US20090043391A1 - Customized Intervertebral Prosthetic Disc with Shock Absorption - Google Patents

Abstract

A prosthesis system comprises plates that can be positioned against vertebrae and a selected resilient core that can be positioned between the plates to allow the plates to articulate. The selected resilient core can be chosen from a plurality of cores in response to patient characteristics, such as age and/or intervertebral mobility, such that the prosthesis implanted in the patient is tailored to the needs of the patient. The plurality of cores may comprise cores with different resiliencies, and one of the cores can be selected such that the upper and lower plates articulate with the desired shock absorbing resiliency and/or maximum angle of inclination when the one selected core is positioned between the plates.

Description

CROSS-REFERENCES TO RELATED APPLICATIONS
• None.
BACKGROUND OF THE INVENTION
• The present invention relates to medical devices and methods. More specifically, the invention relates to intervertebral disc prostheses.
• Back pain takes an enormous toll on the health and productivity of people around the world. According to the American Academy of Orthopedic Surgeons, approximately 80 percent of Americans will experience back pain at some time in their life. In just the year 2000, approximately 26 million visits were made to physicians' offices due to back problems in the United States. On any one day, it is estimated that 5% of the working population in America is disabled by back pain.
• One common cause of back pain is injury, degeneration and/or dysfunction of one or more intervertebral discs. Intervertebral discs are the soft tissue structures located between each of the thirty-three vertebral bones that make up the vertebral (spinal) column. Essentially, the discs allow the vertebrae to move relative to one another. The vertebral column and discs are vital anatomical structures, in that they form a central axis that supports the head and torso, allow for movement of the back, and protect the spinal cord, which passes through the vertebrae in proximity to the discs.
• Discs often become damaged due to wear and tear or acute injury. For example, discs may bulge (herniate), tear, rupture, degenerate or the like. A bulging disc may press against the spinal cord or a nerve exiting the spinal cord, causing “radicular” pain (pain in one or more extremities caused by impingement of a nerve root). Degeneration or other damage to a disc may cause a loss of “disc height,” meaning that the natural space between two vertebrae decreases. Decreased disc height may cause a disc to bulge, facet loads to increase, two vertebrae to rub together in an unnatural way and/or increased pressure on certain parts of the vertebrae and/or nerve roots, thus causing pain. In general, chronic and acute damage to intervertebral discs is a common source of back related pain and loss of mobility.
• When one or more damaged intervertebral discs cause a patient pain and discomfort, surgery is often required. Traditionally, surgical procedures for treating intervertebral discs have involved discectomy (partial or total removal of a disc), with or without fusion of the two vertebrae adjacent to the disc. Fusion of the two vertebrae is achieved by inserting bone graft material between the two vertebrae such that the two vertebrae and the graft material grow together. Oftentimes, pins, rods, screws, cages and/or the like are inserted between the vertebrae to act as support structures to hold the vertebrae and graft material in place while they permanently fuse together. Although fusion often treats the back pain, it reduces the patient's ability to move, because the back cannot bend or twist at the fused area. In addition, fusion increases stresses at adjacent levels of the spine, potentially accelerating degeneration of these discs.
• In an attempt to treat disc related pain without fusion, an alternative approach has been developed, in which a movable, implantable, artificial intervertebral disc (or “disc prosthesis”) is inserted between two vertebrae. A number of different intervertebral disc prostheses are currently being developed. For example, the inventors of the present invention have developed disc prostheses described in U.S. patent application Ser. Nos. 10/855,817 and 10/855,253, previously incorporated by reference. Other examples of intervertebral disc prostheses are the LINK® SB Charité disc (provided by DePuy Spine, Inc.) Mobidisk® (provided by LDR Medical (www.ldrmedical.fr)), the Bryan Cervical Disc (provided by Medtronic Sofamor Danek, Inc.), the ProDisc® or ProDisc-C® (from Synthes Stratec, Inc.), and the PCM disc (provided by Cervitech, Inc.). Although existing disc prostheses provide advantages over traditional treatment methods, improvements are ongoing.
• Work in relation to the present invention suggests that current prosthesis and methodologies may be less than ideal. For example, some disc prostheses may only partially restore patient motion in some patients. Also, some disc prostheses may potentially provide more motion postoperatively than might occur naturally for an individual patient, depending on his or her individual characteristics. For example, older patients may have a smaller range of motion between vertebrae than younger patients, and a prosthesis with an appropriate range of motion for a younger patient may provide an excessive range of motion for an older patient. Younger active patients may place a greater load on a disc prosthesis, and current prostheses may be less than ideal for restoring motion between the vertebrae in a manner that fully accommodates such active patients.
• Therefore, a need exists for improved intervertebral disc prostheses. Ideally, such improved prostheses would avoid at least some of the short comings of the present prostheses.
BRIEF SUMMARY OF THE INVENTION
• Embodiments of the present invention provide customizable intervertebral prostheses systems and methods. The prosthesis system comprises supports that can be positioned against vertebrae and a selected resilient core that can be positioned between the supports to allow the supports to articulate. The resilient core can be selected from a plurality of cores in response to patient characteristics, such as age and/or intervertebral mobility, such that the prosthesis implanted in the patient is tailored to the needs of the patient. The plurality of cores comprise cores with different resiliencies, and one of the cores can be selected such that the upper and lower supports articulate with the desired shock absorbing resiliency and/or maximum angle of inclination when the selected core is positioned between the supports. The shock absorbing core may be compressed during insertion into the intervertebral space to minimize distraction between the vertebrae. The supports can comprise known support plates and may comprise, in some embodiments, in situ expandable supports to minimize the invasiveness of the procedure.
• In a first aspect an intervertebral disc prosthesis system is provided. The system comprises a plurality of selectable cores. Each core comprises upper and lower surfaces and at least one of a resilient material or a resilient member disposed between the upper and lower surfaces to allow the upper and lower surfaces to move resiliently toward and away from each other. The system also comprises upper and lower supports that are locatable about the core. Each support comprises an outer surface which engages a vertebra and an inner surface that is shaped to contact one of the surfaces of each core. Each core of the plurality comprises a different resiliency. The upper and lower supports are adapted to articulate when one of the cores is selected and positioned between the upper and lower supports.
• In many embodiments, each core is identifiable with an indicia, such that each core is selectable in response to the indicia and a patient characteristic. The indicia may comprise at least one of a color of the core, a marking on the core, a height of the core, or a width of the core. In specific embodiments, the indicia of each core corresponds to a resiliency of the core and a maximum angle of inclination between the supports when the core is positioned between the supports.
• In many embodiments, each core of the plurality comprises a different dimension to limit a maximum angle of inclination between the upper and lower supports in response to the patient characteristic. The different dimension may comprise at least one of a height or a width.
• In many embodiments, the upper surface of each core comprises a curved surface to slide against the inner surface of the upper support. In specific embodiments, lower surface of each core may be capable of attachment to the lower support. In some embodiments, the lower surface of each core comprises a curved surface to slide against the inner surface of the lower support.
• In many embodiments, each core comprises an upper component with the upper surface disposed thereon and a lower component with the lower surface disposed thereon. The upper and lower core components of each core can be configured to slide relative to one another in response to loading when positioned between the upper and lower supports, for example loading caused by patient activity. In specific embodiments, the upper and lower components of each core are configured to slide relative to one another with telescopic motion.
• In some embodiments, the upper support comprises a upper plate and the lower support comprises a lower plate.
• In some embodiments, the upper support comprises an upper expandable support and the lower support comprises a lower expandable support.
• In some embodiments, several cores of the plurality comprises the same height and different resiliencies, such that a maximum angle of inclination between the plates is substantially the same for the several cores.
• In many embodiments, the plurality of selectable cores comprises cores with a maximum compression within a range from about ⅓ mm to about 1 mm.
• In another aspect, an intervertebral disc prosthesis system is provided. The intervertebral disc prosthesis system comprises a plurality of selectable cores. Each core comprises upper and lower curved surfaces. At least one of a resilient material or a resilient member is disposed between the upper and lower curved surfaces to allow the upper and lower surfaces to move resiliently toward and away from each other. The system also comprises upper and lower supports that are locatable about the core. Each support comprises an outer surface, which engages a vertebra, and an inner curved surface shaped to slide over one of the curved surfaces of each core. Each core of the plurality comprises a different resiliency. The upper and lower supports are adapted to articulate when one of the cores is selected and positioned between the upper and lower supports.
• In many embodiments, each core is identifiable with an indicia, such that each core is selectable in response to the indicia and a patient characteristic. The indicia may comprise at least one of a color of the core, a marking on the core, a height of the core, or a width of the core. In specific embodiments, the indicia of each core corresponds to a resiliency of the core and a maximum angle of inclination between the supports when the core is positioned between the supports.
• In many embodiments, the at least one resilient material comprises a polymer. The at least one resilient material may comprise a hydrogel. The at least one resilient support member may be disposed within the resilient material and attached to the upper and lower curved surfaces.
• In many embodiments, the at least one resilient support member comprises a plurality of springs.
• In many embodiments, the upper and lower curved surfaces of the core comprise at least one of a polymer, a ceramic and a metal. The metal may comprise at least one of cobalt chrome molybdenum, titanium or stainless steel.
• In another aspect, a method of assembling an intervertebral prosthesis for insertion into a patient is provided. A resilient core is selected from among a plurality of resilient cores. The core is placed between first and second supports. The core is selected in response to a resiliency of the core and a patient characteristic.
• In many embodiments, the selected core is identified with an indicia and selected in response to the indicia and a patient characteristic. The indicia may comprise at least one of a color of the core, a marking on the core, a height of the core, or a width of the core. In specific embodiments, the indicia of each core corresponds to a resiliency of the core and a maximum angle of inclination between the supports when the core is positioned between the supports.
• In many embodiments, the first and second supports articulate when the core is positioned between the supports. The core may comprise first and second components that slide relative to each other when the core is loaded.
• In many embodiments, the core is selected in response to a maximum angle of inclination when the core is positioned between the supports.
• In another aspect, a method of inserting an intervertebral prosthesis into an intervertebral space between vertebrae of a patient is provided. A shock absorbing core is compressed from an expanded profile configuration to a narrow profile configuration when the core is inserted into the intervertebral space. The shock absorbing core can articulate an upper support and a lower support when positioned between the upper support and the lower support.
• In many embodiments, the upper support and the lower support are positioned in the intervertebral space, and the shock absorbing core is inserted between the upper support and the lower support while the upper support and the lower support are positioned in the intervertebral space. In specific embodiments, shock absorbing core locks into place within the upper plate or the lower plate.
• In many embodiments, the core is positioned between the upper support and the lower support when the upper support and the lower support are inserted into the intervertebral space. In specific embodiments, the upper support and the lower support articulate when the upper support and the lower support are inserted into the intervertebral space.
• In some embodiments, the shock absorbing core is compressed with an instrument when the core is inserted into the intervertebral space. The shock absorbing core can be compressed by at least about 0.5 mm when the core is inserted into the intervertebral space.
• In another aspect, an intervertebral disc prosthesis is provided. The prosthesis comprises a resilient core. The core comprises an upper component with an upper surface and a lower component with a lower surface. At least one of a resilient material or a resilient member is disposed between the upper and lower components so as to allow the upper and lower components to move resiliently toward and away from each other. The upper and lower components define an inner chamber of the core. At least one channel extends from the inner chamber to an external surface of the core to allow the passage of fluid through the chamber. The prosthesis also comprises upper and lower supports locatable about the core. Each support comprises an outer surface which engages a vertebra, and an inner surface shaped to contact one of the surfaces of the core. The upper and lower supports are adapted to articulate when the core is positioned between the upper and lower supports.
• In some embodiments, the at least one channel comprises at least two channels that extend from the chamber to the external surface of the core to pass fluid through the core. the at least one channel can be adapted to pump fluid out of the core when the components move toward each other and draw fluid into the core when the components move away from each other.
• In another aspect, an instrument for insertion of a intervertebral disc prosthesis into an intervertebral space is provided. The instrument comprises a distractor tip that comprises a channel dimensioned to pass the prosthesis. The instrument also comprises at least one of a resilient member or a resilient material to compress the prosthesis from an expanded profile configuration to a narrow profile configuration with the distractor tip when the prosthesis slides along the channel toward the intervertebral space.
• In many embodiments, a pair of handles is connected to the distractor tip. The resilient member comprises a spring connected to the handles to drive the handles apart and compress the prosthesis to the narrow profile configuration.
• In another aspect, a system for insertion of an intervertebral disc prosthesis into an intervertebral space is provided. The system comprises a plurality of selectable shock absorbing intervertebral disc prosthesis cores, and an instrument. The instrument comprises a distractor tip with a channel dimensioned to pass the prosthesis. The distractor tip is capable of compressing at least one of the plurality of cores from an expanded profile configuration to a narrow profile configuration when the prosthesis slides along the channel toward the intervertebral space.
• In many embodiments, the expanded profile configuration comprises an unloaded configuration of the at least one of the plurality of cores, and the narrow profile configuration comprises a maximum loaded compression of the at least one of the plurality of cores.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1A is a cross-sectional anterior view of an intervertebral disc prosthesis with the prosthesis plates and selected core in vertical alignment, according to embodiments of the present invention;
• FIG. 1B is a side view of the prosthetic disc inFIG. 1 after sliding movement of the plates over the selected core;
• FIG. 1C is a cross-sectional view a the selected shock absorbing cores shown in detail, according to embodiments of the present invention;
• FIG. 1D shows a plurality of selectable shock absorbing cores with differing heights and differing resiliencies, according to embodiments of the present invention;
• FIG. 1E schematically illustrates a first maximum angle of inclination with the first shock absorbing core ofFIG. 1D positioned between endplates;
• FIG. 1F schematically illustrates a second maximum angle of inclination with the second shock absorbing core ofFIG. 1D positioned between the endplates;
• FIG. 1G schematically illustrates a third maximum angle of inclination with the third shock absorbing core ofFIG. 1D positioned between the endplates;
• FIG. 1H shows a plurality of selectable shock absorbing cores with differing widths and differing resiliencies, according to embodiments of the present invention;
• FIG. 2 is a cross-sectional view a prosthetic disc with a selected core attached to a lower plate, according to embodiments of the present invention;
• FIG. 3 shows an intervertebral prosthesis with an upper plate, a lower plate, and a selected shock absorbing core that locks into the lower plate to provide ball and socket motion, according to embodiments of the present invention;
• FIGS. 4A-4E show a method of inserting a shock absorbing prosthesis, according to embodiments of the present invention;
• FIG. 5 shows a shock absorbing core with channels to allow fluid to move through the core, according to embodiments of the present invention;
• FIGS. 6A to 6D show aplacement instrument600 capable of compressing the core when the implant is inserted into the intervertebral space, according to embodiments of the present invention; and
• FIGS. 7A and 7B schematically illustrate details of the self-expanding intervertebral joint assembly loaded in a cartridge, in accordance with embodiments of the present invention.
DETAILED DESCRIPTION OF THE INVENTION
• Various embodiments of the present invention generally provide for an intervertebral disc prosthesis having upper and lower plates disposed about a selectable core. The selectable core includes a resilient material, which allows the core to absorb forces applied to it by vertebrae. The shock absorbing cores can be used with many prosthesis and approaches to the intervertebral disc space including anterior, lateral, posterior and posterior lateral approaches. Although various embodiments of such a prosthesis are shown in the figures and described further below, the general principles of these embodiments, namely selecting a core with a force absorbing material in response to patient needs, may be applied to any of a number of other disc prostheses, such as but not limited to the LINK® SB Charité disc (provided by DePuy Spine, Inc.) Mobidisk® (provided by LDR Medical (www.ldrmedical.fr)), the Bryan Cervical Disc and Maverick Lumbar Disc (provided by Medtronic Sofamor Danek, Inc.), the ProDisc® or ProDisc-C® (from Synthes Stratec, Inc.), and the PCM disc (provided by Cervitech, Inc.). In some embodiments, the selectable core can be used with an expandable intervertebral prosthesis, as described in U.S. application Ser. No. 11/787,110, entitled “Posterior Spinal Device and Method”, filed Apr. 12, 2007, the full disclosure of which is incorporated herein by reference.
• FIGS. 1A to 1C show aprosthetic disc10 comprising a selected shock absorbing core, according to embodiments of the present invention.Disc10 for intervertebral insertion between two adjacent spinal vertebrae (not shown) suitably includes anupper plate12, alower plate14 and a selectedshock absorbing core16 located between the plates. Theupper plate12 includes anouter surface18 and aninner surface24 and may be constructed from any suitable metal, alloy or combination of metals or alloys, such as but not limited to cobalt chrome molybdenum, titanium (such as grade 5 titanium), stainless steel and/or the like. In one embodiment, typically used in the lumbar spine, theupper plate12 is constructed of cobalt chrome molybdenum, and theouter surface18 is treated with aluminum oxide blasting followed by a titanium plasma spray. In another embodiment, typically used in the cervical spine, theupper plate12 is constructed of titanium, theinner surface24 is coated with titanium nitride, and theouter surface18 is treated with aluminum oxide blasting. An alternative cervical spine embodiment includes no coating on theinner surface24. In other cervical and lumbar disc embodiments, any other suitable metals or combinations of metals may be used. In some embodiments, it may be useful to couple two materials together to form theinner surface24 and theouter surface18. For example, theupper plate12 may be made of an MRI-compatible material, such as titanium, but may include a harder material, such as cobalt chrome molybdenum, for theinner surface24. In another embodiment, upper plated12 may comprise a metal, andinner surface24 may comprise a ceramic material. All combinations of materials are contemplated within the scope of the present invention. Any suitable technique may be used to couple materials together, such as snap fitting, slip fitting, lamination, interference fitting, use of adhesives, welding and/or the like. Any other suitable combination of materials and coatings may be employed in various embodiments of the invention.
• In some embodiments, theouter surface18 is planar. Oftentimes, theouter surface18 will include one or more surface features and/or materials to enhance attachment of theprosthesis10 to vertebral bone. For example, theouter surface18 may be machined to haveserrations20 or other surface features for promoting adhesion of theupper plate12 to a vertebra. In the embodiment shown, theserrations20 extend in mutually orthogonal directions, but other geometries would also be useful. Additionally, theouter surface18 may be provided with a rough microfinish formed by blasting with aluminum oxide microparticles or the like. In some embodiments, the outer surface may also be titanium plasma sprayed to further enhance attachment of theouter surface18 to vertebral bone.
• Theouter surface18 may also carry an upstanding,vertical fin22 extending in an anterior-posterior direction. Thefin22 is pierced bytransverse holes23. In alternative embodiments, thefin22 may be rotated away from the anterior-posterior axis, such as in a lateral-lateral orientation, a posterolateral-anterolateral orientation, or the like. In some embodiments, thefin22 may extend from thesurface18 at an angle other than 90°. Furthermore,multiple fins22 may be attached to thesurface18 and/or thefin22 may have any other suitable configuration, in various embodiments. In some embodiments, such asdiscs10 for cervical insertion, thefins22,42 may be omitted altogether.
• The inner, spherically curvedconcave surface24 is formed at a central (from right to left), axial position with acircular recess26 as illustrated. At the outer edge of thecurved surface24, theupper plate12 carries peripheral restraining structure comprising anintegral ring structure26 including an inwardly directed rib orflange28. Theflange28 forms part of aU-shaped member30 joined to the major part of the plate by anannular web32. Theflange28 has an inwardly tapering shape and defines upper andlower surfaces34 and36 respectively which are inclined slightly relative to the horizontal when theupper plate12 is at the orientation seen inFIG. 1. Anoverhang38 of theU-shaped member30 has a vertical dimension that tapers inwardly as illustrated.
• Thelower plate14 is similar to theupper plate12 except for the absence of theperipheral restraining structure26. Thus, thelower plate14 has anouter surface40 which is planar, serrated and microfinished like theouter surface18 of theupper plate12. Thelower plate14 optionally carries afin42 similar to thefin22 of the upper plate. Theinner surface44 of thelower plate14 is concavely, spherically curved with a radius of curvature matching that of theinner surface24 of theupper plate12. Once again, this surface may be provided with a titanium nitride or other finish.
• At the outer edge of the innercurved surface44, thelower plate14 is provided with aninclined ledge formation46. Alternatively, thelower plate14 may include peripheral restraining structure analogous to theperipheral restraining structure26 on theupper plate12.
• The selectedshock absorbing core16 is symmetrical about a central,equatorial plane52 which bisects it laterally. (Although in other embodiments, the selectedshock absorbing core16 may be asymmetrical.) Lying on this equatorial plane is an annular recess or groove54 which extends about the periphery of the selected shock absorbing core. Thegroove54 is defined between upper and lower ribs orlips56. When theplates12,14 and selectedshock absorbing core16 are assembled and in the orientation seen inFIG. 1, theflange28 lies on the equatorial plane and directly aligned with thegroove54. Theouter diameter58 of thelips56 is preferably very slightly larger than thediameter60 defined by the inner edge of theflange28. In some embodiments, the selectedshock absorbing core16 is movably fitted into theupper plate12 via an interference fit. To form such an interference fit with a metal component of selectedcore16 andmetal plate12, any suitable techniques may be used. For example, theplate12 may be heated so that it expands, and the component of selectedcore16 may be dropped into theplate12 in the expanded state. When theplate12 cools and contracts, the interference fit is created. In another embodiment, theupper plate12 may be formed around the component of selectedshock absorbing core16. Alternatively, the selectedshock absorbing core16 andupper plate12 may include complementary threads, which allow the selectedshock absorbing core16 to be screwed into theupper plate12, where it can then freely move.
• The central axis of the disc10 (the axis passing through the centers of curvature of the curved surfaces) is indicated with thereference numeral62. As shown inFIG. 1, thedisc10 may be symmetrical about a central anterior-posterior plane containing theaxis62. In some embodiments theaxis62 is posteriorly disposed, i.e. is located closer to the posterior limit of the disc than the anterior limit thereof.
• In use, thedisc10 is surgically implanted between adjacent spinal vertebrae in place of a damaged disc. The adjacent vertebrae are forcibly separated from one another to provide the necessary space for insertion. Thedisc10 is typically, though not necessarily, advanced toward the disc space from an anterolateral or anterior approach and is inserted in a posterior direction—i.e., from anterior to posterior. The disc is inserted into place between the vertebrae with thefins22,42 of theplates12,14 entering slots cut in the opposing vertebral surfaces to receive them. During and/or after insertion, the vertebrae, facets, adjacent ligaments and soft tissues are allowed to move together to hold the disc in place. The serrated andmicrofinished surfaces18,40 of theplates12,14 locate against the opposing vertebrae. Theserrations20 andfins22,42 provide initial stability and fixation for thedisc10. With passage of time, enhanced by the titanium surface coating, firm connection between the plates and the vertebrae will be achieved as bone tissue grows over the serrated surface. Bone tissue growth will also take place about thefins22,40 and through thetransverse holes23 therein, further enhancing the connection which is achieved.
• In the assembleddisc10, the complementary and cooperating spherical surfaces of the plates and selected shock absorbing core allow the plates to slide or articulate over the selected core through a fairly large range of angles and in all directions or degrees of freedom, including rotation about thecentral axis62.FIG. 1A shows thedisc10 with theplates12 and14 and selectedshock absorbing core16 aligned vertically with one another on theaxis62.FIG. 1B illustrates a situation where maximum anterior flexion of thedisc10 has taken place. At this position, theupper rib56 has entered the hollow38 of theU-shaped member30, the lower surface of therib56 has moved into contact with theupper surface34 of theflange28, the flange having moved into thegroove54, and thelower surface36 of the flange has moved into contact with the upper surface of theledge formation46, as will be seen in the encircledareas69. Abutment between the various surfaces prevents further anterior flexure. The design also allows for the inner extremity of theflange28 to abut against the base of thegroove54, thereby limiting further relative movement between the selected core and plate. A similar configuration is achieved in the event of maximum posterior flexure of theplates12,14 over the selected shock absorbing core, such as during spinal extension and/or in the event of maximum lateral flexure.
• Theflange28 and thegroove54 defined between theribs56, prevent separation of the selected core from the plates. In other words, the cooperation of the retaining formations ensures that the selected shock absorbing core is held captive between the plates at all times during flexure of thedisc10.
• In an alternative embodiment, the continuousannular flange28 may be replaced by a retaining formation comprising a number of flange segments which are spaced apart circumferentially. Such an embodiment could include a single,continuous groove54 as in the illustrated embodiment. Alternatively, a corresponding number of groove-like recesses spaced apart around the periphery of the selected core could be used, with each flange segment opposing one of the recesses. In another embodiment, the continuous flange or the plurality of flange segments could be replaced by inwardly directed pegs or pins carried by theupper plate12. This embodiment could include a single,continuous groove54 or a series of circumferentially spaced recesses with each pin or peg opposing a recess.
• In yet another embodiment, the retaining formation(s) can be carried by thelower plate14 instead of the upper plate, i.e. the plates are reversed. In some embodiments, the upper (or lower) plate is formed with an inwardly facing groove, or circumferentially spaced groove segments, at the edge of its inner, curved surface, and the outer periphery of the selected core is formed with an outwardly facing flange or with circumferentially spaced flange segments.
• Referring now toFIG. 1C, a cross-sectional view of a selectedshock absorbing core16 is shown in detail.Core16 comprises anupper component70 and alower component72.Upper component70 andlower component72 define achamber71. Aresilient material74 can be positioned betweenupper component70 andlower component72 withinchamber71.Resilient material74 may extend between from one component to the other to component, such thatupper component70 is supported with the resilient material.Resilient material74 may comprise many known resilient materials, for example an elastomer such as siloxane. At least one resilient member can be positioned betweenupper component70 andlower component72. The at least one resilient member may comprise many known resilient members, for example aspring76A, aspring76B and aspring76C. In some embodiments,resilient member74 is positioned between the upper and lower components to provide shock absorption without the springs. In some embodiments, the at least one resilient member is positioned between the upper and lower components without the resilient material. The resilient materials and at least one resilient member may comprise resilient materials and members as described in U.S. application Ser. No. 11/051,513, entitled “Intervertebral Prosthetic Disc with Shock Absorption”, filed on Feb. 4, 2005, the full disclosure of which is incorporated herein by reference.
• Upper component70 andlower component72 are configured to slide relative to one another.Upper component70 comprises an upper slide structure, for example an innerannular sleeve82.Lower component72 comprises a lower slide structure, for example an outerannular sleeve84. The upper slide structure mates with the lower slide structure, such that the two slide structures permit the upper component to slide relative to the lower component, for example with atelescopic slide mechanism80.
• In some embodiments, the sequential motion of the core parts relative to each other can change thevolume chamber71 so as to provide an inflow and outflow of bodily fluids between the sliding members of the core, such that the fluid flow provides and facilitates lubrication of the sliding members with bodily fluids.
• When implanted between vertebrae, at least one ofresilient material74 or the at least one resilient member can resiliently absorb shocks transmitted vertically between upper and lower vertebrae of the patient's spinal column. This shock absorption is related to the material properties and dimensions of the resilient material and resilient members, for example Young's modulus of elasticity. In general, an increased thickness of the resilient material and/or members will increase absorbance of shocks, with more elastic, or springy compression between the vertebrae. In some embodiments, the resilient material may comprise a damping material and/or damping characteristics to improve shock absorption. For example, many resilient materials as described herein also comprise damping materials.
• Selectedshock absorbing core16 comprises aheight78 and awidth58 that can be related to the shock absorbing characteristics of the core and/or prosthesis. In many embodiments, the core can absorb shocks to the vertebrae with compression alongheight78, such thatheight78 can decrease with compression of the core due to forces along the spine. As the thickness of the prosthesis is related to the height of the core, in some embodiments the height of the prosthesis will change with the core, for example decrease when the core is compressed. In many embodiments, the height of the prosthesis corresponds to a distance between serrated andmicrofinished surfaces18,40 of theplates12,14 that locate against the opposing vertebrae. In some embodiments, an increase ofheight78 can increase shock absorption and resiliency of the core, for example with increased thickness of the shock absorbing materials and/or increased length of the resilient members, for example the resilient members such as compressible resilient springs. In some embodiments,width58 of the selected core may also affect properties of the endplates.
• Referring now toFIG. 1D, aplurality100 of selectable shock absorbing cores is shown with differing heights and differing resiliencies, according to embodiments of the present invention.Plurality100 comprises afirst core110A, asecond core110B and athird core110C.
• First core110A comprises anupper component116A and alower component118A. Aresilient material112A is disposed betweenupper component116A andlower component118A. At least oneresilient member114A extends betweenupper component116A andlower component118A.First core110A comprises afirst height122A.Resilient material112A comprises a thickness124A that corresponds to a length of at least oneresilient member114A. The resilience and shock absorption offirst core110A corresponds to thickness124A, such that the resilience and shock absorption increase with increasing of thickness of124A.First core110A comprises an indicia, for example amarking120A on the lower component to identify the first core, such thatfirst core110A can be identified and selected from amongplurality100.
• Second core110B comprises anupper component116B and alower component118B. Aresilient material112B is disposed betweenupper component116B andlower component118B. At least oneresilient member114B extends betweenupper component116B andlower component118B.Second core110B comprises asecond height122B.Resilient material112B comprises athickness124B that corresponds to a length of at least oneresilient member114B. The resilience and shock absorption ofsecond core110B corresponds tothickness124B, such that the resilience and shock absorption increase with increasing of thickness of124B.Second core110B comprises an indicia, for example a marking120B on the lower component to identify the second core, such thatsecond core110B can be identified and selected from amongplurality100.
• Third core110C comprises anupper component116C and alower component118C. Aresilient material112C is disposed betweenupper component116C andlower component118C. At least oneresilient member114C extends betweenupper component116C andlower component118C.Third core110C comprises athird height122C.Resilient material112C comprises athickness124C that corresponds to a length of at least oneresilient member114C. The resilience and shock absorption ofthird core110C corresponds tothickness124C, such that the resilience and shock absorption increase with increasing thickness of124C.Third core110C comprises an indicia, for example a marking120C on the lower component to identify the third core, such thatthird core110C can be identified and selected from amongplurality100.
• In many embodiments, some characteristicsfirst core110A,second core110B andthird core110C are substantially the same, such that the cores are interchangeable. For example, a radius of curvature of the upper component of each core may be substantially the same, such that the plates articulate without point contact between the upper curve surface of the upper components.Resilient material112A,resilient material112B andresilient material112C may comprise the substantially the same resilient material, for example an elastomer. In some embodiments, the curved surfaces of the lower components of each core may be substantially the same such that the selected core can slide over the bottom endplate.
• In many embodiments, the cores may comprise predetermined characteristics that can be identified by the markings. For example,third core110C may comprise the most resilient core of the plurality with the most shock absorption, whilefirst core110A may comprise the least resilient core of the plurality with the least shock absorption. Also,third core110C may comprise the core which provides the largest maximum angle of inclination between the plates of the plurality, whilefirst core110A may comprise core which provides the smallest angle of inclination between the plates.
• In many embodiments, each core of the plurality of core comprises an intended maximum compression under normal patient activity. In some embodiments,first core110A comprises a maximum compression of ⅓ mm alongfirst height122A with normal patient activity;second core110B comprises a maximum compression of ⅔ mm alongsecond height122B with normal patient activity; andthird core110C comprises a maximum compression of 1 mm alongthird height122C with normal patient activity. In some embodiments, the maximum compression can be limited with stops, for example maximum travel ofinner sleeve82 relative toouter sleeve84 such thatinner sleeve82 onupper component70 contactslower core component72 to limit compression. In some embodiments, the plurality of cores may comprise a substantially incompressible core, for example a core made entirely of metal, such as cobalt chrome. In such embodiments, the range of compression provided by the plurality of cores can be from about 0 mm to about 1 mm. A core with maximum compression of substantially zero may comprises a core made entirely from metal, for example cobalt chrome.
• FIG. 1E schematically illustrates a first maximum angle ofinclination108A with the first shock absorbing core ofFIG. 1D positioned between anupper endplate102 and alower endplate104. Firstshock absorbing core110A comprisesfirst thickness122A. At maximum angle ofinclination108A,upper plate102 contactslower plate104 at acontact locus106, for example contact formations as described above. Maximum angle ofinclination108A is determined bythickness122A.
• FIG. 1F schematically illustrates a second maximum angle ofinclination108B with the second shock absorbing core ofFIG. 1D positioned betweenupper endplate102 andlower endplate104. Secondshock absorbing core110B comprisessecond thickness122B. At maximum angle ofinclination108B,upper plate102 contactslower plate104 atcontact locus106, for example contact formations as described above. Maximum angle ofinclination108B is determined bythickness122B.
• FIG. 1G schematically illustrates a third maximum angle ofinclination108C with the third shock absorbing core ofFIG. 1D positioned betweenupper endplate102 andlower endplate104. Thirdshock absorbing core110C comprisesthird thickness122C. At maximum angle ofinclination108C,upper plate102 contactslower plate104 atcontact locus106, for example contact formations as described above. Maximum angle ofinclination108C is determined bythickness122C.
• In some embodiments, the plurality of cores may comprise a constant height among the cores such that the maximum angle of inclination remains constant, while the shock absorption varies. In such embodiments, the thickness of the resilient material and/or thickness of the at least one resilient member differ among the cores of the plurality, while thicknesses of the upper and lower components differ so as to compensate for the different thicknesses of the resilient material and/or thickness of the at least one resilient member. Thus, the thicknesses of the cores among the plurality remain constant.
• Referring nowFIG. 1H a plurality140 of selectable shock absorbing cores of constant height is shown with differing widths and differing resiliencies. Plurality140 comprises afirst core150A, asecond core150B and athird core150C.
• First core150A comprises anupper component156A and alower component158A. Aresilient material152A is disposed betweenupper component156A andlower component158A. At least oneresilient member154A extends betweenupper component156A andlower component158A.First core150A comprises afirst height162A and a first dimension across166A, for example a diameter.Resilient material152A comprises athickness164A that corresponds to a length of at least oneresilient member154A. The resilience and shock absorption offirst core160A corresponds tothickness164A, such that the resilience and shock absorption increase with increasing ofthickness164A.First core150A comprises an indicia, for example amarking160A on the lower component to identify the first core, such thatfirst core150A can be identified and selected from among plurality140.
• Second core150B comprises anupper component156B and alower component158B. Aresilient material152B is disposed betweenupper component156B andlower component158B. At least oneresilient member154B extends betweenupper component156B andlower component158B.Second core150B comprises asecond height162B and a second dimension across166B, for example a diameter.Resilient material152B comprises athickness164B that corresponds to a length of at least oneresilient member154B. The resilience and shock absorption ofsecond core160B corresponds tothickness164B, such that the resilience and shock absorption increase with increasing ofthickness164B.Second core150B comprises an indicia, for example a marking160B on the lower component to identify the second core, such thatsecond core150B can be identified and selected from among plurality140.
• Third core150C comprises anupper component156C and alower component158C. Aresilient material152C is disposed betweenupper component156C andlower component158C. At least oneresilient member154C extends betweenupper component156C andlower component158C.Third core150C comprises athird height162C and a third dimension across166C, for example a diameter.Resilient material152C comprises a thickness164C that corresponds to a length of at least oneresilient member154C. The resilience and shock absorption ofthird core160C corresponds to thickness164C, such that the resilience and shock absorption increase with increasing of thickness164C.Third core150C comprises an indicia, for example a marking160C on the lower component to identify the second core, such thatthird core150C can be identified and selected from among plurality140.
• The height of several cores of the plurality is substantially the same, such that the maximum angle of inclination between the plates is substantially the same for each of the several cores. In some embodiments,first height162A,second height162B andthird height162C are substantially the same, such that the maximum angle of inclination of the plates is substantially the same.
• The each core of the plurality can be identified in many ways. In some embodiments, the core may comprise an indicia that comprises at least one of a color of the core, a marking on the core, a height of the core or a width of the core. The indicia may be located on the upper component of the core, or the lower component of the core.
• The resilient material may comprise many known materials and may comprise at least one resilient material. In some embodiments, the at least one resilient material comprises a polymer. The at least one resilient material may comprise a hydrogel. The at least one resilient support member may be disposed within the resilient material and attached to the upper and lower components comprising the upper and lower curved surfaces.
• In many embodiments, the upper and lower components and the curved surfaces formed thereon comprise at least one a polymer, a ceramic or a metal. The metal can comprise at least one of cobalt chrome molybdenum, titanium or stainless steel.
• Referring nowFIG. 2, a cross-sectional view is shown of aprosthetic disc200 with a selectedshock absorbing core230 attached to alower plate220. Selected shock absorbing core can be selected from a plurality of cores, for example as described above.Prosthetic disc200 comprises anupper plate210. Selectedshock absorbing core230 is positioned between the upper plate and the lower plate. Selectedshock absorbing core230 comprises alower component232 and anupper component234.Core230 comprises a resilient material betweenupper component234 andlower component232. At least one resilient member, for example coils238 is shown betweenupper component234 andlower component232.Lower component232 comprises alower slide structure233, for example an annular inner sleeve.Upper component234 comprises an upper slide structure, for example an outerannular sleeve235. The upper and slide structures comprise a sliding structure, for example a sliding telescopic joint, such that the selected core and resiliently absorb shocks to the prosthesis when positioned in the intervertebral space.
• Lower plate220 can be attached to selectedshock absorbing core230 in many known ways. For example, the selected shock absorbing core can be attached to lower plate by locking the selected core into the lower plate with a detent.Lower plate220 comprisesthreads222 to attach the selected shock absorbing core to the lower plate, for example in the operating room before the prosthesis is inserted into the intervertebral space.
• In some embodiments, the shock absorbing core can be inserted between the intervertebral plates after the plates have been inverted into the intervertebral space, as described in U.S. Pat. No. 6,936,071, the full disclosure of which is incorporated herein by reference. The core can be compressed to a low profile configuration when the core is inserted between the plates to minimize distraction of the vertebrae when the core is inserted between the plates. Once the core is locked into position, the core can provide two piece ball and socket motion and shock absorption.
• Shock absorbing core230 comprises and an upper curvedspherical surface235.Upper plate210 comprises a lower curvedspherical surface212. Upper curvedspherical surface235 and lower curvedspherical surface212 each comprises a radius of curvature. The radius of curvature of the upper curvedspherical surface235 and lower curvedspherical surface212 are substantially the same, such that the upper and lower curved surfaces form a ball and socket joint, as described in U.S. Pat. No. 6,740,118, the full disclosure of which is incorporated by reference. In some embodiments, the selected shock absorbing core comprises and indicia to identify the core, for example a letter etched in upper curvedspherical surface235.
• FIG. 3 shows anintervertebral prosthesis300 with anupper plate310, alower plate320, and a selectedshock absorbing core330 that locks into the lower plate to provide ball and socket motion. Selectedshock absorbing core330 comprises a core selected from a plurality of shock absorbing cores as described above.Upper plate310 comprises achannel312 and achannel314, for example as described in U.S. Pat. No. 6,936,071, the full disclosure of which is incorporated by reference.Lower plate320 comprises achannel322 sized to receivecore330.Lower plate320 comprises achannel324, and anindentation326.Lower plate320 may comprise a second channel similar tochannel324 that is disposed on the lower plate equidistant from the middling of the lower plate and opposite the midline. Selectedshock absorbing core330 comprises aflange334 and adetent332.
• Theupper plate310 andlower plate320 are sized to nest together when inserted into the intervertebral space, as indicated bylines340. Once the upper and lower plates are positioned together in the intervertebral space, selectedshock absorbing core330 can be slid betweenupper plate310 andlower plate320 as indicated bylines350.Channel322 receives the selected shock absorbing core andflange334. When the selected shock absorbing core is positioned in the lower plate,detent332 extends intoindentation326 so as to lock the selected shock absorbing core into position inlower plate320.
• Channel312,channel314 andchannel324 are sized to receive prongs of an insertion tool, for example as describe in U.S. Pat. No. 5,314,477, the full disclosure of which is incorporated herein by reference. In some embodiments, the channels on the upper and lower plate receive an instrument that presses the upper and lower plates together so as to compresscore330 and minimize distraction when the core is inserted between the upper and lower plates while the plates are position in the intervertebral space.
• Referring now toFIGS. 4A-4E a method is shown for inserting anintervertebral disc prosthesis404 comprising a selected shock absorbingshock absorbing core412, according to embodiments of the present invention.Prosthesis402 is inserted into an intervertebral space IS between two adjacent vertebrae V with a resilient shock absorbing core that can compress during insertion into the disc space so as to minimize distraction. The method involves selecting a shock absorbing core, as described above, and inserting thedisc prosthesis404 partway into the space IS while theprosthesis404 is constrained (FIG. 4A), for example as described in U.S. application Ser. No. 10/913,780, entitled “Methods and Apparatus for Invertebral Disc Prosthesis Insertion”, the full disclosure of which is incorporated herein by reference. To insert theprosthesis404 partway under constraint, aninsertion device402 may be used. Such aninsertion device402 may suitably include a graspingmember410 coupled with anelongate shaft408. At an end opposite the grasping member410 (not shown), theinsertion device402 may include a handle, an actuator to control the graspingmember410 and/or any other suitable features.
• Theprosthesis404 may be inserted as far into the intervertebral space IS under constraint as is desired. In some embodiments, for example, theprosthesis404 is inserted under constraint approximately one-third of the way into the space IS. In other embodiments, theprosthesis404 may be inserted less than one-third of the way, closer to one-half of the way, or any other suitable distance into the space IS.
• As shown inFIG. 4B, once theprosthesis404 is inserted partway under constraint, theinsertion device402 may be removed, thus releasing theprosthesis404 from constraint. From this point forward, theendplates406 of theprosthesis404 are free to move about the prosthesisshock absorbing core412. Examples of such aprosthesis404 withendplates406 and selectedshock absorbing core412 are described above.
• Referring now toFIGS. 4C-4E, in some embodiments theinsertion device402 may be used to push theunconstrained prosthesis404 farther into the intervertebral space. In some embodiments, one or more separate pusher devices may be used in addition to or instead of theinsertion device402 for pushing theprosthesis104 farther into the space IS.FIGS. 4C and 4D show that the graspingmember410 of theinsertion device402 can be adapted to push individually against the upper (FIG. 4C) and lower (FIG. 4D)endplates406. As shown inFIG. 4E, the graspingmember410 may also be adapted to push simultaneously against the upper andlower endplates406, thus pushing theprosthesis404 as a unit farther into the intervertebral space IS.
• By inserting theprosthesis404 farther into the space IS while it is unconstrained and compressing the shock absorbing core, thus allowing theendplates406 to articulate about theshock absorbing core412 and come closer together, the method reduces the need for increasing the height of the intervertebral space IS with distraction of the vertebrae V away from each other. Because theendplates406 are free to articulate and can compress the shock absorbing core416 to move the plates together, theprosthesis404 is better able to conform to the intervertebral space IS, thus reducing trauma to the vertebrae V and also limiting trauma to surrounding structures caused by over-distraction.
• Theunconstrained prosthesis404 may be inserted as far into the intervertebral space IS as is desired. In some embodiments, for example, theprosthesis404 is pushed far enough into the space IS so that a center of rotation of theprosthesis404 is closer to a posterior edge P (FIG. 4E) of the vertebrae V than to an anterior edge A of the vertebrae V. In alternative embodiments, any other suitable insertion distance or depth may be used. Once a desired amount of insertion is achieved, theinsertion device402 is removed and theprosthesis404 is in place between the two adjacent vertebrae V.
• In various embodiments, the method just described may include fewer steps or additional steps. For example, in one embodiment, a spreader device is inserted between the two vertebrae V to spread them apart before inserting theconstrained prosthesis404. An example of such a spacing device is described in PCT Patent Application No. 2004/000171, the full disclosure of which is incorporated by reference. In such embodiments, theinsertion device402 can be sized to fit between opposing jaws of the spreader device, such that the jaws can compress the shock absorbing core so as to minimize distraction. When theprosthesis404 is partially inserted, the spreader device is removed from the intervertebral space IS, and theprosthesis404 is released from constraint and inserted the rest of the way into the space IS. Also in some embodiments, a midline indicator device may be used to facilitate the location of a midline on one or both of the two adjacent vertebrae V. An example of such a midline indicator device is described in PCT Patent Application No. 2004/000170, the full disclosure of which is incorporated herein by reference. In some embodiments, the midline indicator can be used before thedisc prosthesis404 is inserted. These and other steps or features may be included in various embodiments of the method without departing from the scope of the invention.
• FIG. 5 shows ashock absorbing core500 with channels to allow fluid to move through the core, according to embodiments of the present invention. Many components ofcore500 are similar tocore16 shown above.Core500 comprises achannel510, achannel512, achannel514 and achannel516. Anupper component570 andlower component572 ofcore500 define achamber502.Resilient material574 andresilient member76A,resilient member76B andresilient member76C can be disposed between the upper and lower components withinchamber502.Resilient material574 may comprise anupper channel520 and alower channel522 to permit drainage fromresilient material574 and/or the chamber. In many, embodiments,core500 compriseschannel510,channel512,channel514 andchannel516 withoutresilient material574.Channel510,channel512,channel514 andchannel516 extend fromchamber502 to an external surface ofcore500 to permit fluid to drain from the core and/or pass through the core.
• The channels in the upper and lower components and resilient material incore500 permit fluid to pass through the core while the patient is stationary and can pump fluid through the core during patient activity. Work in relation to embodiments of the present invention suggests that static accumulation of bodily fluids in the core may occur. By passing fluid through the core, bacteria build up due to static enclosed fluids may be avoided. Whenupper component570 moves toward lower component572 a volume ofchamber502 decreases so as to drive fluid, for example bodily fluid fromchamber502. When theupper component520 moves away fromlower component572, the volume ofchamber502 increases so as to draw fluid into the chamber. As an active person will resiliently compress and expandcore500 with activity,core500 can pump fluid in and out of the core by moving the upper and lower components toward and away from each other with patient movement. In many embodiments, the channels are large enough to enable fluid flow, and small enough to inhibit tissue in growth that may compromise the shock absorbing motion of the core. The number of channels in the upper and lower components and/or resilient material can be selected so as to enable fluid flow and not weaken the core structures.
• FIGS. 6A to 6D show aplacement instrument600 capable of compressing the core when the implant is inserted into the intervertebral space, according to embodiments of the present invention. The placement instrument can be inserted posteriorly through the canal and/or foramen so as to engage the boney endplates near the disc space, as described in U.S. application Ser. No. 11/787,110, entitled “Posterior Spinal Device and Method”, filed Apr. 12, 2007, the full disclosure of which has previously been incorporated herein by reference. In many embodiments, the placement instrument is inserted after two minimally invasive Wiltse incisions and/or dissections and a discectomy that uses a posterior parallel distractor.Placement instrument600 comprises a distractor with adistractor tip630 that can be inserted at least partially into the intervertebral space.Instrument600 comprises a stop to limit penetration ofdistractor tip630.Instrument600 compriseshandles610 to distract the adjacent vertebrae.Instrument600 comprises ahinge620 that opensdistractor tip630 upon inward motion ofhandles610.
• Instrument600 comprises acompression spring615 that presses handles610 apart, so as to oppose inward motion of the handles. By forcinghandles610 apart,compression spring615 can closedistractor tip630 so as to compress the core to a narrow profile configuration.
• Instrument600 is adapted to pass the prostheses in an elongate narrow profile configuration into the intervertebral space.Distractor tip630 comprises achannel640 withgrooves642 formed therein.Channel640 is dimensioned to pass the prosthesis in an elongate narrow profile configuration.Grooves642 are dimensioned and spaced to receive anchors on the external surfaces of the support components, for example pyramidal components as described above. In some embodiments, the anchors may comprise elongate pyramidal anchors and or elongate keels or flanges and the grooves adapted to pass the elongate anchors with the groove aligned with the elongate anchor. In many embodiments,channel640 is sized to distract the vertebrae withdistractor tip630 while the elongate prosthesis slides downchannel640. Nearhinge620,channel640 can be sized to pass the prosthesis with a sliding fit.
• Instrument600 comprises aninsertion tool650 to advance the prosthesis alongchannel640 so as to advance the prosthesis into the intervertebral space.Insertion tool650 comprises ashaft654 and ahandle652. Handle652 is connected toshaft654. In many embodiments handle652 comprises a grub screw, and handle652 andshaft654 comprise strong materials such that handle652 can be hammered so as to drive the prosthesis distally into the intervertebral space and distract the vertebrae with separation ofdistal tip630. Compression spring1651 can expand to forcehandles610 open andclose distractor tip630 so as to press the upper and lower supports of the prosthesis together and compress the selected shock absorbing core. This compression of the shock absorbing core can reduce the height of the prosthesis and reduce distraction of the intervertebral space and/or surrounding tissues when the implant is inserted into the intervertebral space.
• The selectable shock absorbing cores and insertion tool may comprise a system for narrow profile insertion of the prosthesis into the intervertebral space so as to minimize distraction. The compression spring can compress the shock absorbing prosthesis to a narrow profile configuration. Although a compression spring is shown, many springs and/or resilient members and/or materials can be used to compress the prosthesis to a narrow profile configuration, for example resilient materials and members similar to those used in the core as described above. In many embodiments, the selected core provides maximum compression within a range from about ⅓ mm to about 1 mm during patient activity, and the narrow profile configuration of the core comprises a maximum compression of the core, for example ⅓ mm, ⅔ mm or 1 mm, depending on the core as described above. In many embodiments, an expanded configuration of the core comprises an unloaded configuration of the core. In many embodiments, the resilient member and/or material is connected to the distractor tips so as to compress the selected shock absorbing prosthesis and/or core to the narrow profile configuration, for example with maximum compression of the core as described above, when the core is positioned in the channel for insertion into the patient.
• FIGS. 7A and 7B schematically illustrate a selectable shock absorbing core and details of a self-expanding intervertebral joint assembly loaded in a cartridge as described in U.S. application Ser. No. 11/787,110, entitled “Posterior Spinal Device and Method”, filed Apr. 12, 2007, the full disclosure of which has previously been incorporated herein by reference. A system comprising shock absorbing cores, as described above, can be provided to the physician. The physician can select the core from among a plurality of cores as described above.
• Outer cartridge casing820 extends over at least a portion of intervertebral joint assembly to permit advancement of the joint assembly into at least a portion of the intervertebral space while the joint assembly is substantially covered withouter cartridge casing820.Outer cartridge casing820 coverspyramidal anchors712 andpyramidal anchors714.Distal component720 ofupper support702 anddistal component730 oflower support704 are located near an opening inouter cartridge casing820.Inner cartridge part830 includes awedge832,upper flange836 andlower flange838. The upper and lower flanges include inner opposing surfaces, and the inner surface of each flange opposes one of the wedge surfaces to clamp the components of the upper and lower supports in a parallel configuration.Inner cartridge part830 is connected toshaft840.
• Self expanding intervertebral joint assembly700 includes structures to permit articulation betweenupper support702 andlower support704 to restore motion between the vertebrae.Upper support702 has a protrudingstructure725 which extends frommiddle component724 and has a concave surface feature formed therein, as shown herein above, which mates the upper surface of shock absorbingbiconvex core706.Lower support704 has a protrudingstructure735 which extends frommiddle component734 and has a concave surface feature formed therein, which mates the lower surface of shock absorbingbiconvex core706. In an alternate embodiment, the features of the upper and lower support are in direct contact and mate to provide articulation. For example, the upper support can have a protrusion with a convex surface, and the lower support can have a protrusion with a concave surface, in which the two surfaces mate to form a load bearing articulate joint.
• Protruding structure725 and protrudingstructure726 can also include structures to retain the shock absorbing biconvex core and upper and lower retention ring gears, respectively. In many embodiments, shock absorbing core607 comprises anannular channel707 around the periphery of the shock absorbing core.Annular channel707 is sized to receive retention ring structures of the upper and lower plates, so as to retain the shock absorbing core between the plates.
• Protruding structure725 can include a retention ring, rim or annular flange as described above such as anannular flange770 that projects radially inward toward shock absorbingbiconvex core706 to retain shock absorbingbiconvex core706.Protruding structure735 can include a radially inwardly projecting retention ring, rim or annular flange such as anannular flange771 that extends toward shock absorbingbiconvex core706 to retain shock absorbingbiconvex core706.Annular flange770 has abevel772 formed thereon to limit motion between the upper and lower supports.Annular flange771 has abevel773 formed thereon to limit motion between the upper and lower supports.Bevel772 andbevel773 can be inclined so as to avoid point loading when the upper and lower supports are a the maximum angle of inclination.Annular flange770 andannular flange771 can extend into annular channel701 to retain the core. In some embodiments, the plates as described above include an upper retention ring and a lower retention ring with each of the upper and lower retention rings shaped to engage an annular channel of the core so as to retain the core between the plates.
• Retention ring gear716 can have an annular shape formed to mate with protrudingstructure725.Protruding structure725 can include an outer circular surface that mates with an inner surface of inner annular surface ofretention ring gear716.Retention ring gear716 can rotate around protrudingstructure725. In addition to inwardly protrudingannular flange770 that retains shock absorbingbiconvex core706, protrudingstructure725 can include aretention element775 such as an outwardly protruding annular flange and/or C-ring clip to retainretention ring gear716.
• Retention ring gear718 can also have an annular shape formed to mate with protrudingstructure735.Protruding structure735 can include an outer circular surface that mates with an inner annular surface ofretention ring gear718.Retention ring gear718 can rotate around protrudingstructure735. In addition to an inwardly protruding annular flange that retains shock absorbingbiconvex core706, protrudingstructure735 can include an outwardly protrudingretention element775 such as an annular flange and/or C-ring clip to retainretention ring gear718.
• Implant700 can include structures that pivot while the upper and lower supports are formed. Apivot gear727 can engage upperretention ring gear716.Pivot gear727 is connected to joint726 so that rotation ofpivot gear727 rotates pivot joint726 to rotatedistal component720. A pivot joint728 connectsproximal component722 tomiddle component724 ofupper support702. Rotation about pivot joint728 pivotsmiddle component724 toward the deployed position. Apivot gear737 can engage lowerretention ring gear718.Pivot gear737 is connected to pivot joint736 so that rotation ofpivot gear737 rotates pivot joint736 to rotatedistal component704 toward the deployed position. A pivot joint738 connectsproximal component732 tomiddle component734 oflower support704. Rotation about pivot joint738 pivotsmiddle component734 toward the deployed position.
• Wedge832,upper flange836 andlower flange838 restrain motion of the joint assembly during deployment by clamping the joint assembly while the joint assembly is advanced.Wedge832 is positioned betweenupper support702 andlower support704.Wedge832 andupper flange836 engageproximal component722 ofupper support702.Wedge832 andlower flange838 engageproximal component732 oflower support704. Advancement ofinner cartridge part830 advanceswedge832, upper, the upper and lower supports distally to engage gears of the support.
• In many embodiments, the shock absorbing core can be compressed with an instrument during insertion to allow for a lower profile during insertion. For example, casing810 ofcartridge800 can be sized to compress the core during insertion so as to lower the profile of the core. The core can also be compressed during insertion through a tube, sleeve, or the like such that core assumes a low profile compressed configuration during insertion so as to minimize the invasiveness of the procedure, for example with a posterior lateral Wiltse approach as described in U.S. application Ser. No. 11/787,110, entitled “Posterior Spinal Device and Method”, filed Apr. 12, 2007, the full disclosure of which has previously been incorporated herein by reference. In some embodiments, the core and/or prosthesis can be compressed with forceps while inserted into the intervertebral space.
• While the exemplary embodiments have been described in some detail, by way of example and for clarity of understanding, those of skill in the art will recognize that a variety of modifications, adaptations, and changes may be employed. Hence, the scope of the present invention should be limited solely by the appended claims.

Claims (46)

1. An intervertebral disc prosthesis system comprising:

a plurality of selectable cores, each core comprising,

upper and lower surfaces, and

at least one of a resilient material or a resilient member disposed between the upper and lower surfaces to allow the upper and lower surfaces to move resiliently toward and away from each other; and

upper and lower supports locatable about the core, each support comprising,

an outer surface which engages a vertebra, and

an inner surface shaped to contact one of the surfaces of each core;

wherein each core of the plurality comprises a different resiliency and wherein the upper and lower supports are adapted to articulate when one of the cores is selected and positioned between the upper and lower supports.

2. The system ofclaim 1, wherein each core is identifiable with an indicia, such that each core is selectable in response to the indicia and a patient characteristic.

3. The system ofclaim 2, wherein the indicia comprises at least one of a color of the core, a marking on the core, a height of the core, or a width of the core.

4. The system ofclaim 2, wherein the indicia of each core corresponds to a resiliency of the core and a maximum angle of inclination between the supports when the core is positioned between the supports.

5. The system ofclaim 1, wherein each core of the plurality comprises a different dimension to limit a maximum angle of inclination between the upper and lower supports in response to the patient characteristic.

6. The system ofclaim 5, wherein the different dimension comprises at least one of a height or a width.

7. The system ofclaim 1, wherein the upper surface of each core comprises a curved surface to slide against the inner surface of the upper support.

8. The system ofclaim 7, wherein the lower surface of each core is capable of attachment to the lower support.

9. The system ofclaim 1, wherein the lower surface of each core comprises a curved surface to slide against the inner surface of the lower support.

10. The system ofclaim 1, wherein each core comprises an upper component with the upper surface disposed thereon and a lower component with the lower surface disposed thereon, wherein the upper and lower core components of each core are configured to slide relative to one another in response to loading when positioned between the upper and lower supports.

11. The system ofclaim 10, wherein the upper and lower components of each core are configured to slide relative to one another with telescopic motion.

12. The system ofclaim 1, wherein the upper support comprises a upper plate and the lower support comprises a lower plate.

13. The system ofclaim 1, wherein the upper support comprises an upper expandable support and the lower support comprises a lower expandable support.

14. The system ofclaim 1, wherein several cores of the plurality comprises the same height and different resiliencies, such that a maximum angle of inclination between the plates is substantially the same for the several cores.

15. The system ofclaim 1, the plurality of selectable cores comprises cores with a maximum compression within a range from about ⅓ mm to about 1 mm.

16. An intervertebral disc prosthesis system comprising:

a plurality of selectable cores, each core comprising,

upper and lower curved surfaces, and

at least one of a resilient material or a resilient member disposed between the upper and lower curved surfaces to allow the upper and lower surfaces to move resiliently toward and away from each other; and

upper and lower supports locatable about the core, each support comprising:

an outer surface which engages a vertebra, and

an inner curved surface shaped to slide over one of the curved surfaces of each core;

wherein each core of the plurality comprises a different resiliency and wherein the upper and lower supports are adapted to articulate when one of the cores is selected and positioned between the upper and lower supports.

17. The system ofclaim 16, wherein each core is identifiable with an indicia, such that each core is selectable in response to the indicia and a patient characteristic.

18. The system ofclaim 17, wherein the indicia comprises at least one of a color of the core, a marking on the core, a height of the core, or a width of the core.

19. The system ofclaim 17, wherein the indicia of each core corresponds to a resiliency of the core and a maximum angle of inclination between the supports when the core is positioned between the supports.

20. The disc prosthesis system as inclaim 16, wherein the at least one resilient material comprises a polymer.

21. The disc prosthesis system as inclaim 16, wherein the at least one resilient material comprises a hydrogel.

22. The disc prosthesis system as inclaim 16, wherein the at least one resilient support member is disposed within the resilient material and attached to the upper and lower curved surfaces.

23. The disc prosthesis system as inclaim 16, wherein the at least one resilient support member comprises a plurality of springs.

24. The disc prosthesis system as inclaim 16, wherein the upper and lower curved surfaces of the core comprise at least one of a polymer, a ceramic or a metal.

25. The disc prosthesis system as inclaim 24, wherein the metal comprises at least one of cobalt chrome molybdenum, titanium or stainless steel.

26. A method of assembling an intervertebral prosthesis for insertion into a patient, the method comprising:

selecting a resilient core from among a plurality of resilient cores;

placing the core between first and second supports;

wherein the resilient core is selected in response to a resiliency of the core and a patient characteristic.

27. The method ofclaim 26, wherein the selected core is identified with an indicia and selected in response to the indicia and a patient characteristic.

28. The method ofclaim 27, wherein the indicia comprises at least one of a color of the core, a marking on the core, a height of the core, or a width of the core.

29. The method ofclaim 27, wherein the indicia of each core corresponds to a resiliency of the core and a maximum angle of inclination between the supports when the core is positioned between the supports.

30. The method ofclaim 26, wherein the first and second supports articulate when the selected core is positioned between the supports.

31. The method ofclaim 26, wherein the core comprises first and second components that slide relative to each other when the core is loaded.

32. The method ofclaim 26, wherein the core is selected in response to a maximum angle of inclination when the core is positioned between the supports.

33. A method of inserting an intervertebral prosthesis into an intervertebral space between vertebrae of a patient, the method comprising:

compressing a shock absorbing core from an expanded profile configuration to a narrow profile configuration when the core is inserted into the intervertebral space, wherein the shock absorbing core articulates an upper support and a lower support when positioned between the upper support and the lower support.

34. The method ofclaim 33 wherein the upper support and the lower support are positioned in the intervertebral space, and the shock absorbing core is inserted between the upper support and the lower support while the upper support and the lower support are positioned in the intervertebral space.

35. The method ofclaim 34 wherein shock absorbing core locks into place within the upper plate or the lower plate.

36. The method ofclaim 33 wherein the core is positioned between the upper support and the lower support when the upper support and the lower support are inserted into the intervertebral space.

37. The method ofclaim 36 wherein the upper support and the lower support articulate when the upper support and the lower support are inserted into the intervertebral space.

38. The method ofclaim 33 wherein the shock absorbing core is compressed with an instrument when the core is inserted into the intervertebral space.

39. The method ofclaim 38 wherein the shock absorbing core is compressed by at least about 0.5 mm with the instrument when the core is inserted into the intervertebral space.

40. An intervertebral disc prosthesis comprising:

a resilient core, the core comprising,

upper component with an upper surface and a lower component with a lower surface, and

at least one of a resilient material or a resilient member disposed between the upper and lower components to allow the upper and lower components to move resiliently toward and away from each other, wherein the upper and lower components define an inner chamber of the core and wherein at least one channel extends from the inner chamber to an external surface of the core to pass fluid through the chamber; and

upper and lower supports locatable about the core, each support comprising,

an outer surface which engages a vertebra, and

an inner surface shaped to contact one of the surfaces of the core;

wherein the upper and lower supports are adapted to articulate when the core is positioned between the upper and lower supports.

41. The prosthesis ofclaim 40 wherein the at least one channel comprises at least two channels that extend from the chamber to the external surface of the core to pass fluid through the core.

42. The prosthesis ofclaim 40 wherein the at least one channel is adapted to pump fluid out of the core when the components move toward each other and draw fluid into the core when the components move away from each other.

43. An instrument for insertion of an intervertebral disc prosthesis into an intervertebral space, the instrument comprising:

a distractor tip comprising a channel dimensioned to pass the prosthesis; and

at least one of a resilient member or a resilient material to compress the prosthesis from an expanded profile to a narrow profile configuration with the distractor tip when the prosthesis slides along the channel toward the intervertebral space.

44. The instrument ofclaim 43 further comprising a pair of handles connected to the distractor tip, wherein the resilient member comprises a spring connected to the handles to drive the handles apart and compress the prosthesis to the narrow profile configuration.

45. An system for insertion of an intervertebral disc prosthesis into an intervertebral space, the system:

a plurality of selectable shock absorbing intervertebral disc prosthesis cores; and

an instrument comprising a distractor tip with a channel dimensioned to pass the prosthesis, wherein the distractor tip is capable of compressing at least one of the plurality of cores from an expanded profile configuration to a narrow profile configuration when the prosthesis slides along the channel toward the intervertebral space.

46. The instrument ofclaim 45 wherein the expanded profile configuration comprises an unloaded configuration of the at least one of the plurality of cores and the narrow profile configuration comprises a maximum loaded compression of the at least one of the plurality of cores.

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