US20050159746A1 - Cervical facet resurfacing implant - Google Patents

Abstract

The present invention relates to prostheses for treating spinal pathologies, and more specifically to a system and method for treating articulating surfaces of cervical vertebrae facet joints. The system includes a superior implant for placement on a superior articulating surface and an inferior implant for placement on an inferior articulating surface. In addition, described is a method for providing articulating surfaces for cervical vertebrae facet joint articular facets.

Description

FIELD OF THE INVENTION
• The present invention relates generally to prostheses for treating spinal pathologies, and more specifically to a system and method for treating articulating surfaces of cervical facet joints.
BACKGROUND OF THE INVENTION
• Back and neck pain are common ailments. In many cases, the pain severely limits a person's functional ability and quality of life. A variety of spinal pathologies can lead to back pain.
• Through disease or injury, the laminae, spinous process, articular processes, or facets of one or more vertebral bodies can become damaged, such that the vertebrae no longer articulate or properly align with each other. This can result in an undesired anatomy, loss of mobility, and pain or discomfort. With respect to vertebral articular surface degeneration, facet joints may show a reduced thickness of cartilage and may advance to entire disappearance thereof. Furthermore, surrounding the degenerated articular surfaces, there is bony formation capable of causing neurological compressions inside either the foramenae or spinal canal. These facts induce pain which affect a large part of the population.
• The vertebral facet joints, for example, can be damaged by either traumatic injury or by various disease processes, such as osteoarthritis, ankylosing spondylolysis, and degenerative spondylolisthesis. The damage to the facet joints often results in pressure on nerves, also called a “pinched” nerve, or nerve impingement. The result is pain, misaligned anatomy, and a corresponding loss of mobility. Pressure on nerves can also occur without facet joint pathology, e.g., a herniated disc.
• Degenerative spinal diseases can involve articular surfaces only, but may also have a more invasive pathology including traumatic, infectious, tumorous or dysmorphic (spondylolisthesis, for example) effecting the destruction of all or part of the articular process. The locking of vertebral motions by spinal arthrodesis or ligamentoplasty induces, beyond a spinal stiffness, an increased force on the joint facets of the adjacent vertebrae above and below the fusion, usually sustained by the considered intervertebral space and therefore an increase of degeneration of these joint facets.
• One type of conventional treatment of facet joint pathology is spinal stabilization, also known as intervertebral stabilization. By applying intervertebral stabilization, one can prevent relative motion between the vertebrae. By preventing this movement, pain can be reduced. Stabilization can be accomplished by various methods. One method of stabilization is spinal fusion. Another method of stabilization is fixation of any number of vertebrae to stabilize and prevent movement of the vertebrae. Yet another type of conventional treatment is decompressive laminectomy. This procedure involves excision of the laminae to relieve compression of nerves. With regard to discal prostheses, they provide a “space” between two vertebral bodies while preserving some motion. They solve the aging intervertebral disc problem but do not function to reduce the force on posterior joint facets.
• These traditional treatments are subject to a variety of limitations and varying success rates. Furthermore, none of the described treatments puts the spine in proper alignment or returns the spine to a desired anatomy. In addition, stabilization techniques, by holding the vertebrae in a fixed position, permanently limit a person's mobility. Some procedures involving motion devices have a high incidence of spontaneous fusion. There is thus a need in the art for a system and procedure capable of increasing the percentage of good results in disc replacement surgery. In addition, there is a need in the art for better results than are commonly achieved through spinal fusions. Further, there is a need in the art for a system and procedure that permits greater mobility in cases of spinal problems involving only the facet joints, and for obviating the need for spinal fusion associated with degenerative and congenital problems of the spine.
BRIEF SUMMARY OF THE INVENTION
• According to an aspect of the invention, there is provided a cervical facet resurfacing implant comprising: a superior implant having an articulating surface and a fixation surface and configured for secured placement on a resurfaced superior articular facet of a selected cervical vertebra; and an inferior implant having an articulating surface and a fixation surface and configured for secured placement on a resurfaced inferior articular facet of a cervical vertebra immediately above the selected cervical vertebra such that the articulating surface of the inferior implant interacts with the articular surface of the superior implant.
• According to another aspect of the invention, there is provided a facet implant comprising: a generally disk-shaped superior implant having an articulating surface and a fixation surface and being configured for placement on a resurfaced superior articular facet of a selected cervical vertebra, the superior implant having a tab extending from the generally disk-shaped portion of the superior implant, the tab being configured for secured attachment to the lateral mass of the selected vertebra; and a generally disk-shaped inferior implant having an articulating surface and a fixation surface and being configured for placement on a resurfaced inferior articular facet of a cervical vertebra immediately above the selected cervical vertebra such that the articulating surface of the inferior implant interacts with the articular surface of the superior implant, the inferior implant having a tab extending from the generally disk-shaped portion of the inferior implant, the tab being configured for secured attachment to the inferior articular process of the cervical vertebra immediately above the selected vertebra.
• According to another aspect of the invention, there is a method for providing articulating surfaces for cervical vertebrae facet joint articular facets comprising of: creating a space between a superior articular facet of a selected cervical vertebra and an inferior articular facet of a cervical vertebra immediately above the selected cervical vertebra; using a rasp to prepare an articulating surface of the inferior articular facet for an inferior implant; using a rasp to prepare an articulating surface of the superior articular facet for a superior implant; fixing the inferior implant on the inferior articular facet such that a fixation surface of the inferior implant interacts with the articulating surface of the inferior articular facet; and fixing the superior implant on the superior articular facet such that a fixation surface of the superior implant interacts with the articulating surface of the superior articular facet; wherein the articulating surface of the superior implant and the articulating surface of the inferior implant are configured to articulate with one another.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a lateral elevation view of a normal human spinal column;
• FIG. 2A is an anterior view of a normal human cervical vertebra;
• FIG. 2B is a posterosuperior view of a normal human cervical vertebra;
• FIG. 3 is a posterior perspective view of a cervical vertebral facet joint;
• FIG. 4 is a lateral elevation view of a cervical vertebral facet joint;
• FIG. 5 illustrates a cervical facet implant;
• FIGS.6A-C illustrate a facet implant in conjunction with cervical vertebrae;
• FIG. 7 illustrates an alternate embodiment of a cervical facet inferior implant in conjunction with a trans-lateral mass screw;
• FIG. 8 is a flow chart generally illustrating a method for providing articulating surfaces for cervical facet joint articular facets;
• FIG. 9 is an illustration of a rasp being used to prepare an articulating surface;
• FIG. 10 is an illustration of a rasp; and
• FIG. 11 is an illustration of an aiming device for use in positioning a trans lateral mass screw.
DETAILED DESCRIPTION OF THE INVENTION
• Referring initially toFIG. 1, the humanspinal column10 is illustrated. Thespinal column10 is comprised of a series of thirty-three stacked vertebrae divided into five regions. The cervical region includes seven vertebrae, known as C1-C7. The thoracic region includes twelve vertebrae, known as T1-T12. The lumbar region contains five vertebrae, known as L1-L5. The sacral region is comprised of five vertebrae, known as S1-S5. The coccygeal region contains fourvertebrae12, known as Co1-Cu4.
• Turning now toFIGS. 2 and 3, normal humancervical vertebrae12 are illustrated. It will be understood by those skilled in the art that while thecervical vertebrae12 vary somewhat according to location, they share many features common tomost vertebrae12. Eachvertebra12 includes avertebral body14. Two short bones, thepedicles16, extend backward from each side of thevertebral body14 to form avertebral arch18. At the posterior end of eachpedicle16, thevertebral arch18 flares out into broad plates of bone known as thelaminae20. Thelaminae20 fuse with each other to form aspinous process22. Thespinuous process22 provides muscle and ligament attachment.
• The transition from thepedicles16 to thelaminae20 is interrupted by atransverse process24 that thrust out laterally on each side from the junction of thepedicle16 and thelamina20. Thetransverse processes24 serve as guides for the attachment of muscles to thevertebrae12. Connecting thetransverse process24 on each side of thebody14 is alateral mass26. Two inferiorarticular processes28 extend downward from the junction of thelaminae20 and thetransverse processes24. The inferior articular processes28 each have a natural bony structure known as an inferiorarticular facet32, which faces downward. On the superiorarticular facet30 is a superior articulatingsurface38. Similarly, a superiorarticular facet30 faces upward from the junction of thelateral mass26 and thepedicle16. On the inferiorarticular facet32 is an inferior articulatingsurface40.
• As shown inFIGS. 3 and 4, whenadjacent vertebrae12 are aligned, the superiorarticular facet30 and inferiorarticular facet32 interlock. Capped with a smooth articular cartilage, the interlocked vertebrae form a facet joint36, also known as a zygapophysial joint. Anintervertebral disc34 between each pair ofvertebrae12 permits gliding movement betweenvertebrae12. Thus, the structure and alignment of thevertebrae12 permit a range of movement of thevertebrae12 relative to each other.
• The facet joint36 is composed of a superior half and an inferior half. The superior half is formed by the vertebral level below theintervertebral disc34, and the inferior half is formed by the vertebral level above theintervertebral disc34. For example, in the C3-C4 facet joint, the superior portion of the joint is formed by bony structure on the C4 vertebra (e.g., a superior articular surface and supporting bone on the C4 vertebra), and the inferior portion of the joint is formed by bony structure on the C3 vertebra (e.g., an inferior articular surface and supporting bone on the C3 vertebra).
• Turning now toFIG. 5, an exemplary cervical facet resurfacing implant according to the present invention is illustrated. Theexemplary facet implant100 generally has asuperior implant102 and aninferior implant104. Thesuperior implant102 generally has a disk-shapedportion106 and atab108 extending from the disk-shapedportion106. The disk-shapedportion106 includes an articulatingsurface110 and afixation surface112.
• Theinferior implant104 also generally has a disk-shapedportion114 and atab116 extending from the disk-shapedportion114. The disk-shapedportion114 includes an articulatingsurface118 and afixation surface120.
• It should be noted that the term “disk-shaped” is not restricted to circular or ovular shapes. A generally disk-shaped implant may have multiple sides, such as a square-shaped, hexagonal-shaped, or octagonal-shaped implant. While each of these shapes appear similar from a lateral perspective and are capable of performing a similar function according to the present invention, a circular or ovular disk-shape is preferred.
• Turning now to FIGS.6A-C, an exemplary cervical facet resurfacing implant according to the present invention is illustrated in conjunction with a facet joint. Thesuperior implant102 is configured for placement on superiorarticular facet30. Thesuperior implant102 may be fixed to the superior articulatingsurface38 using cemented and/or cementless fixation techniques. In an exemplary embodiment, thesuperior implant106 includes a disk-shapedportion106, which has an articulatingsurface110 and afixation surface112 and is configured for placement on a specifically prepared superior articulatingsurface38.
• The disk-shapedportion106 of thesuperior implant102 may range from about 1 mm thick to about 6 mm thick. In an exemplary embodiment, the thickness of thesuperior implant102 ranges from about 2 mm to about 4 mm. In another exemplary embodiment, the thickness of thesuperior implant102 ranges from about 1.5 mm to about 2.5 mm. The disk-shapedportion106 of thesuperior implant102 may also range from about 3 mm in diameter to about 14 mm in diameter. In an exemplary embodiment, the diameter of thesuperior implant102 ranges from about 6 mm to about 12 mm. In another exemplary embodiment, the diameter of thesuperior implant102 ranges from about 8 mm to about 10 mm.
• Thefixation surface112 may be generally flat or generally curved and is configured to interact with the superior articulatingsurface38. The articulatingsurface110 may be generally curved and may be configured to interact with an articulatingsurface118 of theinferior implant104.
• Extending from the disk-shapedportion106 of the superior implant is atab108 configured to interact with or for attachment to thelateral mass26 of thevertebra12. Thetab108 may be generally curved so that it matches the natural curvature of thevertebra12. For example, thetab108 and the disk-shapedportion106 of thesuperior implant102 may form an angle ranging from about 110 degrees to about 160 degrees. In one exemplary embodiment, thetab108 and the disk-shapedportion106 of thesuperior implant102 form an angle ranging from about 120 degrees to about 150 degrees. In another exemplary embodiment, thetab108 and the disk-shapedportion106 of thesuperior implant102 may form an angle ranging from about 130 degrees to about 145 degrees.
• Thetab108 may include a hole or a slot or the like configured to receive a fixation device, such as a screw or the like. In other words, the fixation device passes through the hole or slot of thetab108 and into thelateral mass26 of thevertebra12.
• Thesuperior implant102 may have a surface fixation mechanism for fixing thesuperior implant102, such as by fixing thefixation surface112, to the superior articulatingsurface38. The surface fixation mechanism may be any fixation mechanism known in the art, such as at least one of: one or more pegs, one or more pips, ridges, one or more grooves, one or more fins, and one or more screws. In an exemplary embodiment, the surface fixation mechanism includes at least onefin122. Thefin122 helps prevent thesuperior implant102 from migrating along the superior articulating surface. In another exemplary embodiment, the surface fixation mechanism may include a plurality of ridges, grouped in regions such that the ridges in different regions are oriented in different directions. For example, the surface fixation mechanism may include four regions on thefixation surface112 where each of the four regions has ridges oriented in a different direction. The various orientations of the ridges prevent theinferior implant104 from moving in different directions with respect to the superior articulatingsurface38.
• Thefixation surface112 of thesuperior implant102 may also have a porous coating; a porous onlay material; a biologic coating; a surface treatment, such as to facilitate bone ingrowth or cement fixation; a material facilitating bone ingrowth; and combinations thereof. For example, thefixation surface112 may have a porous surface that is beaded, threaded, textured, etc. Further, thefixation surface112 may have a hydroxyapatite coating or may be plasma-sprayed. In addition to the examples listed, any known method of improving fixation of biologic implants may be used to improve the interaction of thefixation surface112 and the superiorarticular facet30.
• In one exemplary embodiment, thefixation surface112 of thesuperior implant102 is configured to interact only with the superior articulatingsurface38 and does not interact directly with any other aspect of the superiorarticular facet30 or the facet joint36. Thefixation surface112 of thesuperior implant102 may be generally flat or generally curved for improved interaction with the superior articulatingsurface38.
• The articulatingsurface110 in one exemplary embodiment is generally configured to articulate or interact with the articulatingsurface118 of theinferior implant104. Accordingly, the articulatingsurface110 of thesuperior implant102 may be generally flat or generally curved. Thesuperior implant102 articulatingsurface110 may be configured such that it acts as a “female” surface wherein it is concave or configured to accept a “male” articulatingsurface118 of aninferior implant104. Conversely, thesuperior implant102 articulatingsurface110 may also be configured such that it acts as a “male” surface wherein it is convex or configured to be accepted by “female” articulatingsurface118 of aninferior implant104.
• Thesuperior implant102 may be composed of any material commonly used in the art for articulating medical implants. Such materials include, but are not limited to, cobalt-chromium alloys, ceramics (alumina ceramic, zirconia ceramic, yttria zirconia ceramic, etc.), titanium, ultra high molecular weight polyethylene (UHMWPE), pyrolytic carbon, titanium/aluminum/vanadium (Ti/Al/V) alloys, Tantalum, Carbon composite materials and combinations thereof. For example, thesuperior implant102 may be generally composed of titanium, but have a UHMWPE articulating surface. Some materials are more appropriate for articulating surfaces and some more appropriate for fixation surfaces, but any materials known in the art for use with articulating and fixation surfaces can be used in the present invention. Such materials are commonly used in joint arthroplasty and the like.
• Theinferior implant104 is configured for placement on inferiorarticular facet32. Theinferior implant104 may be fixed to the inferior articulatingsurface40 using cemented and/or cementless fixation techniques. In an exemplary embodiment, theinferior implant104 has a disk-shapedportion114, which has an articulatingsurface118 and afixation surface120 and is configured for placement on a specifically prepared inferior articulatingsurface40.
• The disk-shapedportion116 of theinferior implant104 may range from about 1 mm thick to about 6 mm thick. In an exemplary embodiment, the thickness of theinferior implant104 ranges from about 2 mm to about 4 mm. In another exemplary embodiment, the thickness of theinferior implant104 ranges from about 1.5 mm to about 2.5 mm. The disk-shapedportion114 of theinferior implant104 may also range from about 3 mm in diameter to about 14 mm in diameter. In an exemplary embodiment, the diameter of theinferior implant104 ranges from about 6 mm to about 12 mm. In another exemplary embodiment, the diameter of theinferior implant104 ranges from about 8 mm to about 10 mm.
• Thefixation surface120 may be generally flat or generally curved and is configured to interact with the inferior articulatingsurface40. The articulatingsurface118 may be generally curved and may be configured to interact with an articulatingsurface110 of thesuperior implant104.
• Extending from the disk-shapedportion114 of the inferior implant is atab116 configured to interact with or for attachment to the inferiorarticular process28 of thevertebra12. Thetab116 may be generally curved so that it matches the natural curvature of thevertebra12. For example, thetab116 and the disk-shapedportion114 of theinferior implant104 may form an angle ranging from about 10 degrees to about 70 degrees. In one exemplary embodiment, thetab116 and the disk-shapedportion114 of theinferior implant104 form an angle ranging from about 20 degrees to about 60 degrees. In another exemplary embodiment, thetab116 and the disk-shapedportion114 of theinferior implant104 may form an angle ranging from about 30 degrees to about 50 degrees.
• Thetab116 may include a hole or a slot or the like configured to receive a fixation device, such as a screw or the like. In other words, the fixation device passes through the hole or slot of thetab116 and into the inferiorarticular process28 of thevertebra12.
• Theinferior implant104 may have a surface fixation mechanism for fixing theinferior implant104, such as by fixing thefixation surface120, to the inferior articulatingsurface40. The surface fixation mechanism may be any fixation mechanism known in the art, such as at least one of: one or more pegs, one or more pips, ridges, one or more grooves, one or more fins, and one or more screws. In an exemplary embodiment, the surface fixation mechanism includes at least one fin, such as the fin shown as122 on thesuperior implant102. The fin helps prevent theinferior implant104 from migrating along the superior articulating surface. In another exemplary embodiment, the surface fixation mechanism may include a plurality of ridges, grouped in regions such that the ridges in different regions are oriented in different directions. For example, the surface fixation mechanism may include four regions on thefixation surface120 where each of the four regions has ridges oriented in a different direction. The various orientations of the ridges prevent theinferior implant104 from moving in different directions with respect to the inferior articulatingsurface40.
• Thefixation surface120 of theinferior implant104 may also have a porous coating; a porous onlay material; a biologic coating; a surface treatment, such as to facilitate bone ingrowth or cement fixation; and combinations thereof. For example, thefixation surface120 may have a porous surface that is beaded, threaded, textured, etc. Further, thefixation surface120 may have a hydroxyapatite coating or may be plasma-sprayed. In addition to the examples listed, any known method of improving fixation of biologic implants may be used to improve the interaction of thefixation surface120 and the inferiorarticular facet32.
• In one exemplary embodiment, thefixation surface120 of theinferior implant104 is configured to interact only with the inferior articulatingsurface40 and does not interact directly with any other aspect of the inferiorarticular facet32, the inferiorarticular process28, or even the facet joint36. Thefixation surface120 of theinferior implant104 may be generally flat or generally curved for improved interaction with the inferior articulatingsurface40.
• The articulatingsurface118 in one exemplary embodiment is generally configured to articulate or interact with the articulatingsurface110 of thesuperior implant102. Accordingly, the articulatingsurface118 of theinferior implant104 may be generally flat or generally curved. Theinferior implant104 articulatingsurface118 may be configured such that it acts as a “female” surface wherein it is concave or configured to accept a “male” articulatingsurface110 of asuperior implant102. Conversely, theinferior implant104 articulatingsurface118 may also be configured such that it acts as a “male” surface wherein it is convex or configured to be accepted by “female” articulatingsurface110 of ansuperior implant102.
• Theinferior implant104 may be composed of any material commonly used in the art for articulating medical implants. Such materials include, but are not limited to, cobalt-chromium alloys, ceramics (alumina ceramic, zirconia ceramic, yttria zirconia ceramic, etc.), titanium, ultra high molecular weight polyethylene (UHMWPE), pyrolytic carbon, titanium/aluminum/vanadium (Ti/Al/V) alloys, and combinations thereof. For example, theinferior implant104 may be generally composed of a ceramic material or a cobalt-chromium alloy. Some materials are more appropriate for articulating surfaces and some more appropriate for fixation surfaces, but any materials known in the art for use with articulating and fixation surfaces can be used in the present invention. Such materials are commonly used in joint arthroplasty and the like.
• Turning next toFIG. 7, there is provided an alternate embodiment of a cervical facet inferior implant in conjunction with a trans-lateral mass screw. In another exemplary embodiment, theinferior implant204 is configured to interact with or attach to a trans-lateralmass fixation mechanism202. As shown, the trans-lateralmass fixation mechanism202 is a screw, but may be any like fixation mechanism.
• For example, theinferior implant204 may include a threaded hole212 either extending from or bored into thefixation surface210 of theinferior implant204. The manner in which theinferior implant204 and the trans-lateralmass fixation mechanism202 interact may vary with different anatomies. For example, it may be preferable to offset the trans-lateral mass screw202 from theinferior implant204 such that when the trans-lateral mass screw202 andinferior implant204 interact, the trans-lateral mass screw202 is not perpendicular to theinferior implant204. The trans-lateral mass screw202 may range from about 0 degrees offset from perpendicular to about 60 degrees offset from perpendicular.
• The articulatingsurface208 of theinferior implant204 is generally configured to articulate or interact with the articulatingsurface110 of thesuperior implant102 shown inFIG. 5. Accordingly, the articulatingsurface208 of theinferior implant204 may be generally flat or generally curved. Theinferior implant204 articulatingsurface208 may be configured such that it acts as a “male” surface wherein it is convex or configured to be accepted by a “female” articulatingsurface110 of asuperior implant102. Conversely, theinferior implant204 articulatingsurface208 may also be configured such that it acts as a “female” surface wherein it is configured to accept a “male” articulatingsurface110 of asuperior implant102.
• A trans-lateralmass fixation mechanism202 is configured to interact with theinferior implant204. The trans-lateralmass fixation mechanism202 secures theinferior implant204 to the inferiorarticular facet32. The trans-lateralmass fixation mechanism202 may be any fixation mechanism known in the art, such as a translaminar screw. The trans-lateralmass fixation mechanism202 may be made from any material known in the art for medical fixation devices. For example, the trans-lateralmass fixation mechanism202 may be made from titanium, titanium/aluminum/vanadium (Ti/Al/V) alloys, Tantalum, CrCo, ceramic, carbon or carbon composite materials.
• Turning next toFIG. 8, there is provided a flow diagram generally illustrating a method for providing articulating surfaces for facet joint articular facets. The overall flow begins at process block802 wherein a space is created between the superiorarticular facet30 and the inferiorarticular facet32. It will be understood by those skilled in the art that prior to creating the space, it may be preferable or even necessary to expose the facet joint36 at an effected level and remove the capsule. The effected level may be exposed through use of any appropriate procedure, such as a modified “Wiltse” approach. The creation of the space at process block602 may be accomplished by using a curette or similar device and by removing the cartilaginous surfaces of the facet joint36. In one exemplary embodiment, the created space is sufficient for using a rasp on an articulating surface of an articular facet. The space created between the superiorarticular facet30 and the inferiorarticular facet32 may range, for example, from about 2 mm to about 15 mm. In one exemplary embodiment, the space ranges from about 4 mm to about 8 mm. It should be understood that a rasp can be any tool used to scrape, grate, or file the facets.
• Flow progresses to process block804 wherein the articulatingsurface40 of the inferiorarticular facet32 is prepared for aninferior implant104. Such preparation may be made by a rasp, such as a rasp specifically designed for preparing a surface for the cervical facet implant. Progression then continues to process block806 wherein the articulatingsurface38 of the superiorarticular facet30 is prepared for asuperior implant102. Again, such preparation may be made by a rasp, such as a rasp specifically designed for preparing a surface for the cervical facet implant.
• Each of the rasps of process blocks804 and806 may be either a single shaft rasp or a double action rasp, such as those illustrated inFIGS. 10-12 and described in detail herein. The process of preparing the articulatingsurfaces38 and40 of thearticular facets28 and30 may involve using multiple rasps of increasing thickness while widening the space created inprocess block802. For example, a 2 mm rasp may initially be used, then a 4 mm rasp, then a 6 mm rasp, then an 8 mm rasp, etc., until a desired result is achieved. In addition, the rasps of process blocks804 and806 may be the same rasp. Further, a single rasp can be used to prepare the articulatingsurfaces38 and40 concurrently. The articulating surfaces38 and40 may be prepared such that a bleeding bone bed is created to facilitate bone ingrowth for thesuperior implant102 andinferior implant104.
• As shown inFIG. 9, when the single handed rasp is used to prepare articulatingsurface38 and/or articulatingsurface40, the working end of the tool may be positioned inside the space created inprocess block802. The rasp may then be moved from an anterior to a posterior position inside the facet joint36 in order to effect a clean and uniform resection of the created space in the shape and dimension of both implants. In other words, the articulatingsurface38 is prepared such that its shape and dimension resembles thesuperior implant102 and the articulatingsurface40 is prepared such that its shape and dimension resembles theinferior implant104. The anterior/posterior movement of the rasp may be continued until the rasp is too small for the space created. The rasp may be too small when the space created is so wide that the rasp cannot prepare both the articulatingsurfaces38 and40 concurrently. A larger (thicker) rasp may then be used. Increasingly larger rasps may be used until the created space is increased such that it ranges from about 4 mm to about 8 mm. In one exemplary embodiment, the rasps are designed to cut only when moving in a posterior direction to help prevent injury during the resurfacing process.
• In one embodiment, the steps of process blocks802,804 and806 are repeated on the contralateral side of facet joint36 prior to performing the steps ofprocess block808.
• Progression then flows to process block808 wherein theinferior implant104 is placed on the prepared/resurfaced articulatingsurface40 of the inferiorarticular facet32. In one exemplary embodiment, theinferior implant104 is placed such that the disk-shapedportion114 interacts with the articulatingsurface40 of the inferiorarticular facet32, but not with other aspects of the inferiorarticular facet32.
• In one alternative embodiment, a trans-lateral mass screw202 is used to secure aninferior implant204 to the inferiorarticular facet32. In this embodiment, the above method would also include using the trans-lateral mass screw202 to secure theinferior implant204 to the inferiorarticular facet32.
• To facilitate placement of the trans-lateral mass screw106, an aiming device such as the device illustrated inFIG. 11 may be used. The aiming device can be used to position a drill for creating a trans-lateral mass hole for the trans-lateral mass screw202. A drill can then be used to create the hole, which may have a diameter of about 2 mm, depending on the diameter of the trans-lateral mass screw202.
• Once the hole is drilled, the trans-lateral mass screw202 can be introduced into the hole and then used to secure theinferior implant104 to the inferiorarticular facet32. In one embodiment, the steps of process blocks808, including any steps associated with the drilling or placement of the trans-lateral mass screw202, are repeated on the contralateral side of facet joint36 prior to performing the steps ofprocess block810.
• Progression then continues to process block810 wherein thesuperior implant102 is placed on the prepared/resurfaced articulatingsurface38 of the superiorarticular facet30. In one exemplary embodiment, thesuperior implant102 is placed such that the disk-shapedportion106 interacts with the articulatingsurface38 of the superiorarticular facet30, but not with other aspects of the superiorarticular facet30.
• In one embodiment, the steps of process blocks802,804,806,808 and810 are then repeated on the contralateral side.
• Turning now toFIG. 10, a single handed rasp is illustrated. Therasp1000 includes ahandle1002 and a shaft1004 connecting thehandle1002 to the working end of therasp1000. Attached to theshaft804 at the working end of therasp1000 is ahead1006. Thehead1006 has at least onecutting surface1008. In one exemplary embodiment, thecutting surface1008 is configured to cut when thecutting surface1008 is moved in a first direction (e.g. when the rasp is moved from the anterior to the posterior direction of the facet joint) but not when thecutting surface1008 is moved in a direction opposite to the first direction (e.g. when the rasp is moved from the posterior to the anterior direction of the facet joint).
• Therasp1000 is configured to prepare the articulating surfaces of a facet joint. In an exemplary embodiment, therasp1000 is configured to prepare articulatingsurfaces38 and40 of thearticular facets28 and30 such that the shape and dimension of the prepared articulating surfaces resembles the shape and dimension of the superior implant1.02 andinferior implant104. For example, if thesuperior implant102 and/orinferior implant104 are curved, thehead1006 may be generally curved to properly prepare the surface for the implant.
• In addition, therasp1000 may be made from any appropriate material commonly used for medical tools. In one exemplary embodiment, at least part of therasp1000 is made from titanium, although the rasp could also be made from any material known in the art.
• While the present invention has been described in association with several exemplary embodiments, the described embodiments are to be considered in all respects as illustrative and not restrictive. Such other features, aspects, variations, modifications, and substitution of equivalents may be made without departing from the spirit and scope of this invention which is intended to be limited solely by the scope of the following claims. Also, it will be appreciated that features and parts illustrated in one embodiment may be used, or may be applicable, in the same or in a similar way in other embodiments.

Claims (37)

1. A cervical facet resurfacing implant comprising:

a superior implant having an articulating surface and a fixation surface and configured for secured placement on a resurfaced superior articular facet of a selected cervical vertebra; and

an inferior implant having an articulating surface and a fixation surface and configured for secured placement on a resurfaced inferior articular facet of a cervical vertebra immediately above the selected cervical vertebra such that the articulating surface of the inferior implant interacts with the articular surface of the superior implant.

2. The cervical facet resurfacing implant ofclaim 1 wherein the superior implant and inferior implant are each generally disk-shaped.

3. The cervical facet resurfacing implant ofclaim 1 wherein the superior implant further comprises a tab extending from the generally disk-shaped portion of the superior implant.

4. The cervical facet resurfacing implant ofclaim 3 wherein the tab is configured for attachment to the lateral mass of the selected cervical vertebra.

5. The cervical facet resurfacing implant ofclaim 4 wherein the tab is attached to the lateral mass of the selected cervical vertebra with a screw.

6. The cervical facet resurfacing implant ofclaim 3 wherein the tab and the disk-shaped portion of the superior implant form an angle of from about 110 degrees to about 160 degrees.

7. The cervical facet resurfacing implant ofclaim 1 wherein the inferior implant further comprises a tab extending from the generally disk-shaped portion of the inferior implant.

8. The cervical facet resurfacing implant ofclaim 7 wherein the tab is configured for attachment to the inferior articular process of the cervical vertebra immediately above the selected cervical vertebra.

9. The cervical facet resurfacing implant ofclaim 7 wherein the tab is attached to the inferior articular process of the cervical vertebra immediately above the selected cervical vertebra with a screw.

10. The cervical facet resurfacing implant ofclaim 7 wherein the tab and the disk-shaped portion of the inferior implant form an angle of from about 10 degrees to about 70 degrees.

11. The cervical facet resurfacing implant ofclaim 1 wherein at least one of the superior implant and the inferior implant comprises a surface fixation mechanism.

12. The cervical facet resurfacing implant ofclaim 11 wherein the surface fixation mechanism comprises at least one of: at least one peg, at least one pip, at least one fin, ridges, and at least one screw hole.

13. The cervical facet resurfacing implant ofclaim 12 wherein the surface fixation mechanism comprises multiple regions and wherein each of the regions has at least one ridge oriented in a different direction than the other regions.

14. The cervical facet resurfacing implant ofclaim 1 wherein the fixation surface of at least one of the inferior implant and the superior implant has at least one of: a porous coating, a porous onlay material, a biologic coating, a surface treatment, and a material facilitating ingrowth of bone.

15. The cervical facet resurfacing implant ofclaim 1 wherein the articulating surface of at least one of the inferior implant and the superior implant is composed of at least one of: cobalt-chromium alloy, ceramic, UHMWPE, pyrolytic carbon, and Ti/Al/V.

16. The cervical facet resurfacing implant ofclaim 1 wherein the inferior implant and superior implant each range from about 1 mm thick to about 6 mm thick.

17. The cervical facet resurfacing implant ofclaim 1 wherein the inferior implant and superior implant each range from about 3 mm in diameter to about 14 mm in diameter.

18. The cervical facet resurfacing implant ofclaim 1 further comprising a trans-lateral mass fixation mechanism for securing the inferior implant to the inferior articular facet.

19. The facet implant ofclaim 18 wherein the trans-lateral mass fixation mechanism comprises at least one of: a translaminar screw, a bolt and a fixation pin.

20. A facet implant comprising:

a generally disk-shaped superior implant having an articulating surface and a fixation surface and being configured for placement on a resurfaced superior articular facet of a selected cervical vertebra, the superior implant having a tab extending from the generally disk-shaped portion of the superior implant, the tab being configured for secured attachment to the lateral mass of the selected vertebra; and

a generally disk-shaped inferior implant having an articulating surface and a fixation surface and being configured for placement on a resurfaced inferior articular facet of a cervical vertebra immediately above the selected cervical vertebra such that the articulating surface of the inferior implant interacts with the articular surface of the superior implant, the inferior implant having a tab extending from the generally disk-shaped portion of the inferior implant, the tab being configured for secured attachment to the inferior articular process of the cervical vertebra immediately above the selected vertebra.

21. The cervical facet resurfacing implant ofclaim 20 wherein at least one of the superior implant and the inferior implant comprises a surface fixation mechanism.

22. The cervical facet resurfacing implant ofclaim 21 wherein the surface fixation mechanism comprises at least one of: at least one peg, at least one pip, at least one fin, ridges, and at least one screw hole.

23. The cervical facet resurfacing implant ofclaim 20 wherein the fixation surface of at least one of the inferior implant and the superior implant has at least one of: a porous coating, a porous onlay material, a biologic coating, a surface treatment, and a material facilitating ingrowth of bone.

24. The cervical facet resurfacing implant ofclaim 20 wherein the articulating surface of at least one of the inferior implant and the superior implant is composed of at least one of: cobalt-chromium alloy, ceramic, UHMWPE, pyrolytic carbon, and Ti/Al/V.

25. A method for providing articulating surfaces for vertebrae facet joint articular facets of comprising:

creating a space between a superior articular facet of a selected vertebra and an inferior articular facet of a vertebra immediately above the selected vertebra;

using a rasp to prepare an articulating surface of the inferior articular facet for an inferior implant;

using a rasp to prepare an articulating surface of the superior articular facet for a superior implant;

fixing the inferior implant on the inferior articular facet such that a fixation surface of the inferior implant interacts with the articulating surface of the inferior articular facet; and

fixing the superior implant on the superior articular facet such that a fixation surface of the superior implant interacts with the articulating surface of the superior articular facet;

wherein the articulating surface of the superior implant and the articulating surface of the inferior implant are configured to articulate with one another.

26. The method ofclaim 24 wherein each of the steps are repeated on articular facets on a contralateral side of the vertebrae facet joint.

27. The method ofclaim 24 wherein the created space is begun with a curette.

28. The method ofclaim 24 wherein the created space is a space sufficient for using a rasp on an articulating surface of an articular facet.

29. The method ofclaim 24 wherein the created space ranges from about 2 mm to about 5 mm.

30. The method ofclaim 24 wherein multiple rasps of increasing thickness are used to prepare the articulating surfaces of the superior and inferior articular facets.

31. The method ofclaim 24 wherein the articulating surfaces of the superior and inferior articular facets are prepared such that the created space is increased to accommodate the superior and inferior implants.

32. The method ofclaim 30 wherein the articulating surfaces of the superior and inferior articular facets are prepared such that the shape and dimension of superior articular facet resembles the superior implant and the shape and dimension of the inferior articular facet resembles the inferior implant.

33. The method ofclaim 30 wherein the created space is increased such that it ranges from about 4 mm to about 15 mm.

34. The method ofclaim 24 wherein the articulating surfaces of the superior and inferior articular facets are prepared such that a bleeding bone bed is created to facilitate bone ingrowth.

35. The method ofclaim 24 wherein the inferior and superior articulating surfaces are prepared by the same rasp.

36. The method ofclaim 24 wherein at least one rasp is configured to cut when moving in a first direction, but not when moving in a direction opposite of the first direction.

37. The method ofclaim 24 further comprising securing the inferior implant to the inferior articular facet with a trans-lateral mass fixation mechanism.

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