JP4141259B2 - Outlined spinal fusion implant - Google Patents

Description

  The present invention generally is preferably inserted into an implantable gap created over the entire height of such a space for the purpose of correcting spinal lesions in the intervertebral space between two adjacent vertebral bodies. The present invention relates to an interbody spinal implant adapted to be placed. Implants are adapted to cause fusion at least partially through these implants. Implants can be made from cortical bone, bone composites, or materials other than bone.

  This application claims priority to provisional application number 60 / 281,187 filed April 3, 2001 and provisional application number 60 / 281,112 filed April 2, 2001. Incorporated herein by reference.

  Implants placed between adjacent vertebral bodies in the spine vary in shape and size and are made from a variety of materials. Implants for use in such human spine surgery are designed to promote the fusion of adjacent vertebral bodies by allowing bone to grow through the implant and thereby fusing the adjacent vertebral bodies Implants made of inert selected materials such as bone or titanium having a certain structure.

  Implants made from bone and used for interbody spinal surgery are often made from a portion of the diaphysis. The diaphysis is the major long bone axis between the epiphyses, the ends of which form joints.

  The annulus of the diaphysis is formed by cutting two spaced apart, approximately perpendicular to the long axis of the main long bone diaphysis, and the medullary canal forms an opening through the annulus. Such annulus is generally taken from the femur for use in the lumbar spine. Other bones taken from human skeleton arms, legs, or other parts can also be used in various spinal regions.

  It is common to cut apart to form an annulus of bone that has a height corresponding to the disc space to be repaired or a slightly larger height. A bone graft of an annulus of the diaphysis is inserted into the spine throughout the gap previously occupied by the spinal intervertebral disc between adjacent vertebral bodies and its height, and these vertebrae are inserted through this intervertebral space. Realize body fusion between vertebral bodies. The bone graft of the diaphyseal annular body is incorporated into the bone fusion portion over time.

  However, until now, the success of interbody spinal fusion using a diaphyseal annulus has been limited. Not all causes of failure are known, but nonetheless, the poor alignment of the interface between the bone annulus implant and the adjacent vertebral body and the poor stability of the bone annulus implant are under the control of the surgeon. Two of the more important factors that cause failure.

  During surgery to create a fusion between adjacent vertebral bodies of a patient's spine, the surgeon attempts to fuse by removing some or all of the intervertebral disc between adjacent vertebral bodies to be fused Typically, a hole is prepared at the site. Because the outermost layer of bone in the vertebral endplate is relatively inert to new bone growth, the surgeon can use the endplate to reach blood-rich vascular bone tissue within the vertebral body. It must be processed to remove the outermost cell layer of the bone. In this manner, vertebrae are prepared to promote the growth of new bone within or through the implant placed between the vertebral bodies.

  Current methods of forming such a gap between adjacent vertebral bodies include one or more of the following instruments: hand-held grasping and grasping instruments known as bone forceps, drills and drill guides, motor drives This typically involves the use of a rotating bar, osteotome and scissors, and a dual wheel cutter or intervertebral space preparation device. In particular, the two-wheel cutter or intervertebral space preparation device disclosed by Michelson in WO 99/63891, incorporated herein by reference, is adapted to be inserted linearly, ie along a single axis, Thus, it is not necessary to move the device laterally along the second axis substantially within the intervertebral space. In one such preferred embodiment, the device has an abrasive element at its working end with a width that generally corresponds to the width of the implant to be implanted.

  It would be desirable to improve the implant interface to adjacent vertebral bodies to be consistent and to achieve implant stability. Therefore, the contour of the implant closely matches the implant gap formed between adjacent vertebral bodies and at least in part thereof, enabling more uniform load transmission across the vertebral bodies. Is an advantage.

  Interbody spinal implants that make all or almost all from cortical bone or bone composite materials provide the benefits of such materials, including the appropriate modulus and strength for a given use situation, and are osteoinductive, It provides bioactive capabilities, including osteoinductive, osteogenic, and more generally provides a suitable substrate for new bone formation when fusion occurs. Furthermore, the ability to bioresorb allows the patient's own bone to replace bone material over time, thereby preventing stress blockage and ultimately removing any foreign material from the site of implantation. Because it is desirable to take advantage of all of these benefits, improvements made from bone, bone composites, or non-bone materials that have a configuration that improves implant-vertebral body alignment and improves implant stability. There is a need for a type of interbody spinal fusion implant.

  As embodied and broadly described herein, in accordance with the objectives of the present invention, at least a portion is inserted into an implantation gap formed across the height of the intervertebral space between adjacent vertebral bodies of the human spine. To provide an interbody spinal fusion implant made from cortical bone. The implant includes a front end for initial insertion into the intervertebral space and a rear end opposite the front end. The implant has a length from the front end to the rear end. The front end is configured in a semicircular shape in the lateral direction. The implant also includes opposed upper and lower portions between the front and back ends that are adapted to be positioned within the intervertebral space to contact and support adjacent vertebral bodies. These upper and lower portions are non-arc-shaped along at least a portion of the length of the implant. The implant also includes opposing sides between the top and bottom and between the front and back ends. At least a portion of at least one of these side surfaces is linear along at least a portion of the length of the implant.

  As embodied and broadly described herein, in accordance with the objectives of the present invention, at least a portion is inserted into an implantation gap formed across the height of the intervertebral space between adjacent vertebral bodies of the human spine. To provide an interbody spinal fusion implant made from cortical bone. The implant includes a front end for initial insertion into the intervertebral space and a rear end opposite the front end. The implant has a length from the front end to the rear end. The front end portion is formed in a substantially semicircular shape of the first circle in the lateral direction. The rear end portion has a radius of curvature of the second circle in the lateral direction. The second circle has a radius that is greater than the radius of the first circle. The implant also includes opposed upper and lower portions between the front and back ends that are adapted to be positioned within the intervertebral space to contact and support adjacent vertebral bodies. The implant has a maximum width that is greater than one half of the width of an adjacent vertebral body that is adapted to insert the implant.

  The implants described above are preferably made from a bony annulus obtained from a major human long bone with a medullary canal. The implant includes at least a portion of a medullary canal that passes between an upper portion and a lower portion to form a passage adapted to receive a bone growth promoting material, through which the bone passes from the vertebral body to the vertebra. It can grow into the body. Alternatively, the implants described above can be made from bone composite materials.

  As embodied and broadly described herein, in accordance with the objectives of the present invention, at least a portion is inserted into an implantation gap formed across the height of the intervertebral space between adjacent vertebral bodies of the human spine. To provide an artificial interbody spinal fusion implant made from materials other than bone. The implant includes a front end for initial insertion into the intervertebral space and a rear end opposite the front end. The implant has a length from the front end to the rear end. The front end portion has a substantially semicircular shape in the lateral direction. The implant also includes opposed upper and lower portions between the front and back ends that are adapted to be positioned within the intervertebral space to contact and support adjacent vertebral bodies. These upper and lower portions are non-arc-shaped along at least a portion of the length of the implant. The upper and lower portions include at least one opening adapted to communicate with each other and receive a bone growth promoting material so that bone can grow from vertebral body to vertebral body through the implant. The implant also includes opposing sides between the top and bottom and between the front and back ends. At least a portion of at least one of these side surfaces is linear along at least a portion of the length of the implant.

  As embodied and broadly described herein, in accordance with the objectives of the present invention, at least a portion is inserted into an implantation gap formed across the height of the intervertebral space between adjacent vertebral bodies of the human spine. To provide an artificial interbody spinal fusion implant made from materials other than bone. The implant includes a front end for initial insertion into the intervertebral space and a rear end opposite the front end. The implant has a length from the front end to the rear end. The front end portion is formed in a substantially semicircular shape of the first circle in the lateral direction. The rear end portion has a radius of curvature of the second circle in the lateral direction. The second circle has a radius that is greater than the radius of the first circle. The implant also includes opposed upper and lower portions between the front and back ends that are adapted to be positioned within the intervertebral space to contact and support adjacent vertebral bodies. The upper and lower portions include at least one opening adapted to communicate with each other and receive a bone growth promoting material so that bone can grow from vertebral body to vertebral body through the implant. The implant has a maximum width that is greater than one half of the width of an adjacent vertebral body that is adapted to insert the implant.

  Some of the additional objects and advantages of the present invention are described in the following description, some of which will be apparent from the description or may be learned by practice of the invention. The objects and advantages of the invention will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims.

  The following description is exemplary and not intended to be limiting and many variations can be envisioned in accordance with these teachings and are intended to be within the scope of the present teachings. . Reference will now be made in detail to the preferred embodiments of the invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.

  1-3 show an implantation gap 50 formed in the vertebral body V over the entire gap height occupied by the intervertebral disc D in the lumbar vertebrae. Implant gap 50 is preferably formed using the apparatus and method disclosed by Michelson in US Pat. No. 6,083,228 and WO 99/63891, both of which are incorporated herein by reference. These instruments and methods are not the subject of this application. The methods for preparing implant gaps shown therein are one preferred instrument and method for preparing such implant gaps and that any desired method and instrument suitable for this purpose can be utilized to prepare the desired implant gap. Is clear.

  The implant gap 50 is preferably formed in the endplate portion ER in the subchondral bone of the vertebral body V. The implantation gap 50 is preferably formed so as to have a front edge 52 including a substantially semicircular shape of the first circle A in the lateral direction. The posterior portion 54 of the implantation gap 50 preferably includes at least a portion of the vertebral body front having a radius of curvature of the second circle B in the lateral direction. It is preferable that the radius of the circle A is smaller than the radius of the circle B. The implantation gap 50 can further include side edges 56, 58. These side edges 56, 58 preferably include at least straight portions, are parallel to each other along the line P, and can form a curved transition with the leading edge 52.

  FIGS. 4-6 show an implantation gap 60 formed in the vertebral body V throughout the height of the gap occupied by the intervertebral disc D in the cervical spine. The implantation gap 60 is preferably formed so as to have a front edge 62 including a substantially semicircular shape of the first circle A in the lateral direction. The posterior portion of the implantation gap 60 preferably includes at least a portion of the vertebral body front having a radius of curvature of the second circle C in the lateral direction. It is preferable that the radius of the circle A is smaller than the radius of the circle C. However, since the depth from the front surface to the rear surface of the cervical vertebral body is shallower than the depth from the front surface to the rear surface of the lumbar vertebral body, the implantation gap 60 preferably does not include a straight side edge like the implantation gap 50. Therefore, the radius of the circle C in the cervical vertebra is smaller than the radius of the circle B in the lumbar vertebra.

  7-12 show an implant 100A according to one preferred embodiment of the present invention. The implant 100A is preferably manufactured from a bone annular body obtained from a human major long bone. Implant 100A includes an anterior end 102A for initial insertion into the intervertebral space between two adjacent vertebral bodies, a posterior end 104A opposite to the anterior end 102A, and opposing sides 110A, 112A therebetween. Have The front end 102A is preferably configured to match the contour of the front edge 52 of the implantation gap 50, and the rear end 104A is conformal to the contour of the anterior vertebral body at the rear end 54 of the implantation gap 50. It is preferable to be configured as follows. The side surfaces 110A, 112A are generally planar and preferably correspond to the configuration of the side edges 56, 58 of the implant gap 50.

  In one preferred embodiment of the invention, the front end 102A, the rear end 104A, and the opposing side surfaces 110A, 112A are machined to have various configurations. The front end 102A is preferably machined so as to have a substantially semicircular shape of the first circle in the lateral direction. If the implant gap is prepared in the vertebral body so that it has at least a partially curved lip or ridge, the front end 102A can be adapted to abut at least the lip edge portion of the implant gap.

  One or both of the side surfaces 110A, 112A may be formed at least partially in an orientation that is generally parallel to the central longitudinal axis of the implant 100A and / or to each other. Furthermore, the front end 102A can be tapered to facilitate insertion of the implant 100A between two adjacent vertebral bodies.

  The rear end 104A preferably forms a second circular arc having a radius greater than the radius of the first circle associated with the front end 102A in the lateral direction. Preferably, at least a portion of the posterior end 104A is adapted to be conformal with at least a portion of the peripheral contour of the anterior vertebral body adjacent to the intervertebral space in which the implant is to be inserted, The present invention is not so limited.

  FIG. 12 shows that the implant 100A preferably has a driver hole 116A at its rear end 104A for cooperating engagement with an instrument for inserting the implant 100A into the implantation gap. The driver hole 116A is preferably configured to be screwed with the insertion instrument.

  8, 10 and 11 show that at least a portion of the upper and lower surfaces 106A, 108A are angled relative to each other from the rear end 104A to the front end 102A, and adjacent vertebral bodies are angled relative to each other. Indicates that it can be formed. Upper and lower surfaces 106A and 108A are preferably not arcuate in a direction along the central longitudinal axis of implant 100A. The implant 100A preferably has a maximum height that is less than the maximum width of the implant.

  As shown in FIG. 9, it is preferable that the upper and lower surfaces 106A and 108A have passages 114A passing therethrough and between the front and rear end portions 102A and 104A and between the opposite side surfaces 110A and 112A, respectively. . The passage 114A is preferably adapted to contain a bone growth promoting material so that bone can grow from vertebral body to vertebral body through the passage 114A. In addition to this passage 114A, the upper and lower surfaces 106A, 108A can also include at least one hole communicating with each other so that bone can grow from vertebral body to vertebral body via implant 100A, although the present invention Is not so limited. Upper and lower surfaces 106A, 108A may be porous and may include a bone ingrowth surface.

  As shown in FIG. 9, the implants described herein can include a bone engaging surface 118A, such as a knurled hook, for example. The bone engaging surface 118A is configured to engage the bone of the adjacent vertebral body after implantation to maintain the implant 100A within the adjacent vertebral body. Other preferred embodiments of the bone engaging surface include an implant surface formed with a rough surface, nail teeth, splines, or include at least one protrusion that penetrates and engages the bone of the vertebral body. Can do. By way of example only, implants of the present invention can include a surface configuration taught by Michelson in US patent application Ser. No. 09 / 457,228 entitled “Spinal Implant Surface Configuration,” the disclosure of which is hereby incorporated by reference. Include in the book.

  Implant 100A is preferably made from a bone annulus of the diaphysis, but need not be made therefrom. It is preferred that the diaphysis of the diaphysis is obtained from the major long bones of the human skeleton. The bony annulus is formed by cutting two spaced apart, approximately perpendicular to the major axis of the main long bone, and a portion of the medullary canal forms an opening through the annulus. . Such annulus is generally taken from the femur for use in the lumbar spine. Bone from the arms, legs, or other parts of the human skeleton can also be used in various regions of the spine. The long bone can be cut to form a bone annulus having an upper surface and a lower surface, generally perpendicular to the long axis of the diaphysis or at other angles across the axis. Cutting at an angle to each other results in a bone annulus having upper and lower surfaces that are angled relative to each other. Due to the angled relationship between the upper and lower surfaces of the bone annulus, the next time the annulus is made into an implant and implanted into the spine, adjacent vertebral bodies are positioned in an angled relationship with each other, e.g. Restores the natural curvature of the spine like a forehead.

  The bone is machined to form an implant with a selected shape appropriate for the intended purpose. Examples of tools that can be used for implant machining include, but are not limited to, bars, reamers, mills, saws, drills, scissors, and the like. By way of example only, the front end can be shaped into a semicircle in the lateral direction. The side can be machined at least partially linearly. The posterior end can be machined to any desired shape suitable for the intended purpose, and preferably an anatomical contour of the adjacent vertebral body adapted to insert the implant therebetween And can be shaped conformally. The medullary canal preferably forms a passage adapted to receive bone growth promoting material and / or substance. Where appropriate, it is desirable to leave at least part of the natural curvature around the bony annulus as part of the implant geometry.

  Implant 100A may have a length that is greater than one-half of this vertebral body depth measured between the anterior and posterior surfaces of the vertebral bodies adjacent to the intervertebral space in which the implant is to be inserted. preferable. Implant 100A also preferably has a maximum width that is greater than one half of the width of an adjacent vertebral body adapted to insert the implant.

  For any embodiment of the implant of the present invention made from at least a portion of bone rather than machined from a single bone portion, at least one of cortical bone fibers, bone microfibers, bone particles, or bone powder. The implant can then be made from a composite bone material containing a binding material that may or may not be bioactive and / or bioresorbable, such as plastic, ceramic, and the like. By way of example only and not limitation, the bioabsorbable material can include polygalactone. Once the composite implant material is formed, it is machined or molded into the desired shape.

  13-18 illustrate an implant 100B, preferably made from a material other than bone, according to one preferred embodiment of the present invention. The implant 100B includes a front end 102B for initial insertion into the intervertebral space between two adjacent vertebral bodies, a rear end 104B opposite the front end 102B, and opposing side surfaces 110B, 112B therebetween. Have The front end 102B is preferably configured to match the contour of the leading edge 52 of the implantation gap 50, and the rear end 104B conforms to the contour of the vertebral body front in the posterior portion 54 of the implantation gap 50. It is preferable that it is comprised so that. The side surfaces 110B, 112B are generally planar and preferably correspond to the configuration of the side edges 56, 58 of the implantation gap 50.

  In one preferred embodiment of the invention, the front end 102B, the rear end 104B, and the opposing side surfaces 110B, 112B can have a variety of configurations. The front end 102B is preferably in the shape of a substantially semicircle of the first circle in the lateral direction. If the implant gap is prepared in the vertebral body so that it has at least a partially curved lip or ridge, the front end 102B can be adapted to abut at least the lip edge of the implant gap.

  One or both of the side surfaces 110B, 112B can also be formed at least partially in an orientation that is generally parallel to the central longitudinal axis of the implant 100B and / or to each other. One or both of the side surfaces 110B, 112B may include at least one hole 119B through which bone can pass and grow into the implant 100B, but the invention is not so limited. Furthermore, the front end 102B can be tapered to facilitate insertion of the implant 100B between two adjacent vertebral bodies.

  The rear end 104B preferably forms a second circular arc having a radius greater than the radius of the first circle associated with the front end 102B in the lateral direction. Preferably, at least a portion of the posterior end 104B is adapted to be conformal with at least a portion of the peripheral contour of the anterior vertebral body adjacent to the intervertebral space in which the implant is to be inserted, The present invention is not so limited.

  FIG. 18 shows that the implant 100B preferably has a driver hole 116B at its rear end 104B for cooperating engagement with an instrument for inserting the implant 100 into the implantation gap. The driver hole 116B is preferably configured to be screwed with the insertion instrument.

  FIGS. 14, 16, and 17 show that at least a portion of the upper and lower surfaces 106B, 108B are angled with respect to each other from the rear end 104B to the front end 102B, and adjacent vertebral bodies are angled relative to each other. Indicates that it can be formed. Upper and lower surfaces 106B and 108B are preferably not arcuate in a direction along the central longitudinal axis of implant 100B. The implant 100B preferably has a maximum height that is less than the maximum width of the implant.

  As shown in FIG. 15, the upper and lower surfaces 106B, 108B pass through them and have at least one opening 114B between the front and rear ends 102B, 104B and between the opposing side surfaces 110B, 112B, respectively. It is preferable. The opening 114 is preferably adapted to receive bone growth promoting material through the opening 114B and through the implant 100B so that bone can grow from vertebral body to vertebral body. The upper and lower surfaces 106B, 108B may be porous and may include a bone ingrowth surface.

  As shown in FIG. 15, the implants described herein can include a bone engaging surface 118B, such as a knurled hook, for example. The bone engaging surface 118B is configured to engage the bone of the adjacent vertebral body after implantation to maintain the implant 100B within the adjacent vertebral body. Other preferred embodiments of the bone engaging surface include an implant surface formed with a rough surface, nail teeth, splines, or include at least one protrusion that penetrates and engages the bone of the vertebral body. Can do.

  The substrate material used to form the implants of FIGS. 13-18 is preferably a material other than bone. In one preferred embodiment, the implant material is, but not limited to, metals and ceramics, including titanium and its alloys, ASTM materials, cobalt chromium, or tantalum, various surgical grade plastics, plastic composites It can be made from artificial materials such as wood, carbon fiber composites, corals, etc., and at least some can include bioabsorbable artificial materials.

  Implant 100B has a length greater than one half of this vertebral body depth measured between the anterior and posterior surfaces of the vertebral bodies adjacent to the intervertebral space into which the implant is to be inserted. Is preferred. The implant 100B also preferably has a maximum width that is greater than one half of the width of the adjacent vertebral body into which the implant is inserted.

  FIG. 19 shows another preferred embodiment of the present invention of an implant made from bone or bone composite for use in the cervical spine, generally designated by reference numeral 200A. Implant 200A is similar to that used in connection with the lumbar spine, but with an instrument and method modified for use in the cervical spine, an implant gap formed in the endplate of the adjacent cervical vertebral body It is preferably configured to be conformal to the 60 shape. The implant 200A can have, for example, a front end portion 202A formed so as to have a substantially semicircular shape of a first circle in the lateral direction. It is preferable that the rear end portion 204A can be formed as a circular arc of a second horizontal circle that intersects the curved portion of the front end portion 202A in the horizontal direction. The radius of the second circle associated with the rear end portion 204A is preferably greater than the radius of the first circle associated with the front end portion 202A.

  FIG. 20 illustrates another preferred embodiment of the present invention of an implant made from bone or bone composite for use in the cervical spine, generally designated by the numeral 200B. The implant 200B is preferably configured to conform to the shape of the implant gap 60 formed in the endplate of the adjacent cervical vertebral body. The implant 200B can have, for example, a front end portion 202B formed so as to have a substantially semicircular shape of a first circle in the lateral direction. It is preferable that the rear end portion 204B can be formed as a second circular arc in the lateral direction that intersects the curved portion of the front end portion 202B in the lateral direction. The radius of the second circle associated with the rear end portion 204B is preferably greater than the radius of the first circle associated with the front end portion 202B.

  FIGS. 21-26 illustrate an implant 300A, preferably made from bone or bone composite, according to another preferred embodiment of the present invention, adapted for use from an anterior approach to the spine. FIG. 21 is a perspective view showing the implant 300A from the rear. Implant 300A includes at least two members 300A ', 300A "that are adapted to be placed side-by-side with each other. Member 300A' is preferably a mirror image of 300A", but need not be. The description relating to member 300A ′ is equally applicable to member 300A ″. Member 300A ′ includes an anterior end 302A ′ for initial insertion between two adjacent vertebral bodies and anterior end 302A ′. The member 300A ′ has an upper surface 306A ′, a bottom surface 308A ′, an inner side surface 310A ′, and an outward side surface 312A ′ opposite to the inward side surface 310A ′. The term as used herein refers to the side of a member that is adapted to be oriented toward the inner surface of one member when a pair of members are inserted side-by-side into the intervertebral space. To express. In one preferred embodiment, the medial surface 310A 'includes at least a portion of the medullary canal of the bony annular body.

  The respective front ends 302A ', 302A "of each member 300A', 300A" form the front end 302A of the implant 300A when these members are placed side by side. The front end portion 302A of the implant 300A is preferably configured in the shape of a semicircular first circular circle in the lateral direction. When the members 300A ′, 300A ″ are placed side by side, the posterior end 304A comprising the posterior ends 304A ′, 304A ″ has a radius greater than the radius of the first circle associated with the anterior end 302A of the implant 300A. It can be formed as a circular arc of a transverse second circle having, but need not be.

  Placing member 300A ′ side-by-side with member 300A ″, the medullary canal portions of the inner surface 310A ′ of each member form a passage 314A that is adjacent to each other and penetrates implant 300A. Passage 314A is the passage 314A. Preferably, the member 300A ′ is adapted to receive a bone growth promoting material so that bone can be grown from vertebral body to vertebral body through the member 300A ′. It is preferred to have a maximum width W that is less than about one-half of the width. Also, the combined width of both members 300A ', 300A "is that of an adjacent vertebral body adapted to insert these members. It is preferably greater than one half of the width.

  The members 300A ', 300A "provide the additional advantage that they can be inserted through a smaller gap than a single larger implant to achieve the same effect as this larger implant.

  FIGS. 27-32 illustrate an implant 300B made from a material other than bone according to another preferred embodiment of the present invention adapted for use from an anterior approach to the spine. FIG. 27 is a perspective view showing the implant 300B from the rear. Implant 300B includes at least two members 300B ', 300B "that are adapted to be placed side-by-side with each other. Member 300B' is preferably a mirror image of 300B", but need not be. The description relating to member 300B ′ is equally applicable to member 300B ″. Member 300B ′ includes an anterior end 302B ′ for initial insertion between two adjacent vertebral bodies and an anterior end 302B ′. The member 300B ′ has a top surface 306B ′, a bottom surface 308B ′, an inner side surface 310B ′, and an outward side surface 312B ′ opposite to the inward side surface 310B ′.

  The respective front ends 302B ', 302B "of each member 300B', 300B" form the front end 302B of the implant 300B when these members are placed side by side. The front end portion 302B of the implant 300B is preferably configured in the shape of a semicircular first circle in the lateral direction. When the members 300B ′, 300B ″ are placed side by side, the posterior end 304B comprising the posterior ends 304B ′, 304B ″ has a radius greater than the radius of the first circle associated with the anterior end 302B of the implant 300B. It can be formed as a circular arc of a transverse second circle having, but need not be.

  The member 300B ′ is disposed side by side with the member 300B ″, and the inner side surface 310B ′ portions of the respective members are adjacent to each other. 302B ', 304B' and side surfaces 310B ', 312B' have at least one opening 314B 'through which the bone can grow from vertebral body to vertebral body. Is adapted to receive a bone growth promoting material. Inner surface 310B ′ is also configured to allow at least bone to grow between and into adjacent members 300B ′, 300B ″. There can be one hole 314B ′. Member 300B 'preferably has a maximum width W that is less than about one-half the width of an adjacent vertebral body adapted to insert the member. Also, the combined width of both members 300B ', 300B "is preferably greater than one half of the width of adjacent vertebral bodies that are adapted to insert these members.

  The members 300B ', 300B "provide the additional advantage that they can be inserted through a smaller gap than a single larger implant to achieve the same effect as this larger implant.

  FIG. 33 shows an implant 400A according to another preferred embodiment of the present invention adapted for use from the anterior approach of the spine. Implant 400A is similar to implant 100A and has a front end 402A that is shaped as a substantially semi-circle of the first circle. The implant 400A is adapted to have a maximum width between the side surfaces 410A, 412A that is less than one half of the width of an adjacent vertebral body adapted to insert the implant 400A. The rear end 404A forms a second circular arc having a radius substantially larger than the radius of the first circle associated with the front end 402A. Implant 400A can be made from bone, bone composite, or materials other than bone.

  FIG. 34 shows an implant 500A according to another preferred embodiment of the present invention adapted for use from the anterior approach of the spine. The implant 500A is similar to the implant 400A except that the front end 502A and the rear end 504A are preferably in the shape of a lateral semicircle. Implant 500A can be made from bone, bone composite, or materials other than bone.

  FIG. 35 shows an implant 600A according to another preferred embodiment of the present invention adapted for use from the posterior approach of the spine. This implant 600A is similar to the implant 400A except that the trailing end 604A is preferably at least partially linear in the lateral direction. Implant 600A can be made from bone, bone composite, or materials other than bone.

  FIGS. 36-42 illustrate an implant 700A made from bone or bone composite, according to another embodiment of the present invention. This implant 700A is the same as the implant 100A, and has a front end portion 702A having a substantially semicircular shape of a first circle A and a rear end portion 704A formed as an arc of a second circle C. Implant 700A preferably includes straight portions 711A, 713A along at least a portion of each side 710A, 712A, preferably parallel to each other along line P. Implant 700A also preferably includes a curved transition from each straight portion 711A, 713A to rear end 704A of each side 710A, 712A to form a respective curved portion 715A, 717A. These curved portions 715A, 717A may preferably be arcs of a third circle E having a radius smaller than the radius of the circle A associated with the front end 702A and / or the circle C associated with the rear end 704A.

  In one preferred embodiment, the implant 700A is machined, preferably made from cortical bone, but this may not necessarily be the case with at least one pair of opposing appropriately sized bone screws 722A. It can be received through the bone screw receiving hole 720A of 704A. The bone engaging screws 722A can be aligned with each other or staggered. At least one bone screw 722A engages each of the vertebral bodies to be fused and adjacent to the intervertebral space into which the implant 700A is implanted. One purpose of the bone screw is to secure the implant inside the vertebral segment. Another purpose is to draw each of the adjacent vertebral bodies towards the implant and towards each other. The rear end 704A of the implant 700A cooperates to receive a recess 724A having a bone screw receiving hole 720A therein and a fixation cap 728A adapted to secure at least one bone screw 722A to the implant 700A. Preferably, a configured hole 726A is included.

  As shown in FIG. 41, the implant 700A is further machined to receive a fastener 728A, preferably made from cortical bone, at the rear end 704A, and a bone engaging screw 722A is secured in the rear end 704A. In addition, it is preferable to prevent this screw from falling off. The fixing cap 728A has a head 730A, a shaft 732A, and a tool engaging portion 734A. In use, the fixation cap cooperatively engages the hole 726A in the rear end 704A of the implant 700A to secure at least one bone screw to the implant 700A. If desired, the locking cap 728A can also include threads on the shaft 732A so that the locking cap 728A can be rotated to engage the implant 700A.

  FIG. 42 shows another embodiment of a securing cap, generally designated by reference numeral 736A. The securing cap 736A includes a head 738A having a thread 740A on its outer periphery, the thread being adapted to cooperate with a corresponding threaded recess in the implant.

  Bone implants, bone screws, and / or fasteners can be made from bioabsorbable materials including, but not limited to, cortical bone, plastic, and composite plastic. Suitable plastics include lactides, galactides, glycolides, capronlactone, trimethylene carbonate, and dioxanone or / in various polymer states. Plastics composed of these combinations can be included.

  FIGS. 43-49 illustrate an implant 700B made from a material other than bone according to another embodiment of the present invention. This implant 700B is similar to the implant 100B, and has a front end portion 702B having a substantially semicircular shape of a first circle A and a rear end portion 704B formed as an arc of a second circle C. Implant 700B preferably includes straight portions 711B, 713B along at least a portion of each side 710B, 712B, preferably parallel to each other along line P. Implant 700B also preferably includes a curved transition from each straight portion 711B, 713B to rear end 704B of each side 710B, 712B to form curved portions 715B, 717B. These curved portions 715B, 717B may preferably be arcs of a third circle E having a radius smaller than the radius of the circle A associated with the front end 702B and / or the circle C associated with the rear end 704B.

  In one preferred embodiment, the implant 700B can receive at least one pair of opposing appropriately sized bone screws 722B through the bone screw receiving holes 720B in the rear end 704B. The bone engaging screws 722B can be aligned with each other or staggered. At least one bone screw 722B engages each of the vertebral bodies to be fused and adjacent to the intervertebral space into which the implant 700B is to be implanted. The rear end 704B of the implant 700B cooperates to receive a recess 724B having a bone screw receiving hole 720B therein and a fixation cap 728B adapted to secure at least one bone screw 722B to the implant 700B. Preferably, the configured hole 726B is included.

  As shown in FIG. 48, the implant 700B receives the fixture 728B at the rear end 704B to fix the bone engaging screw 722B in the rear end and to prevent the screw from falling off. preferable. The fixing cap 728B has a head 703B, a shaft 732B, and a tool engaging portion 734B. In use, the fixation cap cooperatively engages the hole 726B in the rear end 704B of the implant 700B to secure at least one bone screw to the implant 700B. If desired, the fixation cap 728B can include threads on the shaft 732B so that the fixation cap 728B can be rotated to engage the implant 700B.

  FIG. 49 shows another embodiment of a securing cap, generally designated by reference numeral 736B. The fixation cap 736B includes a head 738B having a thread 740B on its outer periphery, such that the thread is cooperatively engaged with a corresponding threaded recess in the implant.

  Implant 700B, bone screw 722B, and / or fasteners 728B, 736B can be made from bioabsorbable materials including, but not limited to, plastics and composite plastics. Suitable plastics can include plastics made of lactide, galactide, glycolide, capron lactone, trimethylene carbonate, dioxanone, and / or combinations thereof in various polymeric states.

  By way of example only and not limitation, the implant of the present invention has a depth of about 28-36 mm, a width of about 30-38 mm, and a height (maximum) of about 8-20 mm for use in the lumbar spine. Can do. The radius of curvature of the front end may be about 15-19 mm and the radius of curvature of the rear end may be about 20-30 mm.

  In any embodiment of the present invention, the implant comprises, is made of, or treated with artificial or naturally occurring materials and / or substances suitable for implantation in the human spinal cord. Or coated with them, filled with them, used in combination, or have openings, cavities or passages containing them. These materials and / or substances include bone formation, bone growth promoting materials, bone, bone-derived substances or products, demineralized bone matrix, mineralized protein, ossified protein, bone morphogenic protein, hydroxyapatite, bone production code Any source is included, including but not limited to bone genes, and cortical bone. The implant can include at least a portion of bioabsorbable and / or resorbable material, such as bone and / or bone growth promoting materials. The implants of the present invention can be formed from a porous material or can be formed from a material that is inherently involved in bone growth from one of the adjacent vertebral bodies to the other of the adjacent vertebral bodies. If such an implant is for posterior implantation, the rear end of such an implant can be used in a chemical treatment, coating, or combination to inhibit the formation of scar tissue in the spinal canal. . The implants of the present invention may be modified or used in combination to make the implant antibacterial, such as, but not limited to, electroplating or plasma spraying with silver ions or other materials. it can. At least a portion of the implant can be treated to promote bone ingrowth between the implant and adjacent vertebral bodies. The implants of the present invention include, but are not limited to, interbody spinal implants, structural bone grafts, meshes, cages, spacers, staples, bone screws, plates, mandrels, artificial tendons or wire tethers, or others It can be used in combination with any object spinal fixation implant, regardless of the material, as long as it can be inserted into any part of the spine, such as

  Although the shapes of the various aspects of the implant have been described in detail, the scope of the present invention is not limited thereto, but only by way of example, a few irregularities, such as for the purpose of engaging bone. It is readily envisaged that can disturb the contours and encourage bone ingrowth or bone penetration.

  Although specific innovative features have been presented with reference to specific examples, they are merely examples, and various combinations of these innovative features teach other than the specific combinations shown. It should be understood that they can now be easily combined as an alternative, and are intended and claimed herein.

FIG. 3 is a top view of a vertebral body in the lumbar vertebra, with an implantation gap formed to receive a spinal implant, which is smaller than the radius of curvature of the posterior end of the front of the vertebral body between the implantation gap sides It has a radius of curvature at the front end. FIG. 2 is a side view showing two adjacent vertebral bodies in the lumbar vertebra, with the implant gap of FIG. 1 formed throughout the height of the spinal disc and in the adjacent vertebral bodies. It is a side perspective view which shows the implantation gap | interval of FIG. FIG. 3 is a top view of a vertebral body in the cervical vertebra, with an implant gap formed to receive a spinal implant, the spinal implant having a radius of curvature at the front end that is smaller than the radius of curvature at the rear end of the front of the vertebral body. Have. FIG. 5 is a side view showing two adjacent vertebral bodies in the cervical vertebra, with the implant gap of FIG. 4 formed throughout the height of the spinal disc and in the adjacent vertebral bodies. FIG. 5 is a side perspective view showing the implantation gap of FIG. 4. FIG. 2 is a top view of one preferred embodiment of an implant according to the present invention inserted into the vertebral body in the lumbar vertebra and the implantation gap of FIG. FIG. 8 is a side view of two vertebral bodies, with the implant of FIG. 7 inserted through the entire spinal disc height and into the implantation gap of FIG. 1 formed in the adjacent vertebral body. FIG. 8 is a top view showing the implant of FIG. 7. FIG. 8 is a side view showing the implant of FIG. 7. It is a figure which shows the front-end part of the implant of FIG. It is a figure which shows the rear-end part of the implant of FIG. FIG. 6 is a top view of another preferred embodiment of an implant according to the present invention inserted into the vertebral body in the lumbar vertebra and the implantation gap of FIG. FIG. 14 is a side view showing two adjacent vertebral bodies, with the implant of FIG. 13 inserted through the entire intervertebral disc height and into the implantation gap of FIG. 1 formed in the adjacent vertebral bodies. FIG. 14 is a top view showing the implant of FIG. 13. FIG. 14 is a side view showing the implant of FIG. 13. It is a figure which shows the front-end part of the implant of FIG. FIG. 14 is a view showing a rear end portion of the implant of FIG. 13. FIG. 5 is a top view of another preferred embodiment of an implant according to the present invention for use in the implantation gap of FIG. FIG. 5 is a top view of another preferred embodiment of an implant according to the present invention for use in the implantation gap of FIG. FIG. 7 is a posterior perspective view of another preferred embodiment of an implant according to another preferred embodiment of the present invention having two members that are preferably mirror images of each other. It is a top view which shows one side of the member of the implant of FIG. It is a figure which shows one inner surface of the member of the implant of FIG. It is a figure which shows one outer side surface of the member of the implant of FIG. It is a figure which shows one front-end part of the member of the implant of FIG. It is a figure which shows the one rear end part of the member of the implant of FIG. FIG. 7 is a posterior perspective view of another preferred embodiment of an implant according to another preferred embodiment of the present invention having two members that are preferably mirror images of each other. It is a top view which shows one side of the member of the implant of FIG. It is a figure which shows one inner surface of the member of the implant of FIG. FIG. 28 is a view showing one outer surface of the member of the implant of FIG. 27. It is a figure which shows one front-end part of the member of the implant of FIG. It is a figure which shows the one rear end part of the member of the implant of FIG. FIG. 6 is a top view of another preferred embodiment of an implant according to the invention and a second implant that is a mirror image of this implant shown in broken lines, both implants in the vertebral body shown in broken lines from the anterior approach to the spine Shows where it is implanted. FIG. 6 is a top view of another preferred embodiment of an implant according to the invention and a second implant that is a mirror image of this implant shown in broken lines, both implants in the vertebral body shown in broken lines from the anterior approach to the spine Shows where it is implanted. FIG. 6 is a top view of another preferred embodiment of an implant according to the present invention and a second implant that is a mirror image of this implant shown in broken lines, both implants in the vertebral body shown in broken lines from the posterior approach to the spine. Shows where it is implanted. FIG. 6 is a top view of another preferred embodiment of an implant according to the present invention having a bone engaging screw. FIG. 37 is a side view showing the implant of FIG. 36. It is a figure which shows the front-end part of the implant of FIG. FIG. 37 shows the posterior end of the implant of FIG. 36, with bone engaging screws and fasteners attached. FIG. 40 shows the posterior end of the implant of FIG. 39 with the bone engaging screw and fastener removed. FIG. 37 is a partial side cross-sectional view illustrating one preferred embodiment of a bone screw fastener according to the present invention for use with the implant of FIG. 36. FIG. 6 is a side cross-sectional view illustrating another preferred embodiment of a bone screw fastener according to the present invention. FIG. 6 is a top view of another preferred embodiment of an implant according to the present invention having a bone engaging screw. FIG. 44 is a side view showing the implant of FIG. 43. FIG. 44 is a view showing a front end portion of the implant of FIG. 43. FIG. 44 is a view of the posterior end of the implant of FIG. 43, with bone engaging screws and fasteners attached. FIG. 47 shows the posterior end of the implant of FIG. 46 with the bone engaging screw and fastener removed. FIG. 44 is a partial side cross-sectional view illustrating one preferred embodiment of a bone screw fastener according to the present invention for use with the implant of FIG. 43. FIG. 6 is a side cross-sectional view illustrating another preferred embodiment of a bone screw fastener according to the present invention.

Claims (14)

An interbody spinal implant for inserting at least a portion into an implant gap, the implant gap spanning the entire height prepared by the operation of the intervertebral space between adjacent vertebral bodies of the human spine is formed, the implantable gap is formed in the vertebral body to said adjacent, the vertebral body is closed and the depth between them and the front and rear faces, in implants,
A rear portion opposed to the front end and the front end portion for initially inserted into the intervertebral space, the implant has a length between said front end and said rear end, a front end and a rear End,
A top and bottom faces between the front and the rear end portion, the upper and the lower part, and the interior of the intervertebral space to support them in contact with the vertebral bodies to the adjacent adapted to place at least a portion over the entire height, the upper and the lower is a non-arcuate shape along at least a portion of the length of the implant, and top and bottom,
Between said upper and lower, and a side which faces between the front and the rear end portion, the opposite sides defining the width of the implant, at least one of the at least side surfaces the opposite part, wherein a linearly along at least a portion of the length of the implant, the front end, is constituted by approximately semi-circular shape from one side to the opposite to the other side of the counter, the With opposing sides, wherein the circle has a diameter approximately equal to the width of the implant,
Made from a suitable material for implantation into a human, the upper and the lower portion of the implant, in order to form at least a portion of the through passage you accommodating bone growth promoting material, at least one opening to contact one another An implant through which the bone can grow from vertebral body to vertebral body. An interbody spinal implant for inserting at least a portion into an implant gap, the implant gap spanning the entire height prepared by the operation of the intervertebral space between adjacent vertebral bodies of the human spine is formed, the implantable gap is formed in the vertebral body to said adjacent, the vertebral body is closed and the depth between them and the front and rear faces, in implants,
A rear portion opposed to the front end and the front end portion for initially inserted into the intervertebral space, the implant has a length between the front and rear ends, front and rear And
A top and bottom faces between the front and the rear end portion, the contact with the adjacent vertebral bodies to support them, the at least one over internal entirety and height of the intervertebral space It is the so placing part, and an upper and lower,
Wherein the implant has a greater maximum width than half the width of the adjacent vertebral bodies is to insert the implant, the front end, of the first circle along the width of said implant substantially consists of a semicircular shape, the rear end portion has a second circular radius of curvature along the width of said implant, said second circular has a larger radius than the radius of said first circular , In addition,
Made from a suitable material for implantation into a human, the upper and the lower portion of the implant, in order to form at least a portion of the through passage you accommodating bone growth promoting material, at least one opening to contact one another An implant through which the bone can grow from vertebral body to vertebral body. The front end and the rear end portion of the implant, intersect at opposite points of the implant, implant according to claim 2. The implant is, the greater than half the width of the vertebral bodies where the adjacent have been made to insert the implant has a maximum width between the side surfaces the opposite, any one of the preceding claims The implant according to 1. The implant is, the smaller than half the width of the vertebral bodies where the adjacent have been made to insert the implant has a maximum width between the side surfaces the opposite, any one of claims 1 to 3 The implant according to one item.   The implant according to any one of the preceding claims, wherein the passage intersects at least one of the opposing side surfaces. The implant further comprises a bone engaging surface formed on at least the upper and lower outer surfaces to engage the adjacent vertebral bodies, the bone engaging surface being a protrusion, a nail tooth, a nail-like protrusion The implant of any one of the preceding claims, comprising at least one of:, spline, surface roughening, and knurling. The implant is combined with a bone growth promoting material, implant according to any one of the preceding claims.   The bone growth promoting material is selected from one of bone, bone-derived product, demineralized bone matrix, mineralized protein, ossified protein, bone morphogenic protein, hydroxyapatite, and bone production coding gene; The implant according to claim 8.   Implant according to any one of the preceding claims, wherein at least part of the implant is resorbable. The implant according to any one of the preceding claims, wherein the implant is combined with at least one of a chemical or antimicrobial material adapted to inhibit scar formation. The implant is made from a bone annulus obtained from a major human long bone with a medullary canal and includes at least a portion of the medullary canal that passes through the upper and lower portions to form at least a portion of the passageway; Implant according to any one of the preceding claims. 12. Implant according to any one of the preceding claims, wherein the implant is made from a bone composite material. 12. Implant according to any one of the preceding claims, wherein the implant is made from a material other than bone.

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