Dispositif de stabilisation antérieure du rachis cervical. Anterior stabilization device for the cervical spine.
L'invention se rattache au secteur technique des implants rachidiens. The invention relates to the technical sector of spinal implants.
Le problème que se propose de résoudre l'invention, est de stabiliser les vertèbres cervicales, par voie antérieure, afin d'avoir accès directement aux corps vertébraux et aux disques. Dans le cas d'hernies discales, on est obligé d'enlever le disque, tandis que dans le cas d'ostéophytes on est obligé de reconstruire et de procéder à une fusion entre les vertèbres au moyen de greffes osseuses. The problem which the invention proposes to solve is to stabilize the cervical vertebrae, by the anterior route, in order to have direct access to the vertebral bodies and to the discs. In the case of herniated discs, one is obliged to remove the disc, while in the case of osteophytes one is obliged to reconstruct and to carry out a fusion between the vertebrae by means of bone grafts.
Très souvent, ces greffes, sont stabilisées par des plaques, d'ostéosynthèse en titane ou en acier. Dans ce cas on est obligé d'immobiliser le rachis pendant un certain temps, correspondant au temps de fusion de la greffe. sous peine d'un écrasement. Very often, these grafts are stabilized by plates, of osteosynthesis in titanium or steel. In this case one is obliged to immobilize the spine for a certain time, corresponding to the fusion time of the graft. under penalty of being crushed.
Pour remédier à ces inconvénients, on a proposé une solution telle que définie par l'enseignement du brevet EP 0 369 603. Ce brevet divulgue une pièce de forme générale cylindrique, réalisée en céramique. To remedy these drawbacks, a solution has been proposed as defined by the teaching of patent EP 0 369 603. This patent discloses a part of generally cylindrical shape, made of ceramic.
Cette pièce constitue directement un greffon mais n'est pas destinée à être remplie d'un greffon osseux. Des risques d'expulsion de cette pièce peuvent exister.This part directly constitutes a graft but is not intended to be filled with a bone graft. Risks of expulsion of this piece may exist.
On peut citer également l'enseignement du brevet FR 2570594 qui divulgue une prothèse vertébrale comportant une plaquette rapportée par des vis sur deux vertèbres distinctes, la plaquette portant transversalement, par avance, un greffon artificiel. Cette prothèse ne constitue donc pas une cage destinée à recevoir un greffon osseux. La repousse osseuse parait difficile. We can also cite the teaching of patent FR 2570594 which discloses a vertebral prosthesis comprising a plate attached by screws on two separate vertebrae, the plate carrying transversely, in advance, an artificial graft. This prosthesis therefore does not constitute a cage intended to receive a bone graft. Bone regrowth seems difficult.
L'invention s'est fixée pour but de remédier à ces inconvénients, de manière simple, sûre, efficace et rationnelle. The object of the invention is to remedy these drawbacks in a simple, safe, effective and rational manner.
Le problème que se propose de résoudre l'invention, est d'apporter une stabilité immédiate évitant l'écrasement des vertèbres rune sur l'autre, en évitant tout risque d'expulsion de l'ensemble prothétique. The problem which the invention proposes to solve is to provide immediate stability avoiding the crushing of the one vertebrae over the other, avoiding any risk of expulsion of the prosthetic assembly.
Pour résoudre un tel problème, il a été conçu et mis au point un dispositif ayant pour but de stabiliser les vertèbres cervicales par voie antérieure et qui comprend au moins un élément apte à être monté entre deux corps vertébraux pour maintenir leur écartement, en étant agencé pour recevoir des greffons spongieux et permettre leur fusion intersomatique, le ou lesdits élément(s) étant accouplé(s) d'une manière démontable à une plaque d'ostéosynthèse agencée pour être fixée au niveau de la face antérieure des corps vertébraux entre lesquels est ou sont monté(s) le ou lesdits élément(s). To solve such a problem, a device has been designed and developed with the aim of stabilizing the cervical vertebrae by the anterior route and which comprises at least one element capable of being mounted between two vertebral bodies to maintain their spacing, by being arranged to receive cancellous grafts and allow their interbody fusion, the said element (s) being coupled in a removable manner to an osteosynthesis plate arranged to be fixed at the level of the anterior face of the vertebral bodies between which is or are mounted (s) said element (s).
II apparait que la plaque d'ostéosynthèse permet de stabiliser l'élément, évitant ainsi toute immobilisation de celui-ci, pendant le délai nécessaire à la prise de la greffe osseuse. It appears that the osteosynthesis plate makes it possible to stabilize the element, thus avoiding any immobilization of the latter, during the time necessary for taking the bone graft.
Pour résoudre le problème posé d'éviter l'écrasement, tout en ayant pour objectif de permettre la fusion intersomatique des greffons spongieux, chaque élément est constitué par une structure volumétrique creuse sous forme d'une cage dont les parois présentent des ouvertures de mise en communication. To solve the problem of avoiding crushing, while having the objective of allowing the interbody fusion of the spongy grafts, each element is constituted by a hollow volumetric structure in the form of a cage whose walls have opening for setting in communication.
Pour résoudre le problème posé d'obtenir une bonne récupération de la lordose cervicale,l'élément est de forme générale trapézoidale dont la hauteur de la face antérieure est supérieure à celle de la face postérieure. To resolve the problem of obtaining good recovery from cervical lordosis, the element is generally trapezoidal in shape, the height of the anterior face being greater than that of the posterior face.
Pour résoudre le problème posé de pouvoir procéder, si nécessaire, à une ablation de la plaque d'ostéosynthèse, cette dernière est rendue solidaire par vis de l'élément, au niveau de sa face antérieure. To solve the problem posed of being able to proceed, if necessary, to an ablation of the osteosynthesis plate, the latter is made integral by screw of the element, at its anterior face.
La plaque d'ostéosynthèse est cintrée transversalement pour épouser le profil antérieur des corps vertébraux correspondants. The osteosynthesis plate is bent transversely to match the anterior profile of the corresponding vertebral bodies.
Pour résoudre le problème posé d'assurer une stabilité primaire, avant vissage de la plaque, cette dernière présente à ses extrémités des picots d'ancrage. To solve the problem of ensuring primary stability, before screwing the plate, the latter has at its ends anchoring pins.
Avantagesuement, les bords de l'élément sont arrondis pour épouser la forme antérieure du corps vertébral, chaque l'élément étant réalisé en titane ou en polymère renforcé de fibres de carbone. Advantageously, the edges of the element are rounded to match the anterior shape of the vertebral body, each element being made of titanium or of polymer reinforced with carbon fibers.
L'invention est exposée, ci-après plus en détail à l'aide des dessins annexés, dans lesquels:
La figure 1 est une vue en perspective avant montage, des principaux éléments constitutifs de l'invention.The invention is set out below in more detail using the appended drawings, in which:
Figure 1 is a perspective view before assembly, of the main components of the invention.
La figure 2 est une vue correspondant à la figure 1 après assemblage des éléments. Figure 2 is a view corresponding to Figure 1 after assembly of the elements.
La figure 3 est une vue en coupe montrant le montage du dispositif au niveau des prothèses cervicales du côté antérieur. Figure 3 is a sectional view showing the mounting of the device at the cervical prostheses on the anterior side.
La figure 4 est une vue en coupe transversale considérée selon la ligne 4.4 de la figure 3. Figure 4 is a cross-sectional view taken along line 4.4 of Figure 3.
Selon l'invention, le dispositif comprend en combinaison, au moins un élément (1) et une plaque d'ostéosynthèse (2). L'élément (1) est destiné à être monté entre deux corps vertébraux (C1) (C2) pour maintenir leur écartement. Chaque élément est agencé pour recevoir des greffons spongieux (G) et permettre leur fusion intersomatique. According to the invention, the device comprises in combination, at least one element (1) and an osteosynthesis plate (2). The element (1) is intended to be mounted between two vertebral bodies (C1) (C2) to maintain their spacing. Each element is arranged to receive cancellous grafts (G) and allow their interbody fusion.
Les greffons spongieux sont avantageusement prélevés sur la crête iliaque ou dans l'extrémité supérieure du tibia
Chaque élément (1) est constitué par une structure volumétrique creuse sous forme d'une cage, dont les parois latérales présentent des ouvertures (la) (lob) (tic) (1d).Chaque élement (1) est de forme générale trapézoîdale, la hauteur de la face antérieure (le) étant supérieure à la hauteur de la face postérieure (lof).The spongy grafts are advantageously taken from the iliac crest or from the upper end of the tibia
Each element (1) is constituted by a hollow volumetric structure in the form of a cage, the side walls of which have openings (la) (lob) (tic) (1d). Each element (1) is generally trapezoidal in shape, the height of the anterior face (le) being greater than the height of the posterior face (lof).
On donne ci-après, à titre indicatif, les spécificités dimensionnelles de l'élément (1). The dimensional specifics of element (1) are given below for information.
La longueur antéro-postérieure est d'environ 12mm, la largeur antérieure d'environ 14mm et la largeur postérieure d'environ 12mm. The anteroposterior length is approximately 12mm, the anterior width approximately 14mm and the posterior width approximately 12mm.
Généralement, chaque élément est réalisé en trois hauteurs différentes, à savoir 6mm, 7mm et 8mm du côté de la face antérieure, et 5mm, 6mm et 7mm du côté de la face postérieure. Ces rapports dimensionnels permettent d'obtenir une bonne récupération de la lordose cervicale.Generally, each element is produced in three different heights, namely 6mm, 7mm and 8mm on the side of the anterior face, and 5mm, 6mm and 7mm on the side of the posterior face. These dimensional ratios allow good recovery from cervical lordosis.
A noter que les bords de l'élément (1) sont arrondis pour épouser la forme antérieur du corps vertébral. Note that the edges of the element (1) are rounded to match the anterior shape of the vertebral body.
Les éléments (1) sont avantageusement réalisés en titane ou en polymère renforcé en fibre de verre. The elements (1) are advantageously made of titanium or of glass fiber reinforced polymer.
La plaque d'ostéosynthèse (2) est fixée au niveau de la face antérieure du ou des éléments (1), d'une manière démontable, au moyen de vis (3). La plaque (2) présente donc des trous (2a) pour le passage des vis (3), vissées dans la face antérieure de l'élément correspondant. De même, la plaque (2) présente des trous (2b) pour le passage de vis spongieuses (4), pour la fixation de la plaque, au niveau de la face antérieure des corps vertébraux, entre lesquels est positionné l'élément (1). The osteosynthesis plate (2) is fixed at the anterior face of the element (s) (1), in a removable manner, by means of screws (3). The plate (2) therefore has holes (2a) for the passage of the screws (3), screwed into the front face of the corresponding element. Likewise, the plate (2) has holes (2b) for the passage of cancellous screws (4), for fixing the plate, at the level of the anterior face of the vertebral bodies, between which the element (1) is positioned. ).
A noter que la plaque (1) présente, à ses extrémités, des picots d'ancrage (2c), pour assurer une stabilité primaire, avant sa fixation au moyen des vis spongieuses (4). Cette plaque (2) est cintrée transversalement pour épouser le profil antérieur des corps vertébraux correspondant (C1) et (C2) par exemple. Bien évidemment, la hauteur de la plaque est adaptée au nombre d'éléments (1). Note that the plate (1) has, at its ends, anchoring pins (2c), to ensure primary stability, before its fixing by means of the cancellous screws (4). This plate (2) is bent transversely to match the anterior profile of the corresponding vertebral bodies (C1) and (C2) for example. Obviously, the height of the plate is adapted to the number of elements (1).
A titre indicatif, la plaque (1) peut avoir une longueur de 20mm, une épaisseur de 0,75mm, une largeur extrême de 12mm et une largeur médiane de 8mm. As an indication, the plate (1) can have a length of 20mm, a thickness of 0.75mm, an extreme width of 12mm and a median width of 8mm.
On indique ci-après, le mode opératoire de mise en place du dispositif selon l'invention. The procedure for setting up the device according to the invention is indicated below.
Après ablation du disque intervertébral complétée éventuellement par une résection d'une hernie discale et d'ostéophytes, la distraction intervertébrale est obtenue soit par traction appliquée sur le crane, soit par distraction intervertébrale. La hauteur de l'élément (1) est calculée, et après essai de la bonne hauteur, l'élément définitif est rempli d'os spongieux et disposé dans l'espace intervertébral, I'élément (1) étant équipé de la plaque d'ostéosynthèse antérieure (2) préalablement vissée. After removal of the intervertebral disc possibly completed by resection of a herniated disc and osteophytes, intervertebral distraction is obtained either by traction applied to the skull, or by intervertebral distraction. The height of the element (1) is calculated, and after testing the correct height, the final element is filled with cancellous bone and placed in the intervertebral space, the element (1) being equipped with the plate d 'anterior osteosynthesis (2) previously screwed.
La plaque (2) est ensuite solidarisée aux corps vertébraux adjacents (C1) (C2), au moyen des vis spongieuses (4). Un controle radioçcopique peropératoire est nécessaire pour s'assurer de la bonne position du dispositif, destiné à stabiliser un segment mobile du rachis cervical des vertèbres C2àT1.The plate (2) is then secured to the adjacent vertebral bodies (C1) (C2), by means of the cancellous screws (4). An intraoperative radio control is necessary to ensure the correct position of the device, intended to stabilize a mobile segment of the cervical spine of the C2 to T1 vertebrae.
Les avantages ressortent bien de la description, en particulier on souligne et on rappelle:
- l'apport de la plaque d'ostéosynthèse permet de stabiliser le ou les éléments intersomatique, en évitant tout immobilisation de celui-ci (ou de ceux-ci), pendant le délai nécessaire à la prise de la greffe osseuse,
- la possibilité d'ablation secondaire de la plaque d'ostéosynthèse.The advantages clearly emerge from the description, in particular it is emphasized and recalled:
- the contribution of the osteosynthesis plate makes it possible to stabilize the interbody component (s), avoiding any immobilization of the latter (or of these), for the time necessary for taking the bone graft,
- the possibility of secondary ablation of the osteosynthesis plate.
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| FR9414069AFR2727005B1 (en) | 1994-11-18 | 1994-11-18 | ANTERIOR STABILIZATION DEVICE OF THE CERVICAL RACHIS |
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| FR9414069AFR2727005B1 (en) | 1994-11-18 | 1994-11-18 | ANTERIOR STABILIZATION DEVICE OF THE CERVICAL RACHIS |
| Publication Number | Publication Date |
|---|---|
| FR2727005A1true FR2727005A1 (en) | 1996-05-24 |
| FR2727005B1 FR2727005B1 (en) | 1997-04-18 |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| FR9414069AExpired - Fee RelatedFR2727005B1 (en) | 1994-11-18 | 1994-11-18 | ANTERIOR STABILIZATION DEVICE OF THE CERVICAL RACHIS |
| Country | Link |
|---|---|
| FR (1) | FR2727005B1 (en) |
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| FR2727005B1 (en) | 1997-04-18 |
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| FR2727005A1 (en) | Anterior stabiliser for cervical section of spine | |
| FR2727003A1 (en) | Lumbar-sacral vertebrae anterior stabiliser | |
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| FR2785787A1 (en) | OSTEOSYNTHESIS DEVICE OF AN ANTERIORALLY SPACHED SEGMENT | |
| FR2805457A1 (en) | INTERVERTEBRAL IMPLANT A BODY AND FACE SUPPORT | |
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| FR2651992A1 (en) | Implant for spinal osteosynthesis of the anterior dorsolumbar vertebrae intended for correction of kyphoses | |
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| Date | Code | Title | Description |
|---|---|---|---|
| ST | Notification of lapse |