeth 142 into the vertebral body. The sharp tooth 142 of the outer sleeve 140 is a continuous portion of the tubular shaft 144. It is connected to a circumferentially enlarged tubular trailing end 146 with a corrugated outer surface 148 for easy handling. Another embodiment of the outer sleeve incorporates a keyhole and groove form 154 that is extendable with respect to both sides of the shaft 144 along and parallel to the central plane of the space such that the teeth 142 are provided on both sides of the disk D. FIG. Prevents collapse of the vertebrae V, but nevertheless allows their further stretching if the diameter or base diameter of the implant is larger than the perforated hole.

Drive cap 160, in the form of an implant cap, has a flat sealing surface 162 at the distal end of the cap and a circular opening at its opposite end. Drive cap 160 is fitted over outer sleeve 140 and elongate stretcher 100. As the drive cap 160 is mounted, the inner surface 170 engages circumferentially with the portion 146 of the outer sleeve until the rear end 172 is engaged with the inner shoulder 164. As the mallet strikes the surface 162, the force is transmitted to the outer sleeve 140 via the inner shoulder 164 and through its distal end 172 into the vertebral body adjacent to the disc space D. And the depth of the sharp tooth 142 relative to the flat portion 152. As the outer sleeve 140 advances forward, the crown portion 110 of the elongate stretcher may protrude unobstructed within the drive cap 160 until it contacts the inner flat surface 168.

Referring to FIG. 6, once the crown 110 is in contact with the flat inner surface 168, the additional tabs of the mallet will not advance the outer sleeve, and the additional movement will result in a long contact with the rigid surface of the back vertebral body. It will be prevented by the flat shoulder 104 of the drawer. In this way, the outer sleeve 140 is securely and securely inserted at its optimum depth and strongly secures the two opposing vertebrae as shown in FIG. 6.

Referring to FIG. 9, the cap 160 is then removed and the elongated stretcher 100 is removed from the spine using the stretcher puller 200 of FIG. 9, leaving the outer sleeve 140 in place. The drawer puller 200 has a front portion 202, a central portion 204 and a rear handle portion 206. In the front portion 202 of the drawer puller 200, the socket 208 has its distal end connected to one end of the shaft 210. Socket 208 is formed in cavity 212 with its front end open and its side tapered inward. This cavity 212 is configured such that the head of the drawer puller 200 and the circumferential flange 218 partially engage the circumferential recess 108 of the drawer 100. The inlet of the cavity 212 is slightly funnel-shaped and the tip of the flange 218 is slightly rounded to facilitate coupling of the recess 108 and the head 110 of the stretcher 100. This is easier in that the drive cap 160 precisely levels the recess 108 of the stretcher 100 with the back 172 of the outer sleeve 140. This provides a large flat rear face 172 and also precisely guides the surface 230 and opening 212 of the socket 208 around the head 110 while the flange 218 engages the recess 108. The spring loaded detent ball 228 couples to the hemispherical settlement 112 in the crown 110, as shown in FIG. This spring loaded detent 228 is combined with the supplementary detent 218 to prevent inadvertent separation of the long drawer from the puller 200 after the drawer has been removed from the outer sleeve 140 and before it is removed from the affected part. do. In this position, the two mechanisms are separated out of the body by separating crown 110 from cavity 212 by manual force applied perpendicular to the relatively long axis.

A cylindrical removable balance weight 216 is fitted around the shaft 210 between the front portion 202 and the rear handle portion 206. When this counterweight 216 is gently and repeatedly sliding along the shaft 210 and driven backward with respect to the flat surface 228, a long stretcher to which a rear vector is transmitted to the near front 202 and to which it is coupled 100 is passed.

Paired extended handles 224, 226 allow the surgeon to support excessive back movement of the instrument when the instrument is used to release the elongate stretcher 100. Paired handles 224, 226 are also useful in that they allow rotation of portion 208 via shaft 210. This allows the surgeon to alternately control the direction of the opening of the cavity 212, thereby facilitating application of the stretcher 100 to the head 110.

The drawer puller 200 is a significant improvement over the option of hitting the removal mechanism with individual hammers on exposed lesions or by hand drawing the drawer with strong tensile force. It is dangerous to use free hammers in incisions. That's because the mallet head can swing back and strike the nerve structure by the effects of gravity. Manually pulling and contracting is dangerous because it will interfere significantly with the vertebral portion 102 and significant force is required to remove the stretcher 100, and if the forces are not coaxial, the outer sleeve may be out of position or misaligned. have. In addition, if the flat portion 102 is separated from the space, all resistance to contraction will be lost and the stretcher 100 will injure the patient and / or surgeon under the influence of the considerable force needed to release the instrument. It may be.

Once the long stretcher 100 has been sufficiently removed from the outer sleeve 140, the toothed end 142 of the outer sleeve 140, which acts in conjunction with the short stretcher 120 on the opposite side, determines the relative position of the adjacent vertebrae. Keep it. In addition, because the rest of the process is performed entirely through the protective outer sleeve 140 at a portion of the vertebrae, the nerve and dural sac are external to the outer sleeve and are firmly embedded in the adjacent vertebrae (V). Since on the surface of the toothed end 142, the outer sleeve 140 is suitable to ensure the safety of these sophisticated neural structures. In addition, since the outer sleeve 140 is fixed in length and rigid, its flat rear surface 172 may be used as a detent for the advancement of all instruments installed through the outer sleeve 140 to prevent accidental over-infiltration. have. In addition, the outer sleeve 140 ensures that further processing to be performed takes place coaxially in the disk space D and symmetrically with respect to each opposing vertebral surface.

Referring to FIG. 10B, there is shown a front view of the spine at a surgical stage where a short stretcher 120 is installed on one side of the spine and a bottom portion of the outer sleeve 120 is installed on the opposite side of the spine.

Referring to FIG. 11A, the inner sleeve 242 is inserted from the rear of the outer sleeve 140. This inner sleeve has a collar portion 244 of a predetermined thickness that abuts against the upper edge surface 172 of the outer sleeve 140. The cylindrical barrel member of the inner sleeve 242, when fully fitted, will resemble the backside of the vertebral interior of the outer sleeve. A drill 240 having a predetermined length selected is then introduced through the rear opening of the inner sleeve 242 and pre-determined an arc of bone to be joined from any disc material in the passage as well as from the opposing vertebral end plates and limited depth. It is used to expand into. The drill 240 has a narrow engagement portion 246, which allows the drill to fit into a drill mechanism, which may be a manual or power unit. The large diameter circumferential collar 248 serves to limit the penetration depth of the drill 240 and may be fixed or lockable.

Various mechanisms for braking devices such as drills are not shown here but are well known to those skilled in the art. The mechanism uses, but is not limited to, flanged grooves that are forced therein by collets, threaded shafts with locking nuts, and caps pulling the flange top or screwing down the flange.

In a preferred embodiment, the design of the large longitudinal groove drill is such that the front cutting edge 252 of the drill 240 is shaped like an end cutting mill, which may have a number of but preferably four or more cutting surfaces on which the end moves. By modifying the cutting surface is relatively low in depth so that progression occurs more slowly. The outer diameter of the drill 240 corresponds to the minor diameter of the threaded vertebral graft. The inner sleeve 242 has an inner diameter that is slightly larger than its size and the outer diameter is somewhat smaller than the inner diameter of the outer sleeve 140 having the same outer diameter as the major diameter of the threaded graft.

The drill shaft of the drill 240 includes an upper portion 243, a smaller central recess 256 and a lower cutting drill portion 250. The upper portion 243 of the drill 240 and the lower portion 256 of the drill 240 have the same outer diameter.

Inner sleeve 242 serves many functions. First, this provides more detailed drill guidance for the drill 240 when a hole of a diameter smaller than the hole of the inner diameter of the outer sleeve 140 is drilled. Second, because the inner sleeve guides the drill, the outer sleeve 140 can have an inner diameter large enough to allow for the threaded spinal implant, and usually the implant is actually larger in diameter than the drill 240 itself. Significantly bigger.

If a large diameter outer sleeve 140 was used without an inner sleeve, the drill 240 would move freely in the larger inner space and would not be able to reliably form parallel cuts that separate the same portion of the bone from the adjacent vertebrae (V). will be. In addition, the separation of bones not only needs to be uniform, but also must be oriented exactly in three directions. That is, the path of the drill 240 should be equally centered inside the parallel sagittal sutures that cut between the intervertebral cartilage, the parallel end plates and the internal space.

An additional purpose of the inner sleeve 242 may be detached simultaneously with the drill 240 by capturing tissue fragments along with cartilage and bony generated during the drilling process by the long longitudinal grooves 251 of the drill portion 250. Guided backwards and captured here in the groove 256 between their groove and the inner wall of the inner sleeve 242. Thus, by separating the drill 240 together with the inner sleeve 242, tissue fragments generated by the dilation process are safely separated from the vertebral canal and wound area.

In addition, if the intervertebral cartilage tissue of the area to be enlarged is removed in advance as in the preferred method, then good quality bone to be used for the patient's own surgery will then be received between the inner sleeve 242 and the groove 256 of the shaft. Far from the surgical lesion, the material may be placed deep in the interior space to be loaded or secured to the spinal implant.

The method of actually forming a surgical hole inside the vertebra is variable. As shown in FIG. 11C, the drill end 250 of another embodiment has a front protruding nipple 260, which itself is easily introduced into the intervertebral cartilage space and its tip portion to allow the vertebra to be spaced apart. The shape is made into a bullet shape. Nipple 260 is dislocated and stabilized to prevent the tendency of the vertebrae to move with each other, and is symmetrical to the bone from the opposing vertebral surface, being self-centered on the drill portion 250 when actuated with sleeves 140 and 242. Regular moderation is possible.

Referring to FIG. 11B, a variation of the "trepinene method" mentioned earlier in the present application is shown. In this variant, the elongate stretching machine 100 is placed in place after the outer sleeve 140 is seated. In this case, the elongate stretching machine 100 differs from the preferred embodiment in that the outer diameter of the cylinder 106 is smaller than that of the conventional one. This is necessary because the holes formed irrespective of the present invention correspond to the small diameter of the spinal implant. The hollow, tubular member having trepine 270, a sharply cut tooth 251 at its proximal end, has a long wall thickness because the outer diameter of trepine 270 must match the base diameter of the implant. It has a wall thickness that can be reduced corresponding to the diameter of the stretcher 100.

In the "trepine method" of the elongate stretcher 100, a further variant is provided with a longitudinal groove (not shown) along the tub surface 106 for the purpose of transferring any debris that occurs rearwardly during the cutting process. Is to use. Since the cutting components are centered and aligned by a long stretcher, the inner sleeve 242 need not be used but may be much more useful for controlling the path of debris tissue. To this end, in the "trepine method", since arcs of bone are connected to distant ends, a small amount of debris tissue is generated even when they are simply not cut or expanded when cut into bone. Thus, when the trepine method ends and the trepine 270 and the inner sleeve 242 are separated, it is necessary to separate both the arcs of the bone and any intervening material, unlike in the preferred embodiment where the holes are drilled. The need remains. Nevertheless, this is very easily accomplished by various means, one of which is shown in FIG. 11D.

Referring to FIG. 11D, there is shown an apparatus 272 consisting of a shaft and handle 274 attached off-center to a lower surface 273. Shaft 274 terminates at cutting arm 278. The device 272 is inserted through the outer sleeve 140 and the lower surface 273 of the handle 274 is coplanar with the top surface 172 of the outer sleeve 140, and the downward movement of the device 272 is controlled. Stop, and when the handle 274 is rotated, the vertical cutting arm 278 of the device 272 is correctly positioned so that the cutting arm 278 is also rotated, cutting the arc of the bone and removing them from their final attachment state. Terminate. These parts of the bone are separated using these devices or long tweezers and will be placed inside the implant or otherwise secured.

12 and 13, in a preferred embodiment of the present invention, a spinal implant is provided that the bone is particularly hard enough that it may be desirable to form a screw pattern in the interior space prior to insertion of the implant (I). It is essential that I) diverge itself. For this purpose, as shown in FIG. 12, the tab 280 has a threaded portion 282 connected to the handle 292 by a shaft 286. The handle is here designed to provide mechanical advantages to the rotation of the device for thread cutting. The lower portion of the handle 290 has a forward facing face 288 that is too large to fit snugly through the opening of the outer sleeve 140, thereby safely limiting the penetration depth of the cutting component 282. do. This tab 280 is further secured by a blunt end 294 that will engage the non-cut portion of the vertebral bone just prior to engaging the shoulder 288 to the surface 172. This feature provides less lethal resistance when the blunt nose 294 hits the remaining bone without being cut down for use as a drill hole prior to the sudden increase in resistance caused by the shoulder 288 seating on the upper edge 172. The first resistance serves to warn the surgeon by a discontinuous tapping process. Thus, the surgeon has a visual and tactile warning to prevent stripping of the screw (shoulder 288 approaches upper edge 172). The tab end 282 is highly specialized for each particular purpose. A truncated bullet region 298 that curves upward along a constant diameter in the middle of the cut ridge 296 is particularly formed rearward at the blunt tip 294. The curvature 298 moves away from the vertebral body in the opposite direction and the movement is resisted by the outer sleeve 140, thereby gradually driving the sharp tip of the screw form 296 into the vertebral body. Periodic elongated grooves 284 that interrupt the threads, which may be one to eight, preferably four, serve to collect the body material that separates during the thread cutting process. In this regard, in an ideal embodiment, the threaded form is designed to press the bone to be shaped rather than the trough passing through the bone. Also, although both major and minor diameters of tab 280 may be varied, in preferred embodiments the minor diameter corresponds to the minor diameter of implant (I) but the major diameter is somewhat smaller than the major diameter of the implant.

Once the tab 280 is removed and the sleeve 140 is still in place, the surgical position is now sufficiently prepared to receive the spinal implant (I). In a preferred embodiment of the spinal implant, the implant will be enhanced by filling with a substrate or factor to be immobilized. Thus, the surgeon may prepare sufficient implants for insertion to be performed. At this point, however, human bone is selected as the universal implant and the patient's own bone is considered the best source.

Referring to FIG. 14A, in order to form trepine 300 quickly and cleanly to form a core in the iliac tomb or other bone tissue of the patient's back or to receive the core of bone within the cavity 304 of trepine 300 It is shown with a front cutting edge 302 that is gradually sharpened. Trepine 300 has a rear portion 306 having a pair of radially opposed slots 310 arranged therein, the rear facing apertures and drive mechanisms of their longitudinally oriented for engagement in the radial direction. It is arranged clockwise from the member 312 in the opposite direction of 308. It can be seen that the engagement member 312 is stable during the process of cutting in the clockwise direction but once the cutting is finished, it allows for quick detachment of the two components.

Since the interference between the implant and the inner wall of the cavity 304 is large, relatively weak reticulum bones are collected, which removes trepine during continuous drilling and extracts the core of the bone with trepine. It can be done. However, it is not very easy when the core of the bone is attached to its base and when the drive mechanism 308 is detached, the cork screw 408 shown in FIG. 14C is introduced through the central opening of the rear portion 306. And threaded through the core of the bone interior 304 to the depth of the lower teeth 302. The tip 318 of the cork screw 408, which extends in line with the envelope of the cork screw, is then cut radially from the base of the bone core. When the handle portion 314 of the cork screw 408 is coplanar with the flat rear surface 306, this no longer proceeds. If the cork screw 408 continues to rotate further, the core of the bone will be pulled backwards as the cork is pulled out of the wine bottle. Trepine 300 has a tub member 304 associated with a sharp tooth 302 having an inner diameter smaller than that of the spinal implant I to be mounted.

Referring to FIG. 14B, the trepine 300 with the core of the collected bone passes through the barrel member 304 through the opening 340 of the implant bone mounting device 320, as shown in FIG. 14B. It is stopped by the annular flange 344. The plunger shaft 326 of the device 320 counterclockwise pulls the handle portion 332 counterclockwise such that the plunger 372 is pulled back through the shaft 328 (long threaded) to the seam 330 at the proximal end. It is ready to attach by rotating. In this position, the handle portion 332 extends rearwardly from the seam 330. The plunger shaft 326 is in this position, and the plunger head 372 is inserted into the central cavity 306 of the trepine 300, at which time the plunger 372 is followed by the cylindrical portion of the seam 330 base. It occupies the rear portion of the barrel 304 and the cylindrical portion of the base of the collar 330 fills the central cavity 306. A pair of diametrically opposed oppositely projecting arms 346 on the seam 330 then proceed longitudinally into a pair of diametrically opposed slots 340 and clockwise to complete this assembly. Rotate in the direction. At the other end of the device 320, the spinal implant I is connected to a vertically protruding rod (not shown) extending from the rear portion facing the surface of the end plug 324 through the vertical arm slot 364. By handle portion 334 extending as a rod through a central hole in the end plug 324 which is joined by and centered inside the end plug 324, which extends into a small bolt screwed into the female hole of the spinal implant. It is fixed. When the spinal implant (I) is secured to the opposite end of the implant (I) hollow with the end plug 324, the end plug 324 extends into the device 320 and opposes in a radial direction to rotate and engage. It is fixed by the L-shaped slot 321. Once the device 320 is fully assembled, the end 302 of trepine 300 lies coaxially opposite the open end of trepine I.

Referring to FIG. 15, when the handle portion 332 rotates clockwise, the threaded shaft 328 at the base of the plunger 372 extends vertically into the spinal implant I so that the bone implant protrudes. The cylinder 304 is braked downward. When the bone implant is longer in length than the inside of the spinal implant, the additional pressure forces the bone into radially disposed cracks through the wall of the device in which the bone communicates from the central cavity to the outside.

The end plug 324 is separated from the device 320. When the end plug 324 is used as the handle portion, the end cap 374 shown in FIG. 16 is fixed to the open end of the screw implant I. As shown in FIG. The implant is detached from the end plug 324 by rotating the handle portion 334 counterclockwise.

Referring to FIG. 16, an implant drive device that may be used to insert or remove the implant I is shown. The driver 350 has a right angled protrusion 398 that fits the front end 362 to the complementary right angle slot 364 of the implant i. The threaded portion 353 protrudes from the slot 398 at the end 362 so that the threaded portion passes through the cavity shaft 358 and a handle portion that can be rotationally controlled as the cavity type member 360. 354). The threaded portion 353 is screwed into the arm hole center slot, forcing the threaded portion 353 into the slot 364 and the device 350 extending the arm 366 extending in a pair of diametrically opposed directions. It can be rotated via one of the directions to maintain engagement with the implant.

Referring to FIG. 17 with a drive mechanism 350 attached, implant I is introduced through outer sleeve 140 and implant cap 374 into an opposing interior space between two prepared vertebrae V. FIG. The tip of is screwed in until it reaches the depth of the installed hole, and its forward motion is hindered by the bone in the unperforated state. This allows the surgeon to feel successful when the implant is threaded into place.

As discussed above, using the tab 280, the surgeon can know by touch the final resistance to additional seating. As when using the tab 280 again, when the surface 370 of the device 350 approaches the surface 172 facing rearward of the outer sleeve 140, visual monitoring of the implant insertion depth is performed by the surgeon. By observing a gradual approach of the anterior surface 370 or the barrel member 360. Nevertheless, when the total insertion depth is achieved, i.e. in the final safe mechanism, the surface 370 of the device 350 will be coplanar with the surface 172 of the outer sleeve 140 and the spinal implant No additional installation is required.

Referring to FIG. 18, when the implant is sufficiently installed, the drive mechanism 350 detaches the implant I by rotating the handle portion 354 counterclockwise. The drive mechanism 350 is separated from the outer sleeve 140 and the outer sleeve 140 is separated. This allows the implant to remain fully installed and set at a determined depth as shown in FIG.

Now look at the other side of the spine. The cranial network and the nerve base systolic are used to contract the nerve structure normally, resulting in the total cross-sectional area of the head 128 of the short stretcher 120, and using the device 152 to be coplanar with the bottom of the tube. The extended threaded portion 116 is inserted into the female threaded portion 114 of the stretcher 120 when the extended protrusion 134 of the device 152 engages the female rectangular portion 118 of the short stretcher 120. do. The rear facing portions 108 and 110 use the handle portion 136 of FIG. 2 to store the elongated stretcher shape.

When the dural sac or nerve root is contracted and protected, the outer sleeve 140 slides over the reconstructed elongated stretcher surface and is seated using the drive cap 162. The entire procedure describing the implantation of an already placed spinal implant (I) is repeated so that both spinal implants are placed side by side in the inner space, which is not necessary, but adds a circular or other internal fixed height to be fixed. The wound will be closed in the usual way.

Brief discussion with reference to the accompanying drawings a method of fusion in the human body from the ventral side using an guiding sleeve and performing pre-stretching of internal tissues

Because of the spinal column and nerve roots, one can generally visualize the entire width of the intervertebral cartilage space from the sides to the other side throughout the cervical, thoracic, or lumbar spine at one time. In a preferred embodiment of in-body fusion from the ventral side (front), the implant lies parallel to the internal space from front to back and extends to adjacent vertebral bodies. The lateral width of the intervertebral cartilage is insufficient to use two implants, one of which protrudes sufficiently to the depth needed to be introduced into the adjacent vertebra and a single large enough implant may be centered. With this in mind, in view of the description of this technique and the device, there has already been been provided a method of lumbar fusion in the human body from the back and a simple discussion of vertebral fusion in the human body from the front with a double implant installation would be sufficient and large How to install the central implant will be clear.

The interior space to be fixed is exposed to the front. Soft tissue contracts and protects both sides, if necessary, above and below the wall. In its internal space, the entire width of the adjacent vertebra can be seen, and the surgeon leaves the template x-ray to determine the appropriate pre-stretch and optimal implant size. In a preferred manner, the surgeon makes a wide excision of the intervertebral cartilage of the nucleus (as a variant, the intervertebral cartilage may later remain separated by a drill). On the front, mark the center point between one side and the other side.

The elongated stretching machine 100 centered is inserted at the intersection between the marked points and the transverse extent of the intervertebral space seen from the front. The outer barrel member 106 of the stretcher 100 used will correspond to the outer diameter of the implant to be installed. The inserted drawing tips 102 are sequentially larger in diameter until optimal drawing is performed. It can be seen from the initial plate shape, but it can also be visually and tactilely confirmed that it has been drawn to an optimal state. When stretched in the optimal state, the vertebral end plates will be perfectly matched and parallel to the front shaft 102 of the stretcher 100 so that they deform side by side with the vertebra and the device is increased by overlapping engagement with the tip and increasing pressure. Very stable.

Surgeons feel that two adjacent vertebrae (V) move through the elastic range to the point where they begin to feel as they move. These changes will be readily understood by rearrangement of the vertebrae in line with the tip 102 and may also be readily understood by lateral x-ray imaging. However, if the surgeon cannot know how much longer the internal space needs to be stretched, it will be seen that the problem is due to increased resistance as the tissue is moved beyond the range of elastic deformation. Also, without the resilience to move the vertebrae farther, surgeons will not be able to sense how close the excess stretcher is to the front by tapping it slowly with a brittle little hammer.

Now look again at the operation process, since the long stretching machine 100 is inserted into the human body having a tubular member 106 corresponding to the implant (I) to be installed correctly, the internal space is ideally stretched and then the corresponding vertebrae It is inserted into the abdomen by the same distance. When the tubular member 106 of the elongate stretcher 100 has exactly the same major diameter coaxially at the end as the spinal implant I, the surgeon can evaluate the parallel relationship of the dual implant expected through the implant.

7C and 7D, a double outer sleeve 340 consisting of a pair of hollow tubes is introduced onto a surface parallel to the elongate stretcher 100 protruding from the vertebrae to the inner surface. When the screws of one implant can intervene with the screws of the other so that they all occupy a common area between them, the double outer sleeve 340 consists of two hollow members, which are the same size, ideally ideal for each other Spaced apart by the sum of the differences between the major and minor diameters of both implants combined, but greater than the size between one implant. However, while the preferred embodiment is slightly larger than twice the difference (sum of the two) between the major and minor diameters of the implant, the length may be significantly longer. In a preferred embodiment, while the pair of tubular members 348 of the double outer sleeve 340 are parallel, when the area between them 350 is large enough, these components can be stretched relative to one another. They diverge or converge at their proximal ends. The pair of tubular members 348 may be all or part of their length, and is firmly fixed by the footrest 344. In a preferred embodiment, the top view shows the scaffold 344 that is vertical but without sharp edges. It will be appreciated that the scaffold 344 may be modified in other shapes.

Referring to FIG. 7D, the scaffold 344 is curved to correspond to the full vertebra of the spine. Multiple peg 342 long enough to attach to the vertebrae extends forward from the footrest 344. Pegins 342 are limited in length so that two to ten, preferably six, do not penetrate too far backwards.

7E and 7F, when the double outer sleeve 340 is driven forward using the dual drive cap 420 of FIG. 7E, the peg 342 extending from the footrest 344 moves their forward motion. Interrupted by this curved footrest 344, it stops in accordance with the full vertebral body.

As already shown in FIG. 5, the dual drive cap 420 has a recess corresponding to the recess 168 such that the single drive cap 160 and the outer sleeve are sufficiently seated without disturbing the rear projection of the elongated stretcher unit. 354) is designed in the same way. However, unlike the cap 160, the recess 354 need not be coupled so that the double cap 420 interferes with the forward movement of the elongate stretcher through the portion 110, and the footrest 344 plays its role. It is safer when you do it. In addition, the double cap 420 for the double outer sleeve 340 is coupled to the double pipe member 352 corresponding to itself in a double and facing rearward. The double outer sleeve is fully seated, and the inner space of the adjacent vertebra to be fused is firmly fixed by the footrest 344 and the peg 342. Thus, it is possible to separate the elongate drawers on one side, preferably on both sides using the elongate drawer puller 200, as described above. It is at the discretion of the surgeon whether to use either side of the spine or one side of the spine. As discussed above, the surgeon may use the inner sleeve 242 to puncture the interior space and may also leave the elongate stretcher in place as in the “trepine method”. If necessary, it is by the outer sleeve 340 which is protected by expansion and insertion of the implant. When the implant is fully inserted, the outer sleeve is detached.

Using the perforation or “trepine method”, the outer sleeve 340 to provide an ideal arrangement and alignment of the tab 280 and the implant I, whether or not there is an inner sleeve for preparing the solidarity side. ) Is desirable.

Surgeons who need to work in deeper interior spaces or wish to have a direct view of the tabs used and the implants to be inserted may choose an outer sleeve after or prior to keeping the insertion of the first prosthesis safe. However, it is included within the scope of the present invention.

Preferred Modifications to the Intrabody Solidarity Method from the Back

As described above with respect to accessing the lumbar vertebrae from the rear, a "trepine method" as described in detail may be used.

As a further variant, it is to be noted that the key component in the method from the front is the use of pre-stretching theory, where pre-stretching is maintained by an outer sleeve with or without a long drawer. Thus, once the preparation of the inner space is complete, it is not the preferred embodiment, but it is within the scope of the present invention to insert the implant directly rather than through the outer sleeve and to separate the outer sleeve where there is no neural structure requiring protection. Mine

As another variant of the invention, the height of the inner space to be stretched should be such that the diameter of the implant that needs to be embedded deep enough into the opposing vertebral body does not allow the two implants to be in parallel. Only a single implant, which can be sufficiently increased in diameter, is used and positioned in the center of the inner space rather than on one side. The placement of a single central implant through the method and apparatus according to the present invention will remain in the manner already described and may be performed by a perforation method or a "trepine method".

16-18, a cylindrical spinal implant (I) according to the present invention is shown. In FIG. 16, the implant I is shown attached to the insertion device 350. 17 and 18, an implant I installed in the intervertebral cartilage between adjacent vertebrae is shown.

The cylindrical implant (I), in a preferred embodiment, consists of a hollow tubular member made of ASTM surgically implantable material, preferably titanium. This cylindrical implant I is closed at one end and open at the other end, which is covered by the cap 394. Cylindrical implant I has a series of visible openings 390 through the sidewall of cylindrical implant I. A series of outer screws 392 are formed around the cylindrical implant I. Various types of screws may be used on the implant. Cap 374 has a hexagonal opening 394 that tightens cap 374.

While the present invention has described embodiments of preferred methods and apparatus, it will be appreciated that other embodiments of methods and apparatus may be improved without departing from the scope of the present invention. Another embodiment of the present invention will be described below.

Detailed description of variants of the device and method according to the invention

The human spine consists of a series of bends that are balanced when shown from the side, in contrast to the vertebrae that are stacked on each other in a straight line when viewed from the side. In both the cervical and lumbar vertebrae, the vertebrae are angularly related to each other so as to form the shape of the curves to be placed forward in the human body, and these segments of the spine are called spinal lordosis. Conversely, at the thoracic vertebrae the angular relationship to each other to form so that the apex of the curve is placed rearward, this is called scoliosis. The method and apparatus of the present invention are intended to provide permanent stabilization of the vertebral bone connected by solid surgery, and to protect the spinal lordosis / post-vertebral lordosis before completion of fusion or, if already lost, spinal lordosis / There is a need for means to recover from postprandial sclerosis.

The following examples of the present invention provide both stabilization and fusion for the treatment of the vertebrae in the correct anatomical vertebral lordosis or vertebral lordosis symptom, either individually or in combination. Here, the spinal column can be approached at various angles in each device and has a variety of forms suitable for particular embodiments.

Referring to FIG. 19, there is shown a variant of the device according to the invention comprising an elongated stretcher 400 for lordosis from the back which is accessible from the back of the vertebrae to repair and fix the lordosis of adjacent vertebrae V. have. The elongated stretcher 400 for lordosis from the back is inserted from the back of the spine and at the distal end 421 of the intervertebral cartilage infiltration 420, shown intervening in the disc space between two adjacent vertebrae (V). And a cylinder member 410 for terminating. The intervertebral cartilage penetrating portion 420 is formed with an induction bullet shear 422 at its distal end to facilitate insertion of the disk penetrating portion 420 between two adjacent vertebrae V. As shown in FIG. The disc penetrating portion 420 has a small diameter in the disk space adjacent the distal end 412 of the barrel member 410 and thus has a low height and also has a large diameter in the disk space in the direction of the front end portion 422. It has a shape having a nonuniform diameter so as to have a diameter and a high height. The shape of the disk penetration 420 not only restores the space height between the vertebrae upon insertion of the disk penetration 420 of the elongated stretcher 400 for lordosis from the back side, but also between the adjacent vertebrae V. Restore and maintain normal state. The induced bullet-shaped front end 422 is very important for the elongated stretcher 400 for the lordosis from the back side, and the largest diameter portion of the disc penetration 420 must be introduced into the disc space.

The maximum diameter of the disk penetration 420 is smaller than the diameter of the tubular member 410, so that a circumferential shoulder 424 is formed at the distal end 412 of the tubular member 410 for fullness from the back side. To prevent excessive penetration of the long stretcher 400 into the disk space. This shape of the disk penetration 420 is due to the pressure the spine receives when the elongated stretcher 400 for lordosis from the back side is fairly stable in disk space and the disk penetration 420 is forced forward. It can easily be seen that the resistance to retraction and at the same time the circumferential shoulder 424 makes further movement impossible, so that the elongated stretcher 400 for lordosis from the rear is gradually stabilized.

Referring to FIG. 20, in preparation of the bone separation step, the elongated stretcher 400 for lordosis from the back is shown positioned between adjacent vertebrae V so that the disc infiltration 420 recovers and maintains spinal lordosis. It is. The outer sleeve 140 described with reference to FIG. 5 is suitably seated on the surface of the elongated stretcher 400 for lordosis from the back using a small hammer and drive cap 160 already described. The bone separation step may be performed by the drilling method described above with reference to FIG. 11A or 11C or by the "punching method" described above with reference to FIG. 11B, wherein the "trepine method" may be performed at least from the rear surface by bone separation. In a position to hold the lordosis long stretcher 400 unobstructed from the rear until sufficient space is formed, such as the wall thickness of trepine 270 to allow separation without disturbing the lordosis long stretcher 400. It is desirable to put it.

When the "trepine method" described above with reference to FIG. 11B is used in conjunction with a premature elongate stretcher 400 from the rear, the outer sleeve 140 firstly has a premature elongated extension from the back as shown in FIG. 11B. It is first fixed together with the inner sleeve 242 before both are simultaneously placed on the surface of the barrel member 410 of the wearer 400. When the outer sleeve 140 is seated coaxially with respect to the barrel member 410, the inner sleeve 242 will be detached alone and the surface of the elongated stretcher 400 for thrombosis from the backside of the trepine 270 Inside the outer sleeve 140 and above will be placed in the adjacent vertebrae V to an approximate depth throughout the disk space. The use of the inner sleeve is not necessary when the trepines 270 are centered and aligned by the elongated stretcher 400 for lordosis from the back.

The bone is cut into two semi-cylindrical shapes, one for each vertebrae (V), so that each of the cutting teeth 271 is a sharp cutting tooth 271 adjacent to each other, such as a saw of trepine 270 shown in FIG. It separates the distance of the bone equal to the elongation of, and this distance cannot be smaller than the wall thickness of trepine 270 itself. Thus, when trepine 270 is separated, the combined two spaces will be secured in place by an outer sleeve 140 that engages the lordosis elongate stretcher 400 from the back with two adjacent vertebrae V. When there is enough space to extract the elongated stretcher 400 from the back without disturbing the vertebrae V itself, the outer line of each arc of the bone cut from the adjacent vertebrae V becomes semi-cylindrical. do.

21 and 22, since the vertebrae V are lordosis prior to the bone separation step, the space S formed by the bone separation is cylindrical and is cut to have an angle with respect to the vertebrae V. , This corresponds to the shape of the cylindrical implant (I). As such, cylindrical implants i with parallel walls may be inserted between the vertebrae V to stabilize in angular relation to each other to maintain normal curvature of the spine.

23 and 24, which are top and side plan views, respectively, these refer to a drawer for which a lordosis short drawer 500 is dedicated from the back, generally designated by numeral 500, respectively. Similar to the stretcher 120, the elongated stretcher 400 for lordosis from the back side, as described above with reference to FIGS. 3A-3F, has an increased diameter of the head 128 and a lordosis long from the backside. The disk penetrating portion 520 such as the disk penetrating portion of the stretching machine 400 is configured. As described above for the elongated stretcher 400 for lordosis from the backside, the lordosis short stretcher 500 from the backside significantly stabilizes the shape of the disk infiltration 520. This is a particularly important feature for the short stretcher 500 for lordosis from the back because it is placed in the presence of complex dural sac and nerve roots, while the surgical procedure is performed on the side in conjunction with the opposing similar parts of the spine. To further stabilize the short stretcher 500 for lordosis from the back, the bone engaging surface 530 may be nodular or rumpled, and also has small teeth facing forward.

Referring to Figure 25, there is shown an elongated stretcher 600 for lordosis used to access the inner surface of the spine. As can be seen in the figure, the shape of the disk penetration 620 is the maximum of the disk penetration 620 close to the cylinder member 610 as opposed to the disk penetration 420 of the elongated stretcher for lordosis from the back side. Diameter and height gradually decrease toward the end toward the front end portion 622 along the disk penetration 620.

With reference to FIGS. 26 and 27, a variant of the invention is shown in which the surgical procedure maintains elongation, including more specific specifications of the outer sleeve 140 described above, which is the same as the expandable outer sleeve 700. Expandable outer sleeve 700 includes a hollow tubular member 702 having an extended distal end 710 and is essentially continuous (with or without reinforcement), with the hollow tubular member 702 itself. Pairs of extensions 720, 722 are disposed 180 ° opposite each other, and their leading ends 724, 726 are sharp and have said height to restore the height of the intervertebral disc space for ease of insertion. A tooth 712 or a bone engaging means for the adjacent vertebrae V similar to that described above may be located at the distal end 710. It will be appreciated that distal end 710 may not have teeth 712.

The expandable outer sleeve 700 is a novel invention that is never present in surgery or in the art, and the expandable outer sleeve 700 is both a perforated sleeve as described above and an outer sleeve 140 as described herein above have numerous advantages. To provide. The teeth of the extensions 720 and 722 inserted between adjacent vertebrae themselves act as stretchers in the vertebra and thus inevitably become outer sleeve and stretcher combinations. The expandable outer sleeve 700 is gradually stabilized when the extensions 720 and 722 are hung in the disk space and are additionally secured by significant pressure in the spine.

Referring to FIG. 28, because of its stability, the teeth 772 on the distal end 710 of the expandable outer sleeve 700 ′ are removed as shown in FIG. 28 or to a smaller size as in the preferred embodiment. Additional derivative advantages are provided that may be formed. In addition, it can be seen that the teeth 712 may define a straight region along the vertebral line V and the extensions 720 and 722 can secure an appropriate rotational force.

An additional advantage, which will be described in greater detail in sequence, is that the surgeon defines an area between and between the extensions 720 and 722 and projects all other tissue out of the extensions 720 and 722.

Now, I would like to explain the new concept of the expandable outer sleeve 700, which not only recovers and maintains the appropriate height of the disc space inside the vertebrae, but also additionally manages and maintains anatomical lordosis or emphysema throughout the surgical procedure. Attention may be paid to further variations of the expandable outer sleeve 700.

Referring to FIG. 29, there is shown an expandable outer sleeve 800 for use in the posterior access of the spine. The pancreatic expandable sleeve 800 from the rear has a tubular member 802 having a distal end 810 with a pair of extensions 820, 822, which are continuous portions of the tubular member 802, extending 180 ° from each other. Include. Extensions 820, 822 are formed so that their extensions 820, 822 recover and maintain spinal lordosis similar to the disk infiltration 420 of elongated stretcher 400 for lordosis from the back. It differs in shape from the concave extension portions 720 and 722 which are cited in the specification.

The extensions 820 and 822 become smaller toward the distal end 810 of the pipe member 802, and increase in height in a direction away from the pipe member 802, respectively. Extensions 820 and 822 are tapered at their leading ends, respectively, to facilitate insertion into disk space.

There may be a plurality of teeth 812 between the extensions 820, 822 that join the bones of the vertebrae V when the expandable outer sleeve 800 is inserted into the disc space between adjacent vertebrae V.

Referring to FIG. 30, there is shown an enlarged outer sleeve 800 ′ for lordosis from the back in place of the disc inner space inside the vertebrae.

Referring to FIG. 31, there is shown an expandable outer sleeve 900 from the front side used to access from the ventral side (front side) of the spinal column. The prolonged extension outer sleeve 900 from the front side comprises a hollow tubular member 902 having a distal end 910, which hollow tube member 902 is a pair of extensions that is an extension of the tubular member 902. The extensions 920 and 922 extend so as to be disposed to face each other by 180 degrees. Extensions 920, 922 are extended in that they allow for recovery and maintenance of spinal lordosis from anterior approach, similar to the disk infiltration 620 of the premature elongated stretcher 600 from the front, which is incorporated herein by reference. The parts 820 and 822 are different.

The extensions 920 and 922 are larger in height as they are closer to the distal end 902 of the tubular member 902, respectively, and are reduced in diameter in a direction away from the tubular member 902. Extensions 920 and 922 have their tip portions 924 and 926 tapered so that they can be easily inserted into the disk space, respectively.

It is to be understood that the ecstatic expandable outer sleeve from the front is in a single form and, although shown for use in the lumbar spine, may take the form of a double barrel or may have other forms and may be used throughout the spine.

Referring to Figures 33 and 34, the main part of the double expandable outer sleeve is shown and generally indicated by the number 1100. Double expandable outer sleeve 1100 includes two hollow tubular members 1101, 1102. The two hollow tube members 1101 and 1102 have distal ends 1104 to form an extension 1121 to which the hollow tube members 1101 and 1102 are continuously coupled to each other. The extension part 1121 is similar in shape and function to the extension parts 920 and 922 described above with reference to FIG. 31. In order to maintain each relationship of the vertebrae V by the surgery, the extension 1121 decreases in height as it moves away from the hollow tubular members 1101 and 1102 and approaches the distal end 1104. The more you increase in height. The extension 1121 is sharpened at the tip 1124 to facilitate insertion of the extension 1121 into the disc space between two adjacent vertebrae (V). Sharp teeth 1130 are formed at the distal ends of the tubular members 1101 and 1102 to engage the vertebrae (V).

Each of the hollow tubular members 1101, 1102 has two screwed joints because the tubular members have screws of the implant I that are closely coupled with the screws of the other implant I to form a cavity therebetween. They are arranged by an ideal sum of the difference between the major and minor diameters of each of the implanted spinal implants I, but greater than the difference of one implant I. Typically, the walls of each hollow tubular member 1101, 1102 have a thickness of about 2.0 mm and are in contact with each other. This is accomplished by holding each hollow tubular member 1101, 1102 to reduce the wall thickness of each tubular member 1101, 1102 prior to joining them. As such, the two tubular members 1101 and 1102 may be reduced in thickness so that the two vertebral implants I may be closer to each other when inserted into the disc space between adjacent vertebrae V. As shown in FIG. The hollow tubular members 1101 and 1102 may overlap or displace each other to control the distance between the implants when two implants are implanted using a double expandable outer sleeve.

The hollow tubular members 1101 and 1102 may be connected in whole or in part throughout their length, and are generally fixed by the scaffold 1110 and the scaffold 344 described above with reference to FIGS. 7C and 7D. The function is the same but the shape is not the same.

Referring to FIG. 34, a footrest 1110 is shown extending along the vertebra and having a plurality of peg 1112 extending from the bottom of the footrest 1110 and having a curved oval shape. Pegins 1112, 1113, 1114, and 1115 are long enough to engage the bones of adjacent vertebrae (V), but are limited in length so as not to penetrate excessively beyond the vertebrae once inserted.

Referring to FIG. 35, a second double expandable outer sleeve 1200 is shown. The dual expandable outer sleeve 1200 is larger near the distal end 1204 of the hollow tubular members 1201 and 1202 and has an additional extension 1220 that decreases in height away from the hollow tubular members 1201 and 1202. Similar to the double expandable outer sleeve 1100 except that it has a 1222. The extensions 1220, 1221 and 1222 are the same in terms of their function and shape as the extensions 920 and 922 described above with reference to FIG. In addition, the scaffold 1210 is rectangular and larger than the scaffold 1110, but additional pegins 1216 and 1217 may be added.

In addition, when referring to its use in the lumbar spine, it can be seen that if the lordosis drawer from the rear is applied to the cervical spine, it may be used from the front in a single or double barrel form. This is because the cervical spine usually curves to hirsutism, which is the opposite of lordosis. That is, it would be desirable to separate the rear of the disc space from the front when approaching the cervical vertebrae from the front, and to require an extended outer sleeve as shown in FIG. It may be referred to more accurately as a shaped outer sleeve. The outer sleeve for lordosis from the front, the long drawer for the lordosis from the back, the short drawer for the lordosis from the front, and the short drawer for the lordosis from the front, are already referred to as lordosis when placed in the lumbar spine in the posterior approach. It will be more accurate to call it a cervical stretcher.

It will be readily understood that the expandable outer sleeve described has a uniform diameter and may be used with short drawers and long drawers in a disk space or with a pre- and elongated drawer having a compensating shape.

With reference to FIGS. 36-41, a patent application entitled “IMPROVED INTERBODY SPINAL FUSION IMPLANTS”, filed February 17, 1995, incorporated herein by reference As disclosed herein, an apparatus 1350 is shown that is used to install an improved intra-body spinal fusion implant 1300 having one or more planes. The device 1350 has a pair of overlapping cylindrical tubular members 1352 and 1354 of equal size and each includes a dual outer sleeve 1310 having an inner diameter that is somewhat larger than the outer diameter of the spinal fusion implant 1300. . Cylindrical tubular members 1352 and 1354 are spaced apart by an ideal distance that is in communication with each other along the length and somewhat greater than the sum of the diameters of the two spinal fusion implants arranged side by side so that the flat sides 1302 of each spinal fusion implant 1300. ) Is connected. Cylindrical tubular members 1352 and 1354 are mounted on scaffolding 1322, similar to the scaffolding described in FIG. There is a series of frogs 1364a-1364f that project from the bottom 1366 of the footrest 1360, which is used to join the dual outer sleeve 1310 to the base of the adjacent vertebrae V.

With particular reference to FIG. 36, device 1350 is introduced into the surface of two elongated stretching machines 1320, 1322, which protrude to the ventral side from the vertebrae V and lie side by side. The elongate stretchers 1320 and 1322 are similar to the elongated stretchers described above except that they have flat sides 1324 and 1326 respectively.

37 and 38, in one embodiment, the scaffold 1360 is essentially rectangular but does not have sharp edges. It is known to those skilled in the art and may be used in other shapes.

As shown in FIGS. 36 and 39, the footrest 1360 is curved to allow the outer curved portion of the vertebrae V to approach from the front surface. Multiple sharp peg 1364a-1364f long enough to secure the footrest 1360 to the vertebrae V extends forward from the footrest 1360. The peggins 1364a-1364f are limited in length such that the vertebrae V do not penetrate 2 to 10, preferably 6 back.

Referring to FIG. 39, when the double outer sleeve 1350 proceeds forward, the peggins 1364a-1364f extending from the footrest 1360 have their anterior motion aligned with the medial shape of the vertebra and hampered by the footboard 1360. It is embedded in the opposite vertebrae V until it is received or blocked.

As shown in FIG. 36, when the device 1350 is sufficiently seated, the vertebrae V adjacent to the internal space D to be fixed are firmly secured via the scaffold 1360 and the peg 1364a-1364f. Thus, preferably one of the elongate stretching machines 1320, 1322 may be separated. The double outer sleeve is as described above for the insertion of two implants, each with at least one flat side, and can be elongated, as in the case of lordosis or emesis, as described above, wherein the extension extends alongside the sidewall of the cylindrical tubular member. May have an extension inserted into the disc.

Referring to FIG. 40, when the double outer sleeve 1350 is fully seated, one of the elongated stretchers 1320, 1322 is detached and the surgeon may have overlapped holes into which the spinal fusion implants 1300a, 1300b may be inserted. The hollow cylindrical tube members 1352 and 1354 for guiding the drill 250 to form the holes may be drilled into the inner space D using the drill 250. A hollow inner sleeve (not shown) may be inserted by drilling into the hollow tubes 1352 and 1354 and the long stretcher may be placed in place and fixed on the top surface of each of the long stretchers 1320 and 1322. Those skilled in the art will also appreciate that hollow trepine may be used to puncture the interior space (D). It will be readily understood that the tubular member can have a variety of shapes and sizes. In addition, the disc and bone separation may be performed by using a reamer or chisel of a shape appropriate for the purpose, with or without a drill.

Referring to FIG. 41, once the internal space d is drilled, the implant drive mechanism described above is preferably used to first insert the spinal fusion implants 1300a, 1300b. Implant drive mechanism 350 may be used to insert or remove spinal fusion implants 1300a and 1300b.

Once attached to the implant drive mechanism 350, the vertebral solid implant 1300a is then introduced through one of the hollow cylindrical tubular members 1352 and 1354 or through the implant drive mechanism 350 to impart an impact force. It drives to the internal space D by adding. When the spinal fusion implant 1300a is inserted into the internal space D, the spinal fusion implant 1300a is coupled with the vertebrae V due to the difference in the surface roughness of the spinal fusion implant 1300a, and the implant driving mechanism 350 is the spinal fusion implant. Desorption from 1300a. The implant drive mechanism 350 is withdrawn from the double outer sleeve and the spinal fusion implant 1300a is fully installed and embedded in the interior space D as shown in FIG. 41.

When the first vertebral fusion implant 1300a is inserted into the internal space d, the second vertebral fusion implant 1300b is adjacent to each other at the flat sides 1302a 1302b of each of the vertebral fusion implants 1300a and 1300b. It is driven into the inner space (d) so that it can be contacted. As such, the two vertebral fusion implants 1300a and 1300b are implanted into the interior space D and engage with the bones of the adjacent vertebrae V without exceeding the table of the vertebrae. The two vertebral implants can be in a bimodal form and they can be inserted in a straight line through a single (all at once) or double outer sleeve with members extending between discs effective for stabilization, stretching, and / or lordosis and post cure. You will notice that there are many other ways.

Although the present invention has been described in connection with the implantation of a threaded spinal implant, it will be appreciated that other forms of implant may be used in the present invention. For example, a cylindrical, partially cylindrical or other shaped implant of plunge, rugged or monolithic shape of bone or artificial material that can be introduced through the outer sleeve may be used. Performing a surgical procedure through the outer sleeve makes the surgical procedure safe, fast and more accurate.

Claims (24)

An apparatus for use in intra-body spinal surgery across a disk space between two adjacent vertebral bones, A guide member having an opening for protecting access to the vertebral body adjacent to the disk space; A disc penetrating extension extending from the guide member to be inserted into the disc space between adjacent vertebral bodies and supporting against the end plate of the adjacent vertebral body, the tapered tip being tapered to facilitate placement into the disc space. Intra-body spinal surgery apparatus. The method of claim 1, And a second disc penetration extension extending from the guide member to insert into the disc space and support against the end plate of the adjacent vertebral body. Intra-body spinal surgery apparatus. The method of claim 1, The disk penetration extension has a height that forms a disk space of a selected height between adjacent vertebral bodies. Intra-body spinal surgery apparatus. The method of claim 1, The disc penetration extension has an opposing surface that bears against an end plate of the adjacent vertebral body, the opposing surface diverging from the guide member along a portion of its length. Intra-body spinal surgery apparatus. The method of claim 1, The disc penetration extension has an opposing surface that bears against an end plate of an adjacent vertebral body, the opposing surface converging along a portion of its length from the guide member. Intra-body spinal surgery apparatus. The method of claim 1, And further comprising a structure for preventing overpenetration of the disk penetration extension into the disk space. Intra-body spinal surgery apparatus. The method of claim 1, Further comprising a removable inner sleeve Intra-body spinal surgery apparatus. The method of claim 1, The disc penetration extension includes a first portion supporting the end plate of the adjacent vertebral body, and a second portion bearing the end plate of the adjacent vertebral body and between the first portion and the guide member, wherein the second portion The portion has a height greater than the height of the first portion Intra-body spinal surgery apparatus. The method of claim 1, The disc penetration extension includes a first portion supporting the end plate of the adjacent vertebral body, and a second portion bearing the end plate of the adjacent vertebral body and between the first portion and the guide member, wherein the second portion The portion has a height smaller than the height of the first portion Intra-body spinal surgery apparatus. An apparatus for use in spinal surgery across a disk space between two adjacent vertebral bodies, An opening for protecting access to the vertebral body adjacent to the disk space, a guide member having a distal end on an outer surface thereof, A disc penetration extension extending from the distal end of the guide member so as to be inserted into the disc space between the adjacent vertebral bodies and bearing to the adjacent end plate of the adjacent vertebral body and lying on the same surface as the outer surface of the distal end of the guide member. Spinal Surgery Devices. The method of claim 10, The guide member includes a second disc penetration extension extending from the guide member inserted into the disk space and supporting the end plate of the adjacent vertebral body. Spinal Surgery Devices. The method of claim 10, The disc penetration extension is provided with an opposing surface bearing the end plate of the adjacent vertebral body. And the opposing surface diverges from the guide member along a portion of its length Spinal Surgery Devices. The method of claim 10, The disc penetration extension has an opposing surface that bears against an end plate of the adjacent vertebral body, which opposing surface converges along a portion of its length from the guide member. Spinal Surgery Devices. In a spinal stretching machine for use in spinal fusion for positioning two adjacent vertebral bodies in a predetermined relationship with each other, With the body, A disc penetration extension extending from the body to insert into the disc space between two adjacent vertebral bodies and to bear adjacent end plates of the two adjacent vertebral bodies, the disc penetration extension supporting the one of the adjacent end plates. A first portion and a second portion supporting the other of the adjacent end plates, the first and second portions being converged along a portion of their length from the body; Spinal stretching machine. The method of claim 14, The disk penetration extension has a tapered front end to facilitate insertion into the disk space of the disk penetration extension. Spinal stretching machine. The method of claim 14, The body is removably attached to the disc penetration extension. Spinal stretching machine. In a spinal cord stretcher for use in spinal fusion for positioning two adjacent vertebral bodies in a selected relationship with each other, With the body, A disc penetration extension extending from the body to insert into the disc space between two adjacent vertebral bodies and to bear adjacent end plates of the two adjacent vertebral bodies, the disc penetration extension supporting the one of the adjacent end plates. A first portion and a second portion supporting the other of the adjacent end plates, the first and second portions emanating from the body along a portion of the body length, the disc penetration extension extending from the disc penetration extension. With tapered tip to facilitate placement into disk space Spinal stretching machine. The method of claim 17, The body is removably attached to the disc penetration extension. Spinal stretching machine. The method according to claim 1 or 10, Having a bone removal device sized to move through the opening of the guide member to form a partially implanted space through the guide member across a surgically corrected height of disk space Intra-body spinal surgery apparatus. The method of claim 19, Further comprising a spinal implant adapted for insertion into a graft space defined by the bone removal device Intra-body spinal surgery apparatus. The method of claim 20, The spinal cord implant is one of the haptic, intrabody spinal graft, and intrabody spinal fusion graft. Intra-body spinal surgery apparatus. The method of claim 20, Further comprising a fusion promoting material Intra-body spinal surgery apparatus. The method of claim 22, The fusion promoting material is bone Intra-body spinal surgery apparatus. The method of claim 20, Inserting the spinal column implant into a graft space defined by the bone removal device Further comprising a graft drive mechanism in the shape of Intra-body spinal surgery apparatus.

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