WO2014140503A1 - Spinal ancillary device - Google Patents

Abstract

Spinal ancillary device (1) serving for the insertion, positioning and guiding of an intersomatic implant. The ancillary device (1) comprises an implant holder (2) having an elongate part provided with an anvil (23) with a strike surface, an impactor (3) having an elongate body that ends in a head, and a guide (4) comprising an elongate member with a zone for guiding the impactor (3) in translation, where the anvil (23) of the implant holder (2) has a recessed part extending around said elongate part and geometrically shaped to cover the head of the impactor (3) and extending along a predetermined length, and where the head of the impactor (3) extends along a length shorter than the length of the recessed part of the anvil (23).

Description

 RACHIDIAN ANCILLARY

The present invention claims the priority of the French patent application No. 13/00606 filed March 14, 2013 whose content (description, drawings and claims) is hereby incorporated by reference.

 The present invention relates to a spinal ancillary device for insertion, positioning and guiding of an intersomatic implant, otherwise called an interbody cage, to be inserted as an alternative to an intervertebral disc to restore the height of the intervertebral space and promote arthrodesis of the considered level.

 When an intervertebral disc undergoes degeneration or is damaged, it can no longer assume its mechanical role of support and compression of the disc causes a loss of disc height with consequent loss of mobility and pain for the patient.

 The treatment of this type of pathology consists in stabilizing the articular level considered by creating an intervertebral arthrodesis in order to eliminate any mobility, source of pain, while restoring a normal disc height and normal physiological lordosis. To ensure a good clinical outcome, the arthrodesis should occupy the widest possible space between the vertebral plateaus.

 This arthrodesis is most often performed with the help of an intersomatic implant, or cage, which is generally made of a material resistant to compression stresses, which acts as a graft support, autologous or synthetic, and which brings the primary stability of the vertebral segment before the development of osteosynthesis.

The success of a good arthrodesis depends not only on the implant but also on the way it is implanted. In particular, the introduction of an interbody implant must be done in the least traumatic way possible for the surfaces in contact with the equipment during this establishment. It is therefore essential, in this setting up, that the ancillary is provided to ensure insertion of the implant without danger, on the one hand for the tissues that are on the insertion path of the implant, in particularly the nerve roots and the dura mater, on the other hand for the bone tissues that will be in contact with the implanted material. It is therefore easy to understand that the introduction and guidance of the intersomatic implant are essential elements for the success of arthrodesis.

 The prior art mentions a number of instruments of the ancillary type to facilitate the placement of intersomatic implants.

 According to a first known embodiment of the patent application US 2012/083890, an intersomatic implant insertion system comprises an outer shaft and an inner shaft rotatably mounted within the outer shaft. The inner shaft includes a thumb wheel connected to its proximal end for rotating the shaft and a threaded distal end for supporting the implant. The outer shaft supports on its periphery a proximal guide and a distal guide for guiding and maintaining the alignment of the outer shaft within an outer guide sleeve, and supports a head on its proximal end which forms a stop of the movement of the outer shaft in the outer guide sleeve. The wheel is accessible through a window on the head.

 This insertion system is however complex to use, because it does not allow a simple decomposition of the insertion movement and, in addition, the use of a wheel that the surgeon must handle through the head of the external shaft proves impractical and hinders the insertion operation, with risks of jolts borne the outer shaft that lead to undesirable movements of the implant.

 Furthermore, the distal guide of the insertion system has one or more flat surfaces and optionally angulated, so that the implant is fixed abutting on this or these flat surfaces before insertion. This insertion system therefore has the additional disadvantage of leaving the practitioner unaided for the final positioning of the implant between the vertebral bodies and therefore without guarantee for the precise placement of the implant between the vertebral bodies.

 According to a second known embodiment of the patent application

In EP 1 980 222, an interbody fusion implant insertion system comprises an insertion guide inside which a push rod is slidably mounted, and a control rod which is slidably and rotatably mounted inside the push rod, this control rod being provided with a threaded distal end for attachment to the implant, a flexible intermediate link in flexion and rigid in torsion, and a proximal end opposed equipped with a wheel to be controlled in translation and / or rotation; this wheel can abut against the single push rod.

 This insertion system has the disadvantage that the manipulation in translation of the wheel is inconvenient for the surgeon, because it is possible to push the implant too far if you push too hard the control rod, beyond the thrust margin offered by the push rod, thus affecting the accuracy of insertion of the implant. In addition, the presence of a flexible link on the control rod induces deformation movements that can affect the accuracy of insertion of the implant.

 The present invention aims to solve all or part of the aforementioned drawbacks, providing an ancillary that allows easy and natural handling for the surgeon, as well as a precision insertion of the implant.

 An object of the invention is to provide an ancillary adapted to introduce an intersomatic implant minimally invasive first approach by eliminating any uncertainty related to the subjectivity of the practitioner, ie an implant for automation gestures that guarantees the precise positioning of the implant without questioning by the practitioner and, thereby, increasing the safety of the patient.

 Another object of the invention is to provide an ancillary which provides guidance accompanying the implant between the vertebral trays.

 Another object of the invention is to provide an ancillary which comprises no flexible part of any kind that ensures perfect guidance using the rigidity of the constituent parts of the ancillary.

 For this purpose, it proposes an ancillary spinal insertion, positioning and guiding of an intersomatic implant, said ancillary comprising:

an implant holder comprising an elongated portion provided with two opposite ends, a distal end on which is provided a system for gripping the intersomatic implant and a proximal end on which is provided an anvil having a striking surface;

an impactor comprising an elongated body provided with two opposite ends, a distal end and a proximal end provided with a head respectively, this head having two opposite bearing surfaces, respectively a lower bearing surface located at the junction between the head and the elongate body and an upper bearing surface, and the impactor being provided with a bore shaped for the passage of the elongated portion of the implant holder, said a bore passing through the head and the elongate body from its proximal end to its distal end;

 - A guide comprising an elongate member extending along a longitudinal axis and provided with two opposite ends, respectively a distal end and a proximal end provided with a so-called proximal bearing surface, said elongated member having a translational guide zone. the impactor along its longitudinal axis;

this ancillary being remarkable in that:

a) the anvil of the implant holder has a recessed portion extending around the elongated portion for a predetermined length toward the distal end of said elongated portion, and comprising:

a proximal wall disposed on the proximal end of the elongated portion of the implant holder and having two opposed surfaces, respectively an upper surface opposite to the elongated portion and forming the striking surface of the anvil and a lower surface located at the junction between the proximal wall and the elongated portion, and

a side wall projecting from said proximal wall, extending around the elongated portion over the predetermined length and having a distal bearing surface of the anvil which is remote from the proximal wall of said length;

b) the head of the impactor extends between its two opposed bearing surfaces for a length less than the length of the recessed portion of the anvil, and c) the recessed portion of the anvil is geometrically shaped to cap the head of the impactor.

 Thus, the ancillary has several configurations.

 In a first configuration:

the elongated portion of the implant holder is engaged inside the bore of the impactor until the lower surface of the proximal wall of the anvil abuts against the upper bearing surface of the head of the impactor, and the proximal end of the elongate portion protrudes from the proximal end of the elongated body of the impactor, so that the grasping system supports the implant; - The impactor is engaged in the guide and cooperates with the guiding region of the guide until the distal support surface of the anvil abuts against the proximal bearing surface of the guide.

 Since the anvil encases the head of the impactor, and since the anvil is longer than the head, the head remains in abutment with the proximal wall of the anvil and is separated from the proximal bearing surface of the guide. . In this first configuration, the implant is waiting to be inserted.

 In a second configuration which follows the first configuration, the gripping system is detached from the implant, in particular by unscrewing, and the implant holder is completely removed from the impactor by translation towards the proximal end of the impactor. . Once the implant holder is removed, the impactor is free to slide in the guide towards its distal end to allow precise insertion of the implant. This translation of the impactor is performed until the lower bearing surface of the head abuts against the proximal bearing surface of the guide. In this way, the ancillary according to the invention allows a calibrated and accurate insertion of the implant, thanks to a predefined length difference between the anvil of the implant holder and the head of the impactor.

 Thanks to the judicious choice of the respective lengths of the anvil and the head, the proximal bearing surface of the guide is therefore intended to cooperate successively with the distal support surface of the anvil (in the first configuration) and then with the lower bearing surface of the impactor head (in the second configuration).

 In other words, the ancillary according to the invention makes it possible to cooperate the different parts of the ancillary in a one-to-one manner (first the anvil abuts on the guide then the impactor abuts on the guide) so that that any false maneuver in the succession of the manipulations is made impossible by the logical sequence of the positioning of the ancillary on the patient then of the successive positioning of each part of the ancillary of the invention. For the surgeon, the introduction of the implant in its proper place becomes mechanical, in the sense that the ancillary fills the role of guide and positioning when said ancillary is positioned on the patient.

According to one feature, the elongate body of the impactor is divided into two sectors, respectively a first sector starting from the proximal end and ending with a prismatic portion and a second sector extending the first sector to the end. distal and presenting a width smaller than that of the first sector, the first sector being shaped to cooperate with the guide zone formed on the guide, the said guide zone being of complementary shape hollow with respect to the said first sector so as to form a sliding connection between said impactor and said guide

 Thus, the first sector of prismatic shape (or possibly conical) ensures the guidance of the impactor by shape cooperation with the guiding zone of the guide. The prismatic termination is provided to cooperate with a complementary shape termination of the guiding zone of the guide, in order to regularly and smoothly limit the translation of the impactor.

 This first sector may be of polygonal section. This first sector may extend over at least one third of the length of the elongate body of the impactor. The second sector may have a cylindrical shape or any section.

 According to another characteristic, the first sector comprises a boss forming a polarizer, and the guide has a notch formed in the guiding zone so that said boss cooperates with said notch during translational guidance of the impactor in said guide.

 In this way, the boss provides an indexing of the impactor in the guide, without risk of reversal or rotation of the impactor.

 In a particular embodiment, the elongate member of the guide is extended at its distal end by a curved arm forming an arc, in particular approximately 75 degrees, said curved arm terminating in a free end.

 This curved arm thus forms a sliding surface on which the implant moves under the action of the impaction made by the impactor, so that any subsequent manipulation of positioning becomes unnecessary on the part of the practitioner even though this sliding leads the implant in the desired configuration to ensure the restoration of intervertebral height and lordosis. In other words, this curved arm naturally causes the advantageous sliding and rotation of the implant to obtain its final positioning.

Advantageously, the free end of the curved arm is made of an elastically deformable material, in particular made of foam, so that to accompany the implant smoothly to its final position during the impingement of the impactor.

 In a particular embodiment, the curved arm has a tangent angle at its free end relative to the longitudinal axis of the guide between zero and ninety degrees.

 According to a possibility of the invention, the elongated member of the guide has at its distal end, at the junction between the elongate body and the curved arm, a shoulder of a predefined width to allow to bear on the adjacent vertebral bodies between which is provided the insertion of the implant.

 In other words, this shoulder is wider than the curved arm, being reminded that this curved arm is introduced precisely between the adjacent vertebral bodies. This possibility allows correct axial positioning of the guide, and therefore the ancillary, before insertion of the implant.

 According to another possibility of the invention, the elongated member of the guide has a generally U-shaped section along its length, said elongated member having a notch along its entire length; this notch being delimited on the sides by longitudinal branches.

 According to another advantageous feature of the invention, the notch provided on the elongate member of the guide has three successive portions, a first portion extending from the proximal end and of constant width, a second portion extending the first portion and decreasing width towards the distal end, and a third portion extending the second portion to the distal end and width - for example constant - less than the width of the first portion.

 Thus, the first portion serves primarily for guiding the impactor, and the longitudinal branches tightening at the second portion to form a recessed stop zone in translation of the impactor.

According to one possibility, the distal end of the impactor has a bearing surface provided with a keying system for an indexed positioning of the implant on said bearing surface. Thus, this keying system, of the boss or cavity type, is intended to cooperate with a complementary system of the implant, conversely of the cavity or boss type, in order to ensure the indexation of the implant and to avoid its rotation around the implant. the longitudinal axis. Other characteristics and advantages of the present invention will appear on reading the detailed description below, of an example of non-limiting implementation, with reference to the appended figures in which:

 - Figure 1 shows a schematic perspective view of an example of ancillary according to the invention, complete and in the initial position of use;

 - Figure 2 shows a schematic perspective view of an implant holder assembly, impactor equipping the ancillary of Figure 1, with the implant positioned on the implant holder;

 FIG. 3 represents a schematic perspective view of the single implant holder equipping the ancillary device of FIG. 1;

 - Figure 4 shows a schematic perspective view of the impactor alone equipping the ancillary of Figure 1;

 FIG. 5 represents a schematic perspective view of the single guide equipping the ancillary device of FIG. 1;

 FIG. 6 represents the prior phase of positioning the guide between the vertebral bodies;

 FIG. 7 represents the phase of engagement of the assembly of FIG. 2, with the implant positioned on the implant holder, in the guide after the preliminary positioning phase, the vertebral bodies not being illustrated for reasons of clarity;

 FIG. 8 represents the thrust phase of the assembly of FIG. 2 until reaching the first configuration, according to a first step of insertion of the implant between the vertebral bodies, the vertebral bodies not being illustrated for reasons of clarity;

 FIG. 9 represents the end of the removal phase of the implant holder until reaching the second configuration, the vertebral bodies not being illustrated for the sake of clarity;

 - Figure 10 shows the end of the thrust phase of the impactor, according to a second step of complete insertion of the implant between the vertebral bodies, the vertebral bodies are not illustrated for the sake of clarity;

- Figure 1 1 represents the final phase of removal of the ancillary and illustrates the final position of the implant between the vertebral bodies. Referring to the figures, a spinal ancillary 1 according to the invention comprises three distinct parts, a first piece called implant door 2, a second so-called impactor part 3, and a third piece called guide 3; each piece 1, 2, 3 each extend along a longitudinal axis A, B, C.

 With reference to FIG. 3, the first piece or implant holder 2 comprises an elongated portion 20 extending along a first longitudinal axis A, made in the form of a rod of circular section.

 This elongated portion 20 has two opposite ends, respectively a distal end 21 and a proximal end (not visible).

 The implant holder 2 is provided at the distal end 21 of the elongated portion 20 of a gripping system 22 of the intersomatic implant 5. By way of non-limiting example, the gripping system 22 consists of a externally threaded end piece to be secured to the implant 5 by screwing. In general, the implant 5 has a congruent or complementary system cooperating with the gripping system 22 to ensure removable attachment of the implant 5 to the distal end 21 of the implant holder 2.

 The implant holder 2 is provided at its proximal end with an anvil 23, which anvil 23 has a striking surface 24 located at the proximal end of the elongated portion 20.

 As can be seen in FIG. 3, the anvil 23 is in the form of a cap having a generally disk-like proximal wall 25 and a generally cylindrical sleeve-like sidewall 26 projecting from the proximal wall 25. .

 The proximal wall 25 is disposed on the proximal end of the elongated portion 20 and extends perpendicular to the longitudinal axis A. The proximal wall 25 has an upper surface, or outer surface, forming the striking surface 24 of the Anvil 23. This striking surface 24 is flat. The proximal wall 25 also has a lower surface, or inner surface (not visible), opposite and parallel to the upper surface. This lower surface is flat.

The side wall 26 extends peripherally around a proximal end portion of the elongate portion 20 to a length L2 predetermined along the longitudinal axis A of the elongate portion 20. The side wall 26 extends symmetrically about the longitudinal axis A.

 The side wall 26 has a free peripheral edge which defines a distal bearing surface 27 of the anvil 23; this distal bearing surface 27 being remote from the proximal wall 25 of the length L2. The side wall 26 has a given diameter D2.

 Thus, the cap-like anvil 23 defines a recessed portion extending axially symmetrically about said proximal end portion of the elongate portion 20 on said length L2 toward the distal end 21 of the elongate portion 20.

 Referring to Figure 4, the impactor 3 comprises an elongate body 30 extending along the longitudinal axis B and provided with two opposite ends, respectively a distal end 31 and a proximal end 32 provided with a wider head 33 that the elongated body 30.

 The head 33 has two opposed bearing surfaces, respectively a lower bearing surface 34 located at the junction between the head 33 and the elongate body 30 and an upper bearing surface 35. The head 33 extends according to the B axis, between its two bearing surfaces 34, 35 opposite, over a length L3 less than the length L2 of the anvil 23. These two bearing surfaces 34, 35 are flat, parallel to each other and perpendicular to the axis B.

 In general, the anvil 23 of the implant holder 2 is geometrically shaped to cap the head 33 of the impactor 3, in other words to wrap the head 33. For this purpose, the head 33 is for example of cylindrical shape and diameter D3 less than the diameter D2 of the anvil 23.

 The impactor 3 is provided with a bore 36 shaped for the passage of the elongated portion 20 of the implant holder 2, this bore 36 passing through the impactor 3 over its entire length, and thus passing through the head 33 and the elongated body 30 from its proximal end 32 to its distal end 31. This bore 36 is intended to cooperate with the elongate portion 20 of the implant holder 2 thus allowing the longitudinal axis B of the impactor 3 to become confused in use with the longitudinal axis A of the implant holder 2 .

The elongate body 30 of the impactor is divided into two sectors: a first sector 301 starting from the proximal end 32 and ending with a prismatic portion 303, this first sector 301 being polygonal section and extending over at least one third of the length of the elongated body 30; and

 a second second sector 302 extending the first sector 301 to the distal end 31 and having a width that is smaller than that of the first sector 301.

 The first sector 301 comprises a boss 304 or a projection forming a polarizer, this boss extending along the axis B over all or part of the length of the first sector 301.

 In addition, the distal end 31 of the impactor 3 has a flat bearing surface 37, provided with a keying system, in particular of the pin or centering pin type, for an indexed positioning of the implant 5 on this support surface 37. For this purpose, this keying system cooperates judiciously with a congruent system, or complementary, formed on the implant 5, such as a centering cavity in which pin engagement or centering pin.

 With reference to FIG. 5, the guide 4 comprises an elongate member 40 extending along a longitudinal axis C and provided with two opposite ends, respectively a distal end 41 and a proximal end 42.

 The proximal end 42 is provided with a so-called proximal bearing surface 43, which is flat and perpendicular to the C axis.

 The elongated member 40 has a generally U-shaped section along its length, and for this purpose has a notch 44 over its entire length.

 The notch 44 has three successive portions:

 a first portion 441 starting from the proximal end 42 and of constant width,

 a second portion 442 extending the first portion 441 and of decreasing width towards the distal end 41, and

a third portion 443 extending the second portion 442 to the distal end 41 and of width less than the width of the first portion 441.

The first portion 441 defines a guide zone in translation of the impactor 2 along the longitudinal axis C and in this first portion 441, the notch 44 is delimited by branches which are tightened, in order to prevent the impactor 3 does not escape out of the first portion 441 of the notch 44; while in the other portions 442, 443 the branches can be open or not tightened.

 The first sector 301 of the elongated body 30 of the impactor 3 is shaped to cooperate with this first portion 441, this first portion 441 being of complementary shape recessed with respect to this first sector 301 so as to form a sliding connection between the 3 and the guide 4. In addition, the boss 304 cooperates with the notch 44 in this first portion 441, and more specifically with the constricted portion of the notch 44, during the translational guidance of the impactor 3 in the guide 4.

 The elongated member 40 is extended at its distal end 41 by a curved arm 45 forming an arc of approximately 75 degrees, this curved arm 45 ending in a free end 46 made of an elastically deformable material, in particular of foam .

 The curved arm 45 has a tangent angle at its free end 46 with respect to the longitudinal axis C between zero and ninety degrees, and which is about 70 to 90 degrees in the example of FIGS.

 In addition, the elongated member 40 has at its distal end 41, at the junction between the elongate body 40 and the curved arm 45, a shoulder 47 of a predefined width to allow to bear on the adjacent vertebral bodies CV, and illustrated in Figure 6, between which is provided the insertion of the implant 5.

 The remainder of the description relates to the use of the ancillary device 1 according to the invention.

 In a prior phase, as shown in FIG. 1, the elongated portion 20 of the implant holder 2 is engaged inside the bore 36 of the impactor 2 until the lower surface of the proximal wall 25 the anvil 23 abuts against the upper bearing surface 35 of the head 33 of the impactor 3, and the proximal end 21 of the elongated portion 20 protrudes from the proximal end 31 of the elongate body 30 of the impactor 3, so that the gripping system 22 is accessible. Then, it is a matter of having the implant 5 come into engagement with the implant-holder 2-impactor 3 assembly, by mounting the implant 5 on the gripping system 22 of the implant-holder 2.

Then, reference is made to FIG. 6, then begins the implementation of the insertion where, in a first phase, the surgeon positions the guide 4 by inserting said curved arm 45 between the vertebral plates of the vertebral body CV of the treated segment until the shoulder 37 cooperates with the vertebral bodies CV.

 In a second phase visible in FIGS. 7 and 8, the implant-holder 2-impactor 3 assembly is engaged in the guide 4 and the impactor 3 cooperates with the guiding zone 441 of the guide 4 until the surface distal support 27 of the anvil 23 abuts against the proximal bearing surface 43 of the guide 4. As the anvil 23 caps the head 33 of the impactor 3, and as the anvil 23 is longer that this head 33, the head 33 remains in abutment against the proximal wall 25 of the anvil 23 and is spaced from the proximal bearing surface 43 of the guide 4. In this second phase, we come to coincide the longitudinal axes A , B of the implant holder assembly 2, impactor 3 previously assembled with the longitudinal axis C of the guide 4 by inserting the first sector 301 of the impactor 3 through the notch 44 of the guide 4; the three parts 2, 3, 4 being coaxial, the slide connection thus formed makes it possible to come into contact with the distal support surface 27 of the anvil 23 with the proximal bearing surface 43 of the guide 4 thanks to the judicious choice of the length L2; the implant 5 is thus found in a semi-impacted position between the vertebral bodies CV.

 In a third phase visible in FIG. 9, the implant holder 5 is uncoupled from the implant holder 2 by actuating the gripping system 22 (for example by unscrewing) and then removing the implant holder 2 from the implant holder 2. bore 36 of the impactor 3, the implant 5 thus being in unilateral contact with the bearing surface 37 of the distal end 31 of the impactor 3 and in sliding contact with the curved arm 45 of the guide 4.

In a third phase visible in FIG. 10, once the implant holder 2 has been removed, the impactor 3 is free to slide in the guide 4 towards its distal end 41 in order to allow precise insertion of the implant 5. This translation of the impactor 3 takes place until the lower bearing surface 34 of the head 33 comes into abutment against the proximal bearing surface 43 of the guide 4. Thus, it comes to put in the surface of lower support 34 of the head 33 with the proximal bearing surface 43 of the guide 4 by making play the sliding connection formed by the cooperation of the second portion 442 with the prismatic portion 303 of the impactor 3, thereby automatically causing the sliding of the implant 5 along the curved arm 45, which sliding causes the rotation of the implant 5 between the vertebral bodies CV adjacent, this rotation advantageously and inevitably leading the implant 5 to its proper position.

 In a last phase visible in FIG. 11, the contact of the impinger 3 and guide 4 assembly is released from the implant 5 by exerting a rotation of the guide 4 around the implant 5, which is released without difficulty because the contact is unilateral and the guide 4 slides freely along the implant 5.

 The sequence of operations described above shows that the implantation of an interbody implant using the ancillary according to the invention is easy, safe, fast and naturally leads the implant 5 in the position conform in the intersomatic space.

 According to the invention the goal is thus achieved through the combination of three pieces of ancillary cooperating coaxially according to a perfectly defined role, allowing to link the unit tasks logically and rationally.

 Although the invention is described in detail by the diagrams and description above, other forms of illustrations may be considered without restriction of the features of the invention, it being understood that only the preferred representations have been shown and described and that any changes that remain consistent with the spirit of the invention are considered protected by said invention. It is understood that the skilled person is able to realize different variants of the invention without departing from the scope of the patent

Claims

1. Ancillary (1) spinal insertion, positioning and guiding of an intersomatic implant (5), said ancillary (1) comprising: an implant holder (2) comprising an elongated portion (20) provided with two opposite ends, respectively a distal end (21) on which is provided a gripping system (22) of said intersomatic implant (5) and a proximal end on which is provided an anvil (23) having a striking surface (24); - an impactor (3) comprising an elongate body (30) provided with two opposite ends, respectively a distal end (31) and a proximal end (32) provided with a head (33), said head (33) having two surfaces opposed bearing means, respectively, a lower bearing surface (34) located at the junction between said head (33) and said elongate body (30) and an upper bearing surface (35), and the impactor (3). being provided with a bore (36) shaped for the passage of the elongated portion (20) of the implant holder (2), said bore (36) passing through the head (33) and the elongated body (30) of its proximal end (32) to its distal end (31);  - a guide (4) comprising an elongated member (40) extending along a longitudinal axis (C) and provided with two opposite ends, respectively a distal end (41) and a proximal end (42) provided with a surface said proximal support (43), said elongated member (40) having a guide zone (441) in translation of the impactor (3) along said longitudinal axis (C); said ancillary device (1) being characterized in that the anvil (23) of the implant holder (2) has a recessed portion extending around said elongated portion (20) over a predetermined length (L2) in the direction of the distal end (21) of said elongated portion (20), and comprising:  a proximal wall (25) disposed on the proximal end of the elongated portion (20) of said implant holder (2) and having two opposite surfaces, respectively an upper surface opposite to the elongate portion (20) and forming the striking (24) said anvil (23) and a lower surface located at the junction between the proximal wall (25) and the elongated portion (20), and a side wall (26) projecting from said proximal wall, extending around said elongate portion (20) along the pre-terminated length and having a distal bearing surface of the anvil (23) remote from the proximal wall (25) of said length (L2); in that the head (33) of the impactor (3) extends between its two opposite bearing surfaces (34, 35) over a length (L3) less than the length (L2) of the recessed portion of the anvil (23), and in that the recessed portion of the anvil (23) is geometrically shaped to cap the head (33) of the impactor (3). 2. Ancillary (1) according to claim 1, wherein the elongated body (30) of the impactor (3) is divided into two sectors, respectively a first sector (301) from the proximal end (32) and terminating in a prismatic portion (303) and a second sector (302) extending the first sector (301) to the distal end (31) and having a smaller width than the first sector (301), said first sector (301) being shaped to cooperate with the guide zone (441) formed on the guide (4), said guide zone (441) being of complementary shape hollow with respect to said first sector (301) so as to form a slide connection between said impactor (3) and said guide (4). 3. Ancillary (1) according to claim 2, wherein the first sector (301) comprises a boss (304) forming a polarizer, and the guide (4) has a notch (44) formed in the guide zone (441). so that said boss (304) cooperates with said notch (44) during translational guidance of the impactor (3) in said guide (4). 4. Ancillary (1) according to any one of the preceding claims, wherein the elongated member (40) of the guide (4) extends at its distal end (41) by a curved arm (45) forming a circular arc. , in particular approximately 75 degrees, said curved arm (45) terminating in a free end (46). 5. Ancillary (1) according to claim 4, wherein the free end (46) of the curved arm (45) is made of an elastically deformable material, including foam. 6. Ancillary (1) according to claims 4 or 5, wherein the curved arm (45) has a tangent angle at its free end (46) relative to the longitudinal axis (C) of the guide (4) between zero and ninety degrees. 7. Ancillary (1) according to any one of claims 4 to 6, wherein the elongate member (40) of the guide (4) has at its distal end (41), at the junction between the elongated body (30) and the curved arm (45), a shoulder (47) of a predefined width to allow to bear on the adjacent vertebral bodies (CV) between which is provided l insertion of the implant (5). 8. Ancillary (1) according to any one of the preceding claims, wherein the elongated member (40) of the guide (4) has a generally U-shaped section over its entire length, said elongated member (40) having a notch (44) along its entire length. 9. Ancillary (1) according to claim 8, wherein the notch (44) provided on the elongated member (40) of the guide (4) has three successive portions, a first portion (441) starting from the proximal end. (42) and of constant width, a second portion (442) extending the first portion (441) and of decreasing width toward the distal end (41), and a third portion (443) extending the second portion (442) to the distal end (41) and of width less than the width of the first portion (441). 10. Ancillary (1) according to any one of the preceding claims, wherein the distal end (31) of the impactor (3) has a bearing surface (37) provided with a keying system for positioning indexed implant (5) on said bearing surface (37).