US20060085076A1 - Posterior spinal arthroplasty-development of a new posteriorly inserted artificial disc and an artificial facet joint - Google Patents

Abstract

Lumbar disc and facet joint replacement prosthesis are provided. The lumbar disc prosthesis includes first member having a vertebral disc contact surface and a recessed portion on an opposing surface thereof and a second member having a vertebral disc contact surface and a protruding portion on an opposing surface thereof. The protruding portion of the second member engages the recessed portion of the first member in use. The first and second members are provided with at least a middle section and two end sections. The recessed and protruding portions are provided in the middle section of the respective members and each end section has a narrowing taper. The facet joint prosthesis includes a first member for attachment to a first posterior lumbar disc and a second member for attachment to a second posterior lumbar disc. At least a part of the first member is telescopically mounted in at least a part of the second member.

Description

REFERENCE TO PENDING APPLICATIONS
• This application claims priority to Great Britain Patent Application No. 0422963.9 filed Oct. 15, 2004.
FIELD OF THE INVENTION
• This invention relates to devices and surgical methods for the treatment of various types of lumbar spine pathologies. It is specifically directed to the different types of degenerative pathologies in the lumbar spine. It deals with the development of an artificial facet joint, and an artificial lumbar disc replacement that is specifically designed to be inserted from a posterior approach to the spine.
BACKGROUND OF THE INVENTION
• Back pain affects 40% of the population. Up to 20% of the population visit their family doctor requesting help with their back problem. Up to 30% of patients continue to complain of significant back pain at one year following the onset of their symptoms.
• Although the majority of patients have minor sprains or strains which are self limiting, a significant number of patients go on to develop severe chronic mechanical lower back pain which is caused by inflammatory changes in the lumbar disc associated with degeneration.
• Another group of patients with degenerative spine disease go on to develop degenerative spondylolisthesis and spinal stenosis. This is a narrowing of the spinal canal caused primarily by degenerative changes in the facet joint, combined with a loss of normal disc height and buckling of the ligamentum flavum.
• Degeneration occurs in a spinal segment. The spinal segment consists of the lumbar disc anteriorly and two facet joints posteriorly. This is therefore called a three joint complex. Degenerative changes in the disc can lead to changes in the facet joint and vice versa. In patients with significant lumbar disc degeneration, the facet joints are also usually degenerate.
• Pain occurs from all components of the three joint complex, including the facet joints and the disc. The facet joint is in fact a synovial joint and suffers from the problems that are known to affect other synovial joints in the body like the hip and the knee. The facet joint particularly contributes to degenerate spondylolisthesis and commonly occurs at levels where the facet joints are sagittally orientated, for example at the L4/5 level.
• After failing all the conservative treatments available, a minority of patients with back pain or leg pain will go on to require surgical intervention. For patients with predominantly lower back pain who have a degenerative lumbar disc, some surgeon's consider the solution lies in removing the pain generator which is the disc and restoring normal loading across the disc by doing an inter-body stabilisation procedure.
• The two types of inter-body stabilisation procedure currently available are an artificial disc replacement performed anteriorly and inter-body fusions performed anteriorly and/or posteriorly. These inter-body stabilisation procedures are often combined with decompression of the spinal canal and the nerve roots if there is nerve root impingement.
• As far as inter-body fusions are concerned, there are two basic strategies that surgeons adopt. The first is to perform an anterior inter-body fusion combined with posterior stabilisation externally of the spinal canal. Anterior inter-body fusion on its own is still questioned because it does not provide a posterior tension band. An alternative strategy is a posterior lumbar inter-body fusion, where the entire inter-body fusion procedure is performed from behind and it is combined with neural decompression as well as removal of the degenerative facet joints. Posterior lumbar inter-body fusion also provides a posterior tension band. This strategy therefore deals with all three joint components which can generate possible pain at the disc level, including the lumbar disc, the neural structures and the facet joints.
• When it comes to lumbar disc arthroplasty procedures, these are performed via an anterior lumbar approach. The disc is removed and an artificial lumbar disc is inserted into the space. This removes the pain generator and allows normal loading across the disc, as well as allowing some movement at this level. The advantage of this is to reduce the strains on the disc above and therefore reduce the chances of adjacent segment degeneration. Several studies have shown that adjacent segment degeneration can occur above a fused segment because of the increased loads being transmitted to this level.
• One of the disadvantages of anterior lumbar arthroplasty is that the facet joints at this level continue to move and also continue to act as a pain generator. In addition, if there is any neural impingement, these symptoms can continue. The other disadvantage of anterior lumbar arthroplasty is that the majority of spine surgeons are not familiar with the anterior approach, and although complications are uncommon, they can be life and limb threatening when they do occur.
• There is therefore a concern among researchers and the surgical community, that long term results of anterior lumbar disc arthroplasty may be compromised by progressive degeneration of the facet joint at the same level. In addition, after lumbar disc arthroplasty, several patients continue to complain of facet joint pain because of increased loads being placed on the facet joint as a result of the surgical procedure.
• At present there is no posterior lumbar arthroplasty procedure available. It is therefore an aim of the present invention to provide an artificial lumbar disc that can be inserted posteriorly, thereby delivering the advantages of approaching the spine posteriorly and removing the disadvantages associated with approaching the spine anteriorly.
• It is a further aim of the present invention to provide a facet joint replacement prosthesis.
• It is a yet further aim of the present invention to provide a lumbar prosthetic system that deals with the painful disc, the neural impingement and the painful facet joints by providing a combination of a lumbar disc prosthesis and a facet joint prosthesis as a single unit.
BRIEF SUMMARY OF THE INVENTION
• According to a first aspect of the present invention there is provided a lumbar disc prosthesis, said lumbar disc prosthesis including a pair of disc members, the first member of said disc pair having a vertebral endplate contact surface and a recessed portion on an opposing surface thereof, the second member of said disc pair having a vertebral endplate contact surface and a protruding portion on an opposing surface thereof, the protruding portion of the second member engaging with the recessed portion of the first member in use, and wherein the spinal disc prosthesis includes a further pair of disc members, said further pair of disc members also including first and second members.
• Preferably the disc pairs are mirror images of each other.
• Thus, the present invention provides a lumbar disc prosthesis having two disc member pairs and thus two separate articulating portions, one articulating portion on each pair of disc members. The disc member pairs are each independently inserted into the disc space on either side of the dural sac in use through the trans-foraminal or posterior route bilaterally and are provided a spaced distance apart in use to allow accommodation in accordance with the anatomy of the lateral aspect of the disc space. Thus, the disc prosthesis can be inserted through the posterior route whilst taking into account the neural anatomy posteriorly.
• The lumbar disc prosthesis of the present invention can be inserted at all levels between L2 and the sacrum, typically depending on the level of expertise of the operating surgeon.
• Preferably the first members of each disc pair are provided in the left and right areas of the disc space respectively in use. The second members of each disc pair are also provided in the left and right areas of the disc space respectively in use. Thus, each pair of members constitutes a left and right lumbar disc prosthesis.
• Preferably the recessed portion of the first member is substantially curved and the curvature of the medial part of said recessed portion is asymmetrical to the curvature of the lateral part of said recessed portion.
• The purpose of this asymmetry in the medial-lateral plane is to allow “capture” of the protruding portion of the second member. such that when two pairs of disc prostheses are placed in the patient, the two vertebrae can move from side to side as well as anteriorly and posteriorly.
• Preferably the lateral part of the recess has curvature corresponding to an arc of a circle which has a radius greater that of an arc of a circle corresponding to the curvature of the medial part of the recessed portion. Further preferably the radius of the lateral part is at least twice as big as the radius of the medial part.
• Preferably an anterior part of the recessed portion is substantially symmetrical to a posterior part of the recessed portion.
• The protrusion portion of the second member is typically of different shape and/or dimensions to the recessed portion of the first member. Thus, the protrusion portion is asymmetrical or forms an asymmetrical fit with the recessed portion.
• Preferably the protrusion portion is substantially dome shaped and makes contact with only a part of the recessed portion when assembled. Preferably the recessed portion is substantially an inversed dome shape.
• The protrusion portion is typically symmetrical in the anterior-posterior plane and in the medial to lateral plane. The curvature in the medial to lateral plane can be the same or different to that in the anterior to posterior plane.
• Preferably the inner or opposing surfaces of each of the first and second disc members are provided with at least three sections; a middle section and at least two end sections, the recessed and protruding portions being provided in the middle section of the respective disc members.
• Preferably the thickness or depth of the first disc member is less adjacent the middle section or recessed portion compared to the two end sections thereof.
• The middle and end sections of each disc member are typically arranged transversally along the length thereof, i.e. the boundaries of adjacent sections are provided between the medial to lateral sides of the disc members.
• Preferably one or both ends of the first and second disc members have a narrowing taper (i.e. the prosthesis as a whole has a narrowing taper). This narrowing taper is as a result of the outer or vertebral end plate contact surface of said first and/or second disc member being provided at an acute angle with respect to the horizontal at one or both ends. These angled surfaces are preferably substantially planar in form. For example, the outer or vertebral end plate contact surface of the first disc member slopes downwardly towards the ends of the disc member and/or the outer or vertebral end plate contact surface of the second disc member slopes upwardly towards the ends of the disc member. The narrowing taper of the prosthesis allows easy insertion of the prosthesis in the disc space via a posterior route.
• In one embodiment, the narrowing taper is provided at an anterior end of the prosthesis. Thus, the outer surfaces or vertebral endplate contact surfaces of the disc member(s) slope towards the opposing surfaces thereof at the anterior end of the disc member(s). This provides a “lead in” feature which increases the ease with which the front of the prosthesis can be inserted via a posterior route into the disc space.
• In one embodiment, a narrowing taper is provided at the posterior end of the prosthesis. Thus, the outer surfaces or vertebral endplate contact surfaces of the disc member(s) slope towards the opposing surfaces thereof at the posterior end of the disc member(s). The posterior angled surface allows the prosthesis in the neutral position to be placed such that the vertebral end plates are in lordosis.
• The posterior end of the prosthesis typically slopes or tapers in an opposite direction to the anterior end.
• Preferably the anterior end slope is substantially smaller than the posterior end slope.
• Preferably one or both end sections of the inner or opposing surfaces of said first and/or second members are provided at an acute angle to the horizontal. For example, the inner end section surface of said first member can slope downwardly towards one or both ends of said member. The inner end section surface of said second member can slope downwardly towards the one or both ends of said member.
• Further preferably the outer and inner surfaces of said second disc member form a narrowing taper towards one or both ends of said disc member.
• Further preferably the outer and inner surface of said first disc member form a narrowing taper adjacent an end of said disc member in which attachment screws are to be located therethrough.
• The geometry of the middle and end sections of the first and second disc members allow contact to be made between the recessed and protrusion portions thereof and for a gap to be formed adjacent the end sections of the disc members when the prosthesis is in a neutral position. When the prosthesis is in extension or flexion (i.e. the upper or first disc member moves towards the posterior or anterior end of the lower or second disc member), the gap between the end sections at the opposite end increases, thereby causing the annulus in which the disc prosthesis is located to tighten. Due to the geometry of the planar slopes within the prosthesis the annulus will tighten not only posteriorly in flexion but laterally as well.
• Preferably the vertebral endplate contact surface of the first and/or second members of each disc pair is provided with attachment means for allowing attachment of the disc member to an adjacent disc in use.
• The attachment means can include one or more apertures for the location of screws and/or any other suitable attachment device therewith, one or more tapered members or fins and/or any other conventional attachment apparatus.
• The first and second members of each pair typically correspond to upper and lower disc members. The superior surface of the lower disc member has a protrusion thereon and the inferior surface of the upper disc member has a captive recess or socket thereon.
• Preferably the recessed portion has two sloped surfaces associated therewith, typically corresponding to the end sections thereof, one surface leading anteriorly to the edge of the inferior surface and one surface leading posteriorly to the edge of the inferior surface. These sloping surfaces can be planar or can be slightly concave in form.
• The lumbar disc prosthesis can be used in conjunction with a facet joint prosthesis also provided posteriorly to provide a system which can work together as a single unit to replace the painful disc, overcomes neural impingement and painful facet joints.
• Preferably the facet joint prosthesis typically includes a first member for attachment to a first vertebra of a corresponding disc and a second member for attachment to a second vertebra of a corresponding disc in use, and wherein at least a part of said first member is telescopically mounted in at least a part of said second member in use.
• Preferably the first and second members are elongate members and the provision of one telescopically mounted in the other allows the distance between parts of the first and second members to be increased and/or decreased as required.
• The first vertebra is typically an upper vertebra and the second vertebra is typically a lower vertebra.
• The facet joint prosthesis allows replacement of existing facet joints to be undertaken at all lumbar levels from T12 to the sacrum.
• The interconnecting first and second members are formed such that they can articulate to allow flexion-extension, small degrees of rotation and side to side flexion.
• Preferably securing means are provided for insertion of the first and second members into each of the vertebral bodies above and below the disc between which the facet joint prosthesis is to be located. The first and second members can then be secured to said securing means. A plurality of first and second members can be attached to the securing means if required to form a stack, thereby allowing facet joint replacement at multiple levels within the spine.
• The securing means can include any suitable type of surgical securing device, such as a pedicle screw.
• According to a second aspect of the present invention there is provided a lumbar disc prosthesis, said lumbar disc prosthesis including a pair of disc members, the first member of said disc pair having a vertebral endplate contact surface and a recessed portion on an opposing surface thereof, the second member of said disc pair having a vertebral endplate contact surface and a protruding portion on an opposing surface thereof, the protruding portion of the second member engaging with the recessed portion of the first member in use, and wherein the recessed portion of the first member is substantially curved and the curvature of the medial part of said recessed portion is asymmetrical to the curvature of the lateral part of said recessed portion.
• According to a third aspect of the present invention there is provided a facet joint prosthesis, said prosthesis including a first member for attachment to a first lumbar disc in use and a second member for attachment to a second lumbar disc in use, and wherein at least a part of said first member is telescopically mounted in at least a part of said second member in use.
• The facet joint prosthesis can be used alone or in combination with the lumbar disc prosthesis of the present invention or with any other lumbar disc prosthesis. The facet joint replacement procedure of the present invention alone will have a role in the treatment of patients with spinal stenosis and adjacent level disc disease, where some stability is required at the disc level without fusing a particular disc segment. The facet prosthesis can partially constraining certain degrees of motion.
• According to further independent aspects of the present invention there is provided a prosthesis system including a lumbar disc prosthesis and a facet joint prosthesis as hereinbefore described; a first or upper disc member for inclusion in a lumbar disc prosthesis pair; a second or lower disc member for inclusion in a lumbar disc prosthesis; a method of insertion of a lumbar disc prosthesis in a patient via a posterior route; and a method of insertion of a facet joint replacement prosthesis in a patient via a posterior route.
• Thus, the present invention overcomes the problems and disadvantages associated with current disc replacement strategies. It has all the benefits associated with posterior lumbar inter-body fusion surgery, but at the same time it allows movement at that level and reduces the strain on adjacent discs and the risks of adjacent segment disc failure. This invention also address all three pain generators at the lumbar disc level including the degenerative disc, the impingement of the neural structures, and the facet joint.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIGS. 1-30 relate to a lumbar disc prosthesis according to embodiments of the present invention andFIGS. 31-50 relate to a facet joint replacement prosthesis according to embodiments of the present invention.
• FIG. 1 is a side view of a lumbar disc prosthesis according to one embodiment of the present invention;
• FIGS. 2-4 show the prosthesis inFIG. 1 with the upper disc member in extension, flexion and in a neutral position respectively;
• FIGS. 5 and 6 show the superior surfaces of the upper members of the left and right lumbar prosthesis pairs respectively;
• FIGS. 7 and 8 show rear views of the left and right lumbar prosthesis pairs respectively;
• FIGS. 9 and 10 show front views of the left and right lumbar prosthesis pairs respectively;
• FIGS. 11 and 12 show oblique views of the left and right lumbar prosthesis pairs respectively;
• FIGS. 13 and 14 show the superior surfaces of the lower members of the left and right lumbar prosthesis pairs respectively;
• FIGS. 15 and 16 show rear views of the lower members of the left and right lumbar prosthesis pairs respectively;
• FIG. 17 is a side view of the lower member of a lumbar prosthesis;
• FIGS. 18 and 19 show front views of the lower members of the left and right lumbar prosthesis pairs respectively;
• FIGS. 20 and 21 show oblique views of the lower members of the left and right lumbar prosthesis pairs respectively;
• FIG. 22 is a side view of an upper member of a lumbar prosthesis pair to illustrate the angulations and geometry of the inferior surface thereof;
• FIG. 23 is a front view of the upper member of the lumbar prosthesis pair to illustrate the radius in the medial and lateral part of the curvature of the inferior surface;
• FIG. 24 is an oblique view of the upper member of the lumbar prosthesis pair to further illustrate the shape of the inferior articulating surface thereof;
• FIG. 25 shows a perspective view of the inferior surface of the upper members of the left and right lumbar prosthesis pairs respectively;
• FIGS. 26a-dillustrates a) a solid inverse representation of the recess portion shape on the inferior surface of the upper member of the prosthesis b) an axial view of the prosthesis c) a side view and d) a front view showing the medial/lateral asymmetry of the prosthesis;
• FIG. 27 is a cross section through the upper member of a lumbar prosthesis pair showing the medial lateral curvature of the articulating surface;
• FIG. 28 show front views of the left and right lumbar prosthesis pairs respectively in an alternative embodiment with the screws replaced by fin members;
• FIGS. 29aand29billustrate oblique views of the left and right lumbar prosthesis pairs inFIG. 28 joined together and spaced apart respectively;
• FIGS. 30a-30fshow a) superior surfaces of the upper members of the left and right lumbar prosthesis pairs inFIG. 28 b) a side view c) a front view d) a further side view e) inferior surfaces of the lower members of the left and right lumbar prosthesis pairs and f) oblique views of the pairs;
• FIG. 31 is a side view of a facet joint replacement prosthesis according to an embodiment of the present invention;
• FIGS. 32-36 show a front view, end view, side view, rear view and oblique view respectively of the second or female member of the facet replacement prosthesis;
• FIG. 37 is a cross sectional view of the second or female member of the facet replacement prosthesis taken along the line marked A-A inFIG. 34;
• FIGS. 38-42 show a front view, end view, side view, rear view and oblique view respectively of the first or male member of the facet replacement prosthesis;
• FIG. 43 is a cross sectional view of the first or male member of the facet replacement prosthesis taken along the line marked A-A inFIG. 40;
• FIGS. 44a-44dillustrate a side view, front view, perspective view from the rear and perspective view from the front of the facet joint replacement prosthesis inFIG. 31;
• FIGS. 45aand45billustrate the ability of the male member to move within the female member and produce a flexion and extension movement of the vertebral body respectively;
• FIG. 46 illustrates end views of the facet replacement prosthesis showing the ability of the male and female components to undergo limited relative rotational movement;
• FIG. 47 illustrates front views of the facet replacement prosthesis showing the ability of the male and/or female components to undergo side to side flexion;
• FIGS. 48a-48dshow a side view, front view, perspective view from the rear and perspective view from the front of facet joint prostheses when stacked respectively;
• FIG. 49 is an enlarged view of the ends of the female and male members of the facet joint prosthesis; and
• FIG. 50 is a cross sectional view taken through a pedicle screw attached to a female member of a facet joint prosthesis.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• Lumbar Disc Prosthesis
• Referring firstly toFIGS. 1-30, there is illustrated alumbar disc prosthesis2 which can be inserted into a lumbar disc space via a posterior route as a replacement for a diseased and/or damaged lumbar disc.
• Thedisc prosthesis2 includes two pairs of disc members, each pair including anupper disc member4,4′ and alower disc member6,6′.(Use of a reference numeral with ′ thereafter refers to a second or further feature equivalent to the feature indicated by the reference numeral alone. Thus,disc member4 refers to the first prosthesis pair upper member anddisc member4′ refers to the second prosthesis pair upper member). The upper andlower disc members4,6;4′,6′ of each pair constitute a left and right disc prosthesis respectively. These disc members are shaped and dimensioned such that they can be inserted into a lumbar disc space either side of the dural sac whilst taking into account the posterior neural anatomy.
• Eachupper disc member4,4′ includes a vertebral endplate contacting surface orsuperior surface8,8′ and aninferior surface10,10′. Eachlower disc member6,6′ includes asuperior surface12,12′ and a vertebral endplate contacting surface orinferior surface14,14′.
• A dome shapedprotrusion16 is formed substantially centrally ofsuperior surface12 oflower disc member6.Protrusion16 is received in a substantiallycentral recess18 oninferior surface10 ofupper disc member4 as will be described in more detail below.
• Both the superior surface20 ofupper member4 and theinferior surface22 oflower member6 are angled to provide the prosthesis with a “lead in” or narrowing tapered feature. This lead in feature allows the prosthesis to enter the posterior disc space which is narrower than the anterior disc space. In addition to the lead in feature which is provided at the anterior orfront end24 of the prosthesis members, each prosthesis pair has a lordosis or narrowing taper angle towards the posterior orrear end26 of the prosthesis members between theinferior surface14 of thelower disc member6 andsuperior surface8 of theupper member4 of approximately6 degrees (this angle or any other angle mentioned hereinafter is for exemplary purposes and does not limit the invention in any way), as shown inFIG. 1. This makes the outer surfaces of the disc prosthesis pairs at the posterior and anterior ends substantially wedge shaped or tapered to allow ease of insertion into the disc space. The taper or angle of the outer surfaces at the posterior end is in an opposite direction to the taper or angle of the outer surface at the anterior end.
• With reference toFIGS. 1-27, the superior surface ofupper disc member4 and the inferior surface oflower disc member6 have attachment means in the form ofscrews28 to allow attachment of the disc prosthesis to adjacent vertebrae when positioned in a patient.Apertures30 are provided on the inferior andsuperior surfaces10,12 of the upper andlower disc members4,6 respectively of the prosthesis pairs to allow the insertion ofscrews28 through the prosthesis disc members. The screws are typically fitted from theposterior end26 and the screws and interiorwalls defining apertures30 are provided at an acute angle to the vertical to allow ease of attachment. Apertures30 and screws28 within each pair diverge outwardly away from each other towardsanterior end24. The inferior surface on which these apertures are provided on the upper disc member is angled such that it slopes upwardly towards the superior surface of the upper disc member. The superior surface on which these apertures are provided on the lower disc member is angled such that it slopes downwardly towards the inferior surface of the lower disc member, thereby forming a narrowing taper at the posterior end of the lower disc member. These angled surfaces typically form, at least in part, the posterior end segments of the inferior andsuperior surfaces48,38 of the upper andlower disc members4,6 respectively. This feature is to allow ease of insertion of screws or other attachment means to anchor the prosthesis into the vertebra.
• With theprotrusion16 onlower member6 located inrecess18 ofupper member4 when the prosthesis is assembled, relative movement between the upper andlower members4,6 allows the prosthesis to undergo extension and flexion. The substantially dome shapedprotrusion16 contacts only a part of therecess18 due to differences in symmetry and geometry. In the example illustrated, theupper member4 can move with respect to thelower member6 through approximately10 degrees in a posterior direction to allow extension of the prosthesis, as shown inFIG. 2. Due to the nature of theinferior surface10 ofupper disc member4, as theupper member4 goes into extension there is an increased distance adjacentanterior end24 between the upper andlower members4,6. This results in a tightening of the annulus anteriorly, as is seen in physiological extension in the disc.
• Theupper member4 can also move with respect tolower member6 through approximately10 degrees in an anterior direction to allow flexion of the prosthesis, as shown inFIG. 3. Again, due to the nature ofinferior surface10, as upper member goes into flexion there is in an increased distance adjacentposterior end26 between the upper andlower members4,6. This results in a tightening of the annulus posteriorly and serves as a natural block to further flexion.
• Referring toFIGS. 13-21, there are shown more detailed views of lowerdisc prosthesis member6,6′. The dome shapedprotrusion16 is located in a central or intermediate section ofsuperior surface12 in the anterior to posterior plane. The anterior andposterior end sections36,38 either side of thedome section40, as shown by dottedlines42, are provided at an acute angle to the horizontal sloping downwardly fromintermediate section40 towards ends24,26 respectively. The angled surfaces36,38 are typically substantially planar in form. This downwards incline is to accommodate the flexion and extension of theupper disc member4 without impingement therewith. In the medial and lateral plane,protrusion16 extends substantially the entire distance between the sides of the prosthesis member or from the medial to the lateral edges32,34 respectively.
• Referring toFIGS. 22-27, there is illustrated more detailed views ofupper disc member4 showing in particular the curvature and complex geometry of theinferior surface10. Thesurface10 is divided into three distinct regions as with the superior surface oflower disc member6; a substantially central orintermediate section44 and anterior andposterior end sections46,48 respectively. Each section typically occupies approximately one third of the inferior surface.
• Thecentral section44 is substantially curved and forms an asymmetrical inverse dome shapedrecess18. The curvature of the recess in the medial half (i.e. portion adjacent medial edge32) of the central section differs to the curvature of the recess in the lateral half (i.e. portion adjacent the lateral edge34) of the central section. More specifically, the medial half of the dome has a curvature corresponding to the arc of a circle having a radius of approximately 15 mm as shown byarrow50, whereas the lateral half of the dome has a curvature corresponding to the arc of a circle having a radius of approximately 40 mm, as shown byarrow52 inFIG. 23. Thus, the curvature of the lateral half of the central section corresponds to an arc of a circle having a radius at least double that of the arc of a circle corresponding to the curvature of the medial half of the central section. The purpose of this asymmetry in the medial/lateral plane is to allow capture of the “dome” shapedprotrusion16 of the lower disc member, but still allow some medial and lateral movement of the disc members. This contributes to stability and prevents dislocation of the upper and lower disc members during movement. The shorter curvature of the medial half of the central section relative to the lateral half helps in the medial and lateral movement of the two vertebral bodies on the right and left prosthesis.
• The anterior andposterior end sections46,48 are provided at an acute angle to the horizontal, typically approximately 12-14 degrees as shown inFIG. 22, and provide an incline sloping downwardly from thecentral section44 to the anterior and posterior ends24,26 of the inferior surface respectively. The surface of the anterior and posterior end sections that runs from the central section to the edge of the anterior and posterior sections, as seen inFIG. 25, is generally planar, although a mild curvature or concavity to the surface can be provided. It is to be noted that the slope of theanterior section46,46′ ends before the anterior end, thereby leaving a smallplanar surface54 adjacentanterior end46,46′. In the lateral view, the edge of the anterior and posterior surfaces is substantially planar, and does not include a radius, so that the distance between the vertebrae increases in flexion and extension.
• The curvature of the central section recess on the anterior to posterior axis corresponds to an arc of a circle having a radius of approximately 17 mm, as shown by arrow56 inFIG. 22. This is designed so that in combination with the other geometric features of the prosthesis, anterior and posterior movement of the upper disc member is allowed with respect to the lower disc member of approximately 10 degrees, as previously described in relation toFIGS. 2 and 3, even if the prosthesis pairs are not exactly parallel to each other. This geometry is also designed to allow limited sideways (medial/lateral plane) tilt of the upper disc member on the lower disc member, allowing sideways movement of the two disc members on each other, such that the right and the left prosthesis move in tandem.
• The geometry of the inferior surface of the upper disc member is also designed to allow limited rotation of the right or left prosthesis pairs. This means that if the upper disc member of the right prosthesis pair moves anteriorly, the upper disc member on the left prosthesis pair moves posteriorly allowing limited rotation of the two vertebral members to occur.
• The aim of the surgical procedure for the disc replacement is to insert the left and right prosthesis pairs as parallel to each other as possible within the disc space. However, even if there is medial tilt of between 0-25 degrees between the prosthesis pairs, anterior and posterior movement of the pairs will still be possible and the upper and lower disc members will remain articulated during this movement. Thus, one disc pair is located at one side of the disc space and the other disc pair is located at the opposite side of the disc space (i.e in the medial lateral plane).
• According to a further embodiment of the present invention, alternative attachment means can be provided in the form offin members58 on thesuperior surface8 of theupper disc member4 and on theinferior surface14 of thelower disc member6, as shown inFIGS. 28-30f.Fin members58 anchor the disc prosthesis to adjacent vertebrae.
• Fins58 are substantially triangular in shape and are provided longitudinally of the prosthesis (i.e. between the posterior and anterior ends) towards themedial edge32 of the disc members, so as to avoid the exiting nerve root which goes across the disc laterally. More specifically, the fins are located adjacentposterior end26 and end before the lead infeature20,22 at the anterior end to avoid the exiting lumbar nerve root above the disc on the lateral side (i.e. they extend for approximately two-thirds of the disc surface). The fin has a narrowing taper fromposterior end26 towardsanterior end24.
• With the disc prosthesis pairs fitted, the upper disc members typically move substantially symmetrically on the lower disc members as the upper vertebral body moves forward on the lower vertebral body. The anterior and posterior translations of these upper disc members are limited by a tightening of the anterior and posterior annulus in flexion and extension. This is designed to reflect the physiological process by which the anterior and posterior annulus tightens in flexion and extension in a normal lumbar disc.
• It is to be noted that the end parts of thelateral side34 of the disc members are curved to accommodate the lateral aspect of the disc space which is similarly curved, thereby allowing better anatomical placement. Thus, the lateral side includes an intermediate substantially straight/linear/planar surface with the end portions either side thereof curving inwardly towards the posterior and anterior ends respectively. Themedial side32 of the disc members is substantially straight/linear/planar.
• Apertures60 are defined in theposterior end26 of the upper and lower disc members of each prosthesis pair to allow engagement of an insertion tool therewith so that the prosthesis pairs can be inserted into the disc space.Apertures60 are typically a spaced distance apart and the apertures on the upper disc member are substantially aligned with the apertures on the lower disc member.
• Facet Joint Replacement Prothesis
• Referring toFIGS. 31-50, there is illustrated a facetjoint replacement prosthesis102 according to an embodiment of the present invention. Facetjoint prosthesis102 can be used alone, or in combination with the lumbar disc prosthesis described above to form a single unit system. It is designed to replace the entire facet joint on both the right and the left side of the vertebrae.
• Prosthesis102 includes a first member ormale member104 and a second member orfemale member106. Both male andfemale members104,106 are substantially elongate in form.Male member104 has afirst end108 with securing means in the form of anaperture110 defined therein and asecond end112.End108 is in the form of a flat orplanar plate portion113 and acurved arm portion114 is provided between thisplate portion113 and end112.Female member106 has a first end116 with securing means in the form of anaperture118 defined therein and asecond end120. End116 is in the form of a flat orplate portion117 and acurved channel portion122 is provided between thisplate portion117 and end120.
• Thefacet prosthesis102 is inserted by removing the entire existing facet joint and placingpedicle screws124 into the vertebral body above and below the disc.End112 ofmale member104 is inserted intoend120 ofchannel122 offemale member106 and the ends of the pedicle screws123 are threaded throughapertures118 and110 and secured with anut126. The edge ofplate portions113 and117 which defineapertures118 and110 are tapered inwardly so as to allow a good fit with a tapered or conical shaped lockingnut126, as shown inFIG. 50. A further spacing or lockingnut127 can also be provided.
• Male member104 has a rear orposterior128 and a front oranterior surface130. Theanterior surface130 ofarm portion114 is typically substantially concave in shape and theposterior surface128 ofarm portion114 is typically substantially convex in shape. As such, whenmember104 is fitted topedicle screw124 in use,anterior surface130 typically faces the vertebrae to which it is to be attached.
• Female member106 has a rear orposterior surface132 and a front oranterior surface134. Theanterior surface134 ofchannel portion122 is typically substantially concave in shape and the posterior surface ofchannel portion122 is typically substantially convex in shape. As such, whenmember106 is fitted topedicel screw124 in use,anterior surface134 typically faces the vertebrae to which it is to be attached.
• Thus, with the female member interconnected to the male member, the prosthesis curves outwardly from the vertebrae and outwardly of theplate portions117 and113.Arm portion114 ofmale member104 is freely slidable or movable inchannel portion122 offemale member106. The curvature of the male and female members is substantially the same. Themale member104 is of slightly smaller dimensions than the interior dimensions ofchannel portion122, such that there is a small gap therebetween to allow some sideways movement, as shown byarrows150 inFIG. 47, and rotation of the male member in the female member, as shown byarrows152 inFIG. 46. The male member can also move longitudinally in the female member to allow flexion and extension of the prosthesis and thus the vertebral body, as shown byarrows154 inFIGS. 45aand45b.
• End120 ofchannel portion122 hascurved ends136 and straight side walls138 or side walls of less curvature than said curved ends to form a flattened oval shape, as shown inFIG. 49. Preferably side walls138 form part of an arc, the radius of which is larger than for the arc of the curved ends136.End112 ofarm portion114 is substantially complementary in shape to end120 havingcurved ends140 andstraight side walls142 or side walls of less curvature than said curved ends. Preferablyside walls142 form part of an arc, the radius of which is larger than for the arc of the curved ends140. The provision of the shaped ends allows a small degree of rotation of the male component in the female component.
• Theanterior surface134 ofchannel portion122 has aslot144 provided longitudinally thereof.Slot144 is of such a width that the channel portion encloses approximately 70% of themale member104 when interconnected therewith and is provided to allow some lateral flexion and/or extension and rotation between the male and female members.
• A left and right pair of facet joint prostheses are located between the disc on each side thereof. It is irrelevant whether the female or the male member is uppermost and thus the position of the members is interchangeable. In addition, the facet prosthesis can be used at two adjacent levels, and anchor into pedicle screws, as seen inFIGS. 48a-48d.Amiddle pedicle screw124′ can be used to accommodate two plate portions of the male and/or female members to form a stack. Any number of members can be attached to a pedicle screw as required.
• The prosthesis can be formed from any suitable material, such as for example, stainless steel, ceramics, titanium, carbide or other suitable metal alloys. The surface of the prosthesis can be provided slightly roughened so as to increase bonding of the same with bone and/or one or more surface coatings can be provided thereon, such as for example, hyroxyapitite or plasma spray.
• Thus, it can be seen that in one aspect of the present invention, the two pairs of lumbar disc prosthesis and the two pairs of facet joint prosthesis can be used to form a system designed to allow an arthroplasty to be performed through the posterior route, allowing movement between the vertebral bodies as well as restoring stability between the two vertebral bodies by allowing normal load transmission across the disc, freeing up the neural structures and replacing the facet joints as well.

Claims (56)

1. A lumbar disc prosthesis, said lumbar disc prosthesis including a pair of disc members, a first member of said disc pair having a vertebral endplate contact surface and a recessed portion on an opposing surface thereof, a second member of said disc pair having a vertebral endplate contact surface and a protruding portion on an opposing surface thereof, the protruding portion of the second member engaging in the recessed portion of the first member in use, and wherein the prosthesis includes a further pair of disc members, said further pair of disc members also including first and second members.

2. A prosthesis according toclaim 1 wherein the two pairs of disc member are mirror images of each other.

3. A prosthesis according toclaim 1 wherein the pairs of disc members are inserted via a posterior route into a disc space in the patient.

4. A prosthesis according toclaim 1 wherein each pair of disc members is independently inserted into the disc space in the patient and is located on either side of the dural sac.

5. A prosthesis according toclaim 1 wherein the recessed portion of the first member is substantially curved and the curvature of a medial part of said recessed portion is asymmetrical to the curvature of a lateral part of said recessed portion.

6. A prosthesis according toclaim 5 wherein the lateral part of said recessed portion corresponds to an arc of a circle which has a radius greater than that of an arc of a circle corresponding to the curvature of the medial half of the recessed portion.

7. A prosthesis according toclaim 1 wherein an anterior part of the recessed portion is substantially symmetrical to a posterior part of the recessed portion.

8. A prosthesis according toclaim 1 wherein the recessed and protrusion portions in each disc member pair are asymmetrical.

9. A prosthesis according toclaim 1 wherein the protrusion portion in a disc member pair makes contact with only a part of the recessed portion of said disc member pair.

10. A prosthesis according toclaim 1 wherein the protrusion portion is symmetrical in the medial-lateral plane and the anterior-posterior plane but the curvature in the medial to lateral plane may be different to that in the anterior to posterior plane.

11. A prosthesis according toclaim 1 wherein one or both ends of each prosthesis pair have a narrowing taper towards said end or ends.

12. A prosthesis according toclaim 1 wherein the vertebral endplate contact surfaces at one or both ends of said first and/or second member is provided at an acute angle to the horizontal such that the surfaces slopes towards the ends of the disc member(s).

13. A prosthesis according toclaim 12 wherein the angled surface or surfaces are substantially planar in form.

14. A prosthesis according toclaim 12 wherein with the vertebral endplate contact surfaces provided at an angle at both ends of said first and/or second member, the angle of the surface towards an anterior end is in an opposite direction to the angle of the surface towards a posterior end.

15. A prosthesis according toclaim 14 wherein the anterior end angled surface is substantially smaller in dimensions that the posterior end angled surface.

16. A prosthesis according toclaim 1 wherein the vertebral endplate contact surface of the first and/or second disc members are provided with attachment means thereon to allow attachment of the disc members to an adjacent vertebra in use.

17. A prosthesis according toclaim 16 wherein the attachment means includes one or more apertures thereon for the location of screws or other attachment devices therewith.

18. A prosthesis according toclaim 16 wherein the attachment means are provided adjacent a posterior end of the first and/or second disc members.

19. A prosthesis according toclaim 16 wherein the attachment means includes one or more tapered members protruding outwardly of the vertebral endplate contact surface, the taper of said member narrowing from a posterior end towards an anterior end of the disc member.

20. A prosthesis according toclaim 16 wherein the attachment means are provided towards a medial side of the first and/or second disc members.

21. A prosthesis according toclaim 1 wherein the inner or opposing surfaces of the first and/or second members in a disc pair are divided into at least three sections; a middle section and at least two end sections, the recessed and protruding portions being provided in the middle section of the respective disc members.

22. A prosthesis according toclaim 21 wherein the depth of the first disc member is less adjacent the middle section or recessed portion compared to the two end sections thereof.

23. A prosthesis according toclaim 21 wherein the boundaries of the middle and end sections are arranged in the medial to lateral plane of each disc member.

24. A prosthesis according toclaim 21 wherein the middle section is located substantially centrally of said first and/or second disc members.

25. A prosthesis according toclaim 21 wherein the middle and end sections each comprise at least one third of a disc member surface.

26. A prosthesis according toclaim 21 wherein one or both end sections of the opposing surfaces of the first and/or second disc members are provided at an acute angle to the horizontal.

27. A prosthesis according toclaim 26 wherein the angled surface of one or both end sections of said first and/or second disc members are substantially planar in form.

28. A prosthesis according toclaim 16 wherein the end sections of the opposing surface of said first disc member are mildly concave in form.

29. A prosthesis according toclaim 16 wherein when one of the disc members moves towards an end of the prosthesis in extension or flexion, a gap between the end sections of the disc members increases at an opposite end of the prosthesis.

30. A prosthesis according toclaim 1 wherein the vertebral endplate contact surface and opposing surface of said second disc member form a narrowing taper towards one or both ends of said disc member.

31. A prosthesis according toclaim 1 wherein the vertebral end plate contact surface and opposing surface of said first disc member form a narrowing taper towards one or both ends of said disc member.

32. A prosthesis according toclaim 1 wherein the protrusion portion extends across substantially the whole of the second disc member in the medial to lateral plane.

33. A prosthesis according toclaim 1 wherein the lateral side of the first and/or second disc members has one or more curved sections whereas the medial side of the first and/or second disc members is substantially straight or planar.

34. A prosthesis according toclaim 1 wherein one or more apertures are provided at or adjacent the posterior end of the disc members.

35. A prosthesis according toclaim 1 wherein said prosthesis is used in conjunction with a facet joint prosthesis.

36. A facet joint prosthesis according toclaim 35 wherein a first member is provided for attachment to a first posterior lumbar disc in use and a second member is provided for attachment to a second posterior lumbar disc in use, and wherein at least a part of said first member is telescopically mounted in at least a part of said second member in use.

37. A facet joint prosthesis according toclaim 36 wherein the first and/or second members are provided with or are associated with securing means for securing the members to a disc in use.

38. A facet joint prosthesis according toclaim 37 wherein the securing means includes one or more pedicle screws.

39. A facet joint prosthesis according toclaim 36 wherein the first member includes an elongate arm portion which is movably located in an elongate channel portion on said second member.

40. A facet joint prosthesis according toclaim 39 wherein the arm portion and said channel portion are curved in form.

41. A facet joint prosthesis according toclaim 39 wherein each of said arm portion and said channel portion communicate with a plate portion.

42. A facet joint prosthesis according toclaim 36 wherein a slot is provided longitudinally of said channel portion.

43. A facet joint prosthesis according toclaim 42 wherein said slot is of such a width to allow approximately 30% of the arm portion to be visible therethrough.

44. A facet joint prosthesis according toclaim 36 wherein the arm portion is of slightly smaller dimensions than the interior dimensions of said channel portion, such that a small gap is provided therebetween to allow some movement between said arm portion and said channel portion.

45. A facet joint prosthesis according toclaim 36 wherein with the arm portion located in the channel portion, the arm portion can undergo limited rotation, side ways movement and sliding movement to allow flexion and extension with respect to said channel portion.

46. A facet joint prosthesis according toclaim 36 wherein the end of the arm portion engaging in said channel portion has curved end walls and curved side walls, the curvature of said side walls being less than the curvature of said end walls.

47. A facet joint prosthesis according toclaim 36 wherein the open end of the channel portion in which the arm portion engages has curved end walls and curved side walls, the curvature of said side walls being less than the curvature of said end walls.

48. A facet joint prosthesis according toclaim 35 wherein a pair of facet joint prosthesis are used for each disc.

49. A facet joint prosthesis according toclaim 36 wherein a plurality of first members can be attached to a second member and vice versa to form stacking of said prosthesis.

50. A prosthesis system, said system including a lumbar disc prosthesis and facet joint prosthesis as defined inclaim 1.

51. A first disc member for use with a lumbar disc prosthesis according toclaim 1.

52. A second disc member for use with a lumbar disc prosthesis according toclaim 1.

53. A facet joint prosthesis, said facet joint prosthesis including a first member for attachment to a first posterior lumbar disc in use and a second member for attachment to a second posterior lumbar disc in use, and wherein at least a part of said first member is telescopically mounted in at least a part of said second member in use.

54. A prosthesis system, said system including a lumbar disc prosthesis and facet joint prosthesis as defined inclaim 53.

55. A method of attachment of a lumbar disc prosthesis in a patient, said lumbar disc prosthesis including a pair of disc members, a first member of said disc pair having a vertebral endplate contact surface and a recessed portion on an opposing surface thereof, a second member of said disc pair having a vertebral endplate contact surface and a protruding portion on an opposing surface thereof, the protruding portion of the second member engaging in the recessed portion of the first member in use, the prosthesis including a further pair of disc members, said further pair of disc members also including first and second members, said method including the steps inserting each pair of disc members via a posterior route.

56. A method of attachment of a facet joint prosthesis in a patient, said facet joint prosthesis including a first member and a second member, at least a part of said first member is telescopically mounted in at least a part of said second member in use, said method including attaching a part of said first member to one of an upper or lower vertebrae in use posteriorly and attaching a part of said second member to the other of said upper or lower vertebrae in use posteriorly.

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