US20120130497A1 - Arthroplasty spinal prosthesis and insertion device - Google Patents

Abstract

An arthroplasty spinal prosthesis with first and second vertebra contacting members that are configured for engaging opposing vertebrae An articulation is supportively associated with the contacting members to allow relative pivotal and translational motion therebetween over anterior-posterior and lateral pivotal axes, and over anterior-posterior and lateral translational axes. This motion allows the opposing vertebrae to pivot and translate with respect to each other. The articulation is configured to permit translational movement substantially uncoupled from the pivoting movement.

Description

FIELD OF THE INVENTION
• The present invention relates to a prosthesis for articular association with the bone structure of a patient, and more particularly to a spinal prosthesis.
BACKGROUND OF THE INVENTION
• Procedures exist for replacing diseased intervertebral disks in which the disk material is typically removed from between adjacent vertebral bodies, and the adjacent bodies are fused. This has been done with a cage filled with bone or bone forming proteins placed in between the bodies to fix them to each other, generally to support and promote fusion between the adjacent vertebrae.
• In arthroplastic procedures, a pivotally articulated prosthesis is implanted between the vertebrae in the site of the diskectomy. For example, U.S. Pat. Nos. 5,425,773 and 6,063,121 disclose intervertebral arthroplasty devices that use different ball and socket arrangements to permit movement between the vertebrae. The ball and socket is disposed at center between surfaces of plates that are placed against the vertebrae. The intervertebral disk prosthesis disclosed in U.S. Pat. No. 5,556,431 has a core and endplates with a spherical articular surface. The core has an edge rim that limits the range of movement.
• Other teachings also provide for translational movement between the vertebrae. U.S. Pat. No. 6,113,637, for instance, shows an intervertebral joint with a ball component engaged with a vertebra and with a trough component, which is engaged with another vertebra. The trough component has a flat portion that allows translation of the ball component on one axes. A prosthesis disclosed in Patent Application Publication US 2002/0128715 shows a flexible central body between two rigid opposing shells to allow combined translation and bending.
• There is a need for an improved disk prosthesis that provides improved articulation between the vertebrae between which it is implanted.
SUMMARY OF THE INVENTION
• The present invention relates to an anthroplasty spinal prosthesis for implantation in a human or animal to provide improved implantation longevity and articulation kinematics similar to the tissue being replaced. The preferred embodiment of the prosthesis has first and second bone or vertebra contacting members configured for engaging opposite articulated bones, preferably bones of the axial skeleton, such as two vertebrae or a vertebra and the skull. An articulation is supportively associated with the contacting members to allow relative pivotal and translational movement therebetween. This movement is preferably over anterior-posterior and lateral pivotal axes and over anterior-posterior and lateral translational axes. The movement between the contacting members allows the opposing vertebrae to pivot and translate with respect to each other. Also, the preferred articulation is configured to permit the translational movement to occur without coupling or causing a pivotal movement, although another embodiment can provide the coupling if desired. Preferably, the amount of translational or pivotal movement is substantially not affected or dependent on the other of these movements. Thus, the contacting members can translate regardless of whether they also pivot, and they can pivot regardless of whether they may also translate. Similarly, the preferred articulation allows the contacting members to rotate axially with respect to each other, and this rotation is also not substantially coupled by the articulation with the pivotal or translational movement. Preferably, the prosthesis also allows synchronous movements of flexion and translation as well as movement simultaneously in rotation bending, and flexion/extension.
• The preferred articulation is configured for limiting the translational movement along both translational and pivotal axes to within predetermined ranges. The preferred translational axes extends substantially through at least one of the pivotal axes, and most preferably both anterior-posterior and lateral translational axes extend substantially through both anterior-posterior and lateral pivotal axes, with regard to one or both contacting members.
• Preferably, the articulation has first and second articulation portions that are moveably associated with each other. The first articulation portion is pivotally associated with the first contacting member, and the second articulation portion is pivotally associated with the second contacting member. The first articulation portion or first contacting member can define a protrusion, while the other defines a recess configured to receive the protrusion to pivotally associate these two elements. A similar structure with a protrusion and recess can also be provided for the second articulation portion and second contacting member. At least one of the recess and protrusion is preferably tapered substantially about a spinal axes that extends axially between the connecting members. The articulation portions also preferably comprise blocking members that are juxtaposed radially with respect to the spinal axes to abut each other for limiting the translational movement between the articulation portions to provide semiconstrained translation. The blocking members can include a key that extends from one articulation portion and that fits into a keyway defined in the other articulation portion. The association between the key and keyway allows translational movement, and the keyway provides an edge wall disposed to block the translational movement of they key. Preferably, the edge wall substantially surrounds the key, and both the edge wall and key are annular about the spinal axes. Most preferably, the edge wall comprises two edge walls that are disposed on opposite sides of the keyway so that the key and edge wall concurrently contact each other at at least two locations to block the translational movement. In one embodiment, the key and keyway can have a dovetail configuration or cross-section to axially retain the key within the keyway at a limit of the translational travel.
• The preferred articulation portions are ring shaped with a hollow center. A retaining member can be associated with the contacting members to extend through the hollow center of the articulation portions to prevent the escape of the articulation portions, such as when subjected to extreme trauma. The retaining member can comprise, for example a suture or other flexible material or a post extending through the hollow center of at least one of the articulation portions. Suture openings can be provided through the contacting members and any structures therebetween to allow the suture to extend from one contacting member to the other and to be fastened thereabout.
• The first and/or second contacting members of the preferred embodiment include a fastener mount portion that is configured to attach a bone fastener from the prosthesis to the vertebra that is engaged therewith. Vertebral contacting surfaces of this contacting member are disposed and oriented to position the body of the engaged vertebra such that the apophyseal ring of the body is disposed with respect to the fastener mount portion in an attachment position for attaching the fastener from the fastener mount portion through the apophyseal ring. The fastener mount portion can define an opening to receive a threaded surgical fastener, such as a surgical screw, and which can be made of metal, polymer, or absorbable material. The preferred fastener mount portion is oriented for inserting the fastener diagonally into the apophyseal ring. Also, a plurality of fastener mount portions can be provided to insert a plurality of fasteners through the apophyseal ring. Additional fastener mount portions can be provided to insert other fasteners in other orientations and locations into the vertebra, such as oblongly or laterally, which can be beneficial for use in different parts of the spine, for instance with L1 or L2 vertebrae.
• The vertebral contacting surfaces of the preferred embodiment are oriented to capture axial and radial surfaces of the vertebral body to position the apophyseal ring in the attachment position. The axial contacting surface is preferably oriented to abut and support an axial face of the vertebral body, while the radial contacting surface is preferably configured to abut a radial side of the vertebral body. An apophysis grove can be defined between the axial and radial contacting surfaces to receive the apophyseal ring. A fastener mount portion is preferably configured to direct the fastener into the apophysis grove, to ensure that the fastener penetrates the apophyseal ring.
• An embodiment of the prosthesis has at least one of the contacting members and articulation that is made of radiolucent material to reduce or avoid creating an artifact on an MRI, computed tomography or an x-ray or otherwise significantly obscure or block an image being produced. Preferably, the entire prosthesis, and at least major portions thereof, such as the contacting members and articulation and optionally the fasteners, are substantially radiolucent. Radiopaque markings can be provided that are visible on an MRI, an x-ray, a CT scan, or other imaging systems to help displace and position the prosthesis during implantation, or to monitor its position thereafter. The prosthesis can be configured to deliver a treatment, such as by comprising and delivering an antibiotic, protein, or biologically active substance to the implantation site. This substance can be impregnated in the material of one or both of the contacting members, Polymethylmethacrylate (PMMA) can be used for a slow release of the substance.
• Some embodiments of the inventive prosthesis have a vertebral body prosthetic portion that is configured to replace at least a portion of a vertebral body of the patient. The body prosthetic portion is fitted between the contacting members and is articulably associated therewith via articulations, such as the articulation portions described. Consequently, this prosthesis has portions configured to replace both at least a portion of a vertebral body and two adjacent disks. This prostheses can be used in an implantation site between two nonadjacent vertebrae, and is preferably configured to carry the spinal loads through the contacting members, articulations, and vertebral body portion when implanted.
• A preferred prosthesis insertion device includes first and second holding portions that have a holding position in which the holding portions cooperatively and positively hold the prosthesis. A connecting member is associated with the holding portions to selectively maintain the holding portions in the holding position and for releasing them therefrom. In the holding position, the holding portions cooperatively capture the prosthesis sufficiently to prevent removal thereof from the holding portions and to maintain a predetermined orientation between the articulated portions of the prosthesis, such as the contacting member. When released from the holding position, the holding portions are configured to release the prosthesis.
• Preferably, the connecting member comprises a hinge that pivotally connects the holding portions. This hinge can be part of a scissor linkage for moving the holding portions to and from the holding position. Alignment bores can be provided in the holding portions, including bores formed cooperatively by aligning groves in each holding portion when they are placed in the holding position. These bores can be configured for guiding a drill, such as by inserting a drill guide therein, or for guiding a fastener or fastener driver to a predetermined position and orientation with respect to the prosthesis.
• The present invention thus provides an improved prosthesis and implantation device for use in the spinal column with improved wear and articulation characteristics.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIGS. 1-3 are perspective, exploded, and side cross-sectional views, respectively, of a preferred embodiment of an intervertebral disk prosthesis constructed according to the present invention;
• FIGS. 4 and 5 are anterior and posterior views, respectively, of another embodiment of a prosthesis with three bone-screws for fastening to each vertebra;
• FIGS. 6 and 7 are exploded and perspective views, respectively, of another embodiment of a prosthesis that does not employ bone fasteners;
• FIGS. 8 and 9 are exploded and cross-sectional views, respectively, of a prosthesis embodiment with a resilient shock-absorbing member between two vertebra contacting members;
• FIG. 10 is a cross-sectional view of another embodiment with upper and lower shock absorbing members;
• FIGS. 11 and 12 are exploded and perspective views, respectively, of another embodiment of a prosthesis that uses a dovetail configuration for limiting translation between articulation portions, and which has channels to promote lubrication of the articulation;
• FIG. 13 is a cross-sectional view of the articulation portions thereof;
• FIG. 14 is an anterior perspective view of a prosthesis embodiment with a fastener-locking mechanism;
• FIG. 15 is an exploded view showing the locking mechanism thereof;
• FIGS. 16a-eshows several prostheses that can be assembled from a kit provided in accordance with the present invention;
• FIG. 17 is a perspective view of an inventive broach configured for determining a desired prosthetic assembly;
• FIGS. 18 and 19 are perspective and exploded views of an embodiment of a prosthesis for use with a corpectomy procedure;
• FIG. 20 is an exploded view of another embodiment of a prosthesis for use with a corpectomy procedure;
• FIG. 21 is a perspective posterior view of an insertion device holding a prosthesis for implantation;
• FIGS. 22 and 23 are side views of a holding member of the insertion device, showing the use of a drill guide and a fastener driver, with the opposing holding member of the insertion device not shown for clarity; and
• FIG. 24 is a top view of a preferred embodiment of the insertion device.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• Referring toFIGS. 1-3, the preferred embodiment of the invention is avertebral disk prosthesis10, which includes top andbottom contacting members12,14. The contactingmembers12,14 preferably include top and bottom endplates. Each contactingmember12,14 of this embodiment has a mainbody support portion15 that includes an axialvertebral contacting surface16 facing axially and configured for engaging axial superior or inferior faces of opposing vertebral bodies when implanted along a spinal column.
• The vertebral contactingsurfaces16 preferably have a texture, shape, and/or treatment to promote engagement with the face of the engaged vertebral body. The texture shown provides an uneven surface to improve gripping against the vertebral body and to promote bone ingrowth into thesurfaces16. The uneven surface can include a series of angular or pointed shapes or other protrusions and indentations, such as pyramids, scales, or tetrahedrons, or trebecular metal for example. Alternatively or additionally, the axial contactingsurfaces16 can have other surface treatments, and can be coated, for instance, with plasma sprayed titanium, calcium phosphate, hydroxyapetite, or proteins. In some embodiments, the surfaces can be smooth.
• The uneven surface is preferably disposed to engage and grip the concave interior portion of the axial face of the vertebral body, most preferably within the apophyseal ring. To best engage this interior portion, the axial contactingsurfaces16 are preferably convex and curved along one or two radial directions, preferably along an anterior-posterior direction and a lateral direction. The contacting surface preferably has an overall rounded shape to prevent expulsion and increase contact. The rounded shape can improve and provide immediate stability to prevent expulsion.
• The contactingmembers12,14 also preferably includeflanges18 that extend axially at an angle to the axialvertebral contacting surfaces16 and include radial vertebral contacting surfaces20. Theradial contacting surfaces20 are preferably oriented to abut the radial wall of the vertebra body. Most preferably, theradial contacting surfaces20 are concave to follow the shape of the radial wall. In a preferred embodiment, theflanges18 are disposed and configured to contact the front radial side of the vertebral body, but in an alternative embodiment, theflanges18 and radial contacting surfaces can be oriented to contact another radial side of the vertebral body, such as a lateral side or a portion partway between a lateral side and the anterior or posterior side, such as at an oblique side of the wall.
• Afastener mount portion22 is preferably provided for attaching abone fastener24 thereto, such as a bone screw or other bone fastener. Thefastener mount portion22 preferably defines anopening24 to receive a threadedportion26 of thefastener24 for insertion into the vertebra, and has afastener seat28 to align and seat ahead30 of thefastener24.
• The contacting surfaces16,20 are disposed and oriented to position the vertebral body to be engaged with theprosthesis10 to position apophyseal ring of the body in an attachment position with respect to thefastener mount portion22. In the attachment position, shown inFIG. 3, theapophyseal ring34 of thevertebral body32, shown in phantom lines, is disposed with respect to thefastener mount portion22, such that thefastener24 is aligned to extend through theapophyseal ring34 to attach the contactingmembers12,14 to thevertebra32. This positioning of the fastener is desired since theapophyseal ring24 is the strongest part of the vertebral body and it ensures a strong, robust and immediate attachment of theprosthesis10 to thevertebra32. Thefastener24 preferably extends diagonally into the apophyseal ring, preferably at anangle38 of at least about 10°, more preferably at least about 30°, and most preferably at least about 40° with respect to thespinal axes36; and preferably at most about 80°, more preferably at most about 60°, and most preferably at most about 50° thereto.
• The contacting surfaces16,20 of the contactingmembers12,14 also preferably define aapophysis groove40 defined between the axial and radial contactingsurfaces16,20 to receive theapophyseal ring34. Theapophysis groove40 has a curvature around thespinal axes36 configured to follow the general shape of theapophyseal ring34. The dimensions of theapophysis groove40 are selected to receive theapophyseal ring40 therein so that the axial and radial contactingsurfaces16,20 can abut the axial and radial surfaces of thevertebral body32. Thefastener mount portion22 is preferably disposed with theopening24 extending into theapophysis groove40 to direct thefastener24 into theapophysis groove40 as well.
• Although theapophysis groove40 can be made to extend into only the axial or theradial contacting surface16 or20, in the preferred embodiment, the apophysis groove extends into both the axial and radial contactingsurfaces16,20. Theradial width42 andaxial height44 of theapophysis groove40 are preferably between about 2 mm and 5 mm, and more preferably between about 2.5 mm and 4 mm. The height and width can have the same or different dimensions from each other. Most preferably, theheight44 of theapophysis groove40 is sufficient to position theapophyseal ring34 to extend vertically within thegroove40 in theflange18 at least up to about half the height of thefastener24 to ensure thefastener24 transects theapophyseal ring34. In the preferred embodiment, theapophysis groove40 is configured so that its surface abuts and supports theapophyseal ring34, although in another embodiment, theapophysis groove40 provides a clearance from theapophyseal ring34. The dimensions ofgroove40 can be selected to move the center of rotation posteriorly in the disk space. Preferably, the axial and radial contactingsurfaces16,20 are oriented to capture axial and radial surfaces of thevertebral body32 for positioning the apophyseal ring in the attachment position.
• Theprosthesis10 includes anarticulation46 that articulably connects the contacting,members12,14. Thearticulation46 preferably includes upper andlower articulation portions48,49 that are received inarticular cavities50 defined on the opposite side of themain support portion15 from the axial contactingsurface16 of each contactingmember12,14. Thearticulation portions48,49 of the preferred embodiment are preferably ring shaped disks, preferably being rounded, preferably circular along a generally radial plane, with a hollow central,axial opening52.
• Outer bearing surfaces54 of thearticulation portions48,49 are supportively associated with bearingsurfaces56 of thecavities50. The corresponding bearing surfaces54,56 are preferably curved in cross-section, although one set may be curved, while the abutting bearing surface is generally straight. The bearing surfaces54,56 are configured and associated to allow the contactingmembers12,14 to pivot about thearticulation portions48,49, preferably about more than one axes. When the prosthesis is loaded by supporting the adjacent vertebrae engaged therewith, a clearance58 is preferably provided on an axial side between thearticulation portions48,49 and the contactingmembers12,14. This clearance can be provided due to the axial taper of one or both of these members. The bearing surfaces54,56, which preferably face predominantly in a radial direction but are inclined with respect to the axial and radial direction, are in supportive abutment with each other, preferably radially outside the clearance58 area.
• Thearticulation46 is preferably configured to permit independent and concurrent anterior-posterior flexion and extension and lateral bending and preferably also axial rotation between the contactingmembers12,14. The range of flexion/extension and lateral bend is preferably at least about 5°, more preferably at least about 8°, and most preferably at least about 10°; and is preferably up to about 20°, and more preferably up to about 16°. The pivoting is preferably limited by the abutment of edges of the contactingmembers12,14, or by the articulation portions reaching the ends of possible travel within thecavities50, although another mechanism can be provided. Other ranges can be provided for different needs in different locations of the spine.
• Thearticulation portions48,49 are preferably are configured to translate with respect to each other, preferably by sliding, to allow relative translation between the contactingmembers12,14. Timer bearing surfaces60 of thearticulation portions48,49 are preferably supportively and slidingly associated with each other to allow translation, preferably along more than one axes. In the embodiment shown, the inner bearing surfaces60 are substantially planar. Preferably, one or both translational axes extend substantially through or very near the pivotal axes.
• Articulation portion48 defines akeyway channel62 that receives a key64, which protrudes from theinner bearing surface60. Thekeyway62 is radially wider than the key64 by an amount selected to permit and limit the translation between the contactingmembers12,14. Both thekeyway62 and key64 are preferably annular, and most preferably circular. The key64 andkeyway62 are preferably configured such that at the limit of the sliding travel, the key64 and the wall of thekeyway62 abut at two points, such as at opposite ends of the respective annuli formed by thekeyway62 and key64. Alternatively, a single point of contact can be used to block excessive translational movement. With this construction, the key64 andkeyway62 are juxtaposed radially with respect to the spinal axes to function as blocking members.
• The allowable translation can occur on more than one axes independently and simultaneously. The preferred embodiment allows anterior-posterior translation and lateral translation in ranges that are preferably about 1 mm to 2 mm for a cervical prosthesis, about 1 mm to 2.5 mm for a thoracic prosthesis, and about 2 mm to 4 mm for a lumbar prosthesis.
• To prevent thearticulation portions48,49 from exiting the space between the contactingmembers12,14 in a extremely traumatic event, the contactingmembers12,14 haveposts66 that extend into thearticular cavities50 andaxial openings52. Under normal flexion, extension, and bending motion limits, thearticulation portions48,49 are retained in thearticular cavities50 and are prevented from escaping into the space between the radially outer edges of the contactingmembers12,14 by the associated shapes of the contacting bearing surfaces54,56. Theposts66 are most preferably configured to abut the edge of theaxial openings52 at the limit of pivotal motion, while the bearing surfaces54,56 are also in contact.
• Axial rotation between the contactingmembers12,14 is preferably provided by rotational sliding between the contactingmembers12,14 and thearticulation portions48,49 and/or between thearticulation portions48,49 themselves. In the preferred embodiment, the axial rotation is unlimited, and the patient's facet joints, ligaments, annulus, and tendons provide axial rotation stability.
• In the preferred embodiment, the contactingmembers12,14 are articulated to allow relative pivotal and translational motion therebetween over anterior-posterior and lateral pivotal axes, and also anterior-posterior and lateral translational axes, The opposing vertebrae can thus pivot and translate with respect to each other. Thearticulation46 is configured to permit translational movement substantially uncoupled from the pivoting movement. Similarly, the preferred articulation allows axial rotation substantially uncoupled from the other axes of movement as well. As a result, flexion, extension, or lateral bending that is initiated in the adjacent vertebrae does not cause the articulation to induce a translation or axial rotation, for instance, and vice versa. A movement along any one axes preferably does not cause the articulation to induce a movement in another axes. This is particularly useful because normal movements in the spine can combine variable amounts of movements along different axes simultaneously or sequentially. Theprosthesis10 can thus accommodate synchronous, coupled movement and sequential movement along the spine over different axes. Additionally, due to the construction of the preferred articulation, the contacting members can have pivotal and axial-rotational axes that are displaced from each other when the articulation is in an off-center state of translation.
• Referring toFIGS. 4 and 5, another embodiment of aprosthesis68 has contactingmembers70 with threefastener mount portions22 on each contactingmember70.
• A plurality offasteners24 is beneficial for use with less stable or weakened bone such as with ligamentous instability, i.e., when sacrificing the posterior longitudinal ligament complex. Preferably, the majority of thefastener mount portions22 are disposed and oriented to insert therespective fasteners24 diagonally into the apophyseal ring. In this embodiment,fastener mount portions22a have such a configuration, which fastener mounts22bare configured to attach a fastener at a more horizontal angle into the vertebral body at a position above the apophyseal ring. Theapophysis groove40 shown principally extends into theaxial surface16, and by a small amount or not at all into theradial surface20.
• FIGS. 6 and 7 show an embodiment of aprosthesis72 for more highly stable implantation sites, such as when sparing the posterior longitudinal ligament complex. In this embodiment, no fastener mount portions are provided. Theledges74 of the contactingmembers76 are sufficiently tall to engage the apophyseal ring of the engaged vertebral body, to prevent theprosthesis72 from sliding further into the intervertebral space and to permit subsidence. When the ledge is implanted on the front side of the vertebral body, ledges74 keep theprosthesis72 from sliding towards the spinal chord. Additionally, there is no apophyseal groove provided in this embodiment, although an alternative embodiment can incorporate such a groove to positively capture the apophyseal ring.
• Aflexible sheath78 is provided around the contactingmembers76, preferably enclosing and optionally sealing: the articular space in which thearticulation portions48,49 are disposed. Thesheath78 can advantageously resist or prevent debris from migrating, from the bearing surfaces of the articulation into the body, as such debris can cause weakening of the bone. The sheath can also or alternatively be configured to resiliently bias the contacting members, such as towards a central axial rotation position. Advantageously, the periphery of the contactingmembers74 can be angled to allow provide the resilient rotational bias. Other embodiments can have round contacting members, however. The membrane can also send in lubricating fluids, natural and synthetic or to provide treatments, such as antibiotics or anti inflammatory treatments. The membrane can also prevent interposition of surrounding soft tissue into the device.
• Referring toFIGS. 8 and 9, another embodiment of aprosthesis80 does not employ posts to keep thearticulation portions48,49 from exiting thearticular cavity50. Aresilient member82 is disposed between the contactingmembers84 to absorb axial shocks between the engaged vertebrae. Theresilient member82 in this embodiment has a double tapered shape, with the narrowest part at the axial center thereof to correspond with the taper of thecentral opening52 in thearticulation members48,49, within whichopening52 the resilient member is preferably disposed. The resilient member is preferably made of an elastically compressible material that is significantly softer than the contactingmembers84 andarticulation portions48,49. Suitable materials include elastomeric materials, including rubber and synthetic elastomers. A resilient member can also be employed with an embodiment withposts66 to provide axial compression damping.
• Suture recesses ornotches86 in which suture holes88 are disposed are defined on the outer axial side of the contactingmembers84. The suture holes88 extend into thearticular cavity50 and are aligned withsuture holes88 of the opposing contactingmember84. Asuture90, preferably of resorbable material, can be threaded through the suture holes88 to tie the contactingportions84 together to retain theprosthesis80 in an assembled condition, which is beneficial when certain ligaments have been severed for implantation, such as the annular ligament and posterior longitudinal ligament. As the tissue heals, thesuture90 can dissolve when it is no longer needed for the stability of theprosthesis80. Alternatively, a non-dissolving suture can be used. If a central resilient shock absorbing member is employed, as shown in this embodiment, themember82 preferably also hasopenings92 through which to thread thesuture90. A different type of retaining member to retain the contactingmembers84 together can alternatively be used. Thenotches86 can be used for recessing thesuture knot91 or for another desired purpose, such as for anchoring a bone graft.
• Theprosthesis embodiment94 ofFIG. 10 has resilient shock-absorber members96 fitted incentral recesses98,100 of the contactingmembers102 andarticulation portions104. In this embodiment, thearticulation portions104 have an axially closed center, not having a central opening that extends axially completely therethrough. Theresilient members96 of this embodiment can also be employed to provide a resilient bias about the anterior-posterior and lateral bending axes. A resilient shock-absorber can also be employed between the contactingmembers102.
• An embodiment of aprosthesis106 is shown inFIGS. 11-13, in which thearticulation portions108,110 defineexterior lubrication channels112 to allow human fluid serum to enter and lubricate the bearing surfaces54,56. In an alternative embodiment, the lubrication channels are provided in the bearing surfaces56 of the contacting members118, and the articulation-portion bearing-surfaces54 are smooth. Additionally, the key114 andkeyway116 have dovetail cross sections to help retain thearticulation portions108,110 from separating radially or axially at a limit of the translational movement range. In an other embodiment, one of the radial sides of the key114 andkeyway116 cross-sections can have the respective tapered portion of a partial dovetail cross-sectional shape, and the other radial side can be generally flat or can have a different shape.
• Referring toFIGS. 14 and 15, another embodiment of aprosthesis122 has afastener mount portion120 with alocking element124. A locking fitting126 is attached, and preferably fixed, to the contactingmembers128, for example via a tongue-in-groove fitting, with atongue130 and agrove132. The fitting126 includes a locking tab with aledge134 that is sufficiently resilient and deformable to allow thehead30 of thefastener24 to pass thereby when it is screwed into the vertebra. Preferred materials for the construction of the fitting126 include cobalt chrome and plastics, such as polyethylene and PEEK (polyetheretherketone), or resorbable polymers. A locking ledge that is unitary with the main body of the contacting member can alternatively be used. Theledge134 blocks retrograde movement of thefastener24 out of the bone once implanted. Alternative fastener locking devices can be used, such as fasteners with compressible or expanding locking heads.
• A kit is preferably provided to a surgeon with various contacting members136a-jcan be provided for assembly about an articulation member that includesarticulation portions138 to provide an assembled prosthesis for implantation. A variety of kit parts allows modularity of prosthetic size to custom fit the device to the patient's evacuated disk space. Examples of prostheses that can be assembled from the kit are shown inFIGS. 16a-e.Several broaches such as thebroach140, shown inFIG. 17, can be inserted into the disk space after performing a diskectomy to determine the appropriate height and lordotic angle for the assembled disk prosthesis to be implanted. The broach also distracts the disk space, allowing nerve root decompression and loosening of the ligaments adjacent to the disk space, i.e., annular ligament and posterior longitudinal ligament. The preferred broaches140 have aprobing end142 that has contacting surfaces in the same general shape as of various assembled prosthesis that can be assembled from the kit parts. Aledge144 extends adjacent an axial contactingportion146 to stop the insertion of theprobing end142 at the appropriate location. At the opposite end from the probingtip142 is ahandle148. Once the proper dimensions of the disk space are determined, contacting members with the desiredaxial height150 between the opposed axial contactingsurfaces16 and lordotic angle can be selected to produce the desired configuration in the assembled prosthesis. Preferably, prostheses with axial heights from about 6 mm to about 30 mm, and with between about 0° and 20° of lordosis can be assembled. In the cervical spine, a height of about between 6 mm and 12 mm is preferred. In the thoracic spine, a height of about between 6 mm and 20 mm is preferred. In the lumbar spine:, a height of about between 9 mm and 30 mm is preferred.
• As shown inFIGS. 18 and 19, the embodiment ofprosthesis152 includes a prosthetic vertebral-body portion154 for use after a corpectomy.Vertebral contacting members156 are articulated viaarticulation portions48,49 to thebody portion154. On an opposite axial side, thebody portion154 is articulably associated with a anothervertebral contacting member156 via a second set ofarticulation portions48,49. Thebody portion154 definesarticular cavities50 to pivotally and rotatably receive thearticulation portions48 or49.
• Thebody portion154 has major andminor openings160,162 to promote bone growth and fusion therewith from remaining portions of the vertebra on which the corpectomy has been performed, and into which the body portion is being implanted. Thehollow interior164 of thebody portion154 can be filled with a protein, bone, or other material to further promote the bone growth and fusion. Additionally,suture openings170 can be provided to thread a suture therethrough or to pass another retaining member between the contactingportions156 to retain the unit assembled.
• Theaxial height166 of thebody portion154 is preferably selected to be about the height of a healthy vertebral body or of the vertebral body it replaces, although thebody portion height166 can be made sufficiently larger to position thearticulations46 in the desired position. Preferably, the combinedheight168 of theprosthesis152, measured between the axial contactingsurfaces16 of the contactingmembers156 is preferably selected to be about the combined height between the opposed vertebrae that are engaged with the contactingsurfaces16, or of the healthy or desired height of a vertebral body plus the height of a disk on each axial side. Disk heights typically range from about 4 mm to about 20 mm, and vertebra height typically ranges from about 10 mm to 50 mm. The preferred height in the cervical spine is about between 10 mm to 30 mm, in the thoracic spine is about between 20 mm and 60 mm and in the lumbar spine is about between 30 mm and 70 mm. The axial position of the articulations is also preferably selected to provide the desired movement characteristics at the relevant portion of the spine.
• Referring toFIG. 20, anotherprosthesis172 embodiment for use with a corpectomy has a cylindrical bodyprosthetic portion174 withangular openings176 to promote bone fusion. Anarticulation portion178 can be of unitary construction with thebody portion174 or otherwise fixed thereto, or can alternatively be slideably associated with thebody portion174, such as by providing a key and keyway translational articulation. The articulation portion is pivotally associated with the contactingmembers156. In another embodiment, the body portion has a recess to receive a protrusive articulation portion in fixed association with the contacting member. Amembrane78, as shown inFIGS. 6 and 7 can also be applied to corpectomy orthroplasty embodiments, as well as posts66.
• Substantially the entire prosthesis can be made of a single material to avoid galvanic corrosion or from different materials to take advantage of the different material properties in different parts of the prosthesis. A preferred material for the contacting members, articulation portions, and any present body portion is titanium or another durable and hard material. In one embodiment, the contacting members, articulation portions, and body portion, if employed, are made from a radiolucent material or are otherwise configured to reduce or avoid the production of radio artifacts in an MRI or in an x-ray. As such, the entire device or substantially the entire device can be made of a polymer, such as PEEK. Alternatively, certain portions can be made radiolucent, while others are not. This can be employed to produce better images of the structure of the body without the prosthesis blocking portions of the image. Additionally,radiopaque markers180, such as shown inFIG. 1, can also be employed in predetermined radiolucent portions of the prosthesis to aid in its imaging, without interfering significantly with the imaging of the surrounding tissue. Preferably, the contacting members, and articulation portions are substantially rigid.
• Referring toFIGS. 21-24, the preferred embodiment of an inventiveprosthesis insertion device182 is shown, which functions as a jig to hold an assembledintervertebral prosthesis10. The insertion device has opposed holdingportions184 that preferably come together along a generally laterally facing vertical surface.
• In the holding position ofFIG. 21, the holdingportions184 cooperatively and positively hold theprosthesis10. This is preferably accomplished by the holdingportions184 cooperatively extending around theprosthesis10 to sufficiently to capture it to inhibit or prevent removal of theprosthesis10 from the holdingportions184.Extensions186 extend around theledges18, for example, to trap the connecting members against a holdingsurface188 that faces theextensions186.Spacer lips190 is also preferably provided to fit between the contactingmembers12,14 to hold and maintain a predetermined orientation between articulated parts of theprosthesis10 during implantation.
• In the holding position, the holdingportions184 thus block exit of the contactingmembers12,14 preferably all directions. The holdingportions184 can be separated, preferably laterally and in an unrestricted manner, to release the prosthesis.
• The insertion device preferably also definesbores192 for receiving and aligning a drill bit or adrill guide194, as shown inFIG. 22, and thefasteners24 andfastener driver196, as shown inFIG. 23, while holding theprosthesis10 in the desired implantation position in the spine. Thedrill guide194 is preferably configured for automatic positioning at a predetermined depth in thebores192, such as by providing anangled shoulder198 to abut the outer surface of the holdingportions184.
• Thebores192 are preferably defined cooperatively between the holdingportions184 by employing a groove in the inside surface of one holdingmember184 that faces a groove in the inside surface of the other holdingmember184, but the bores alternatively can extend completely through one of the holdingmembers184. In addition, thebores194 for insertion of the diagonally orientedfasteners24 can cross each other, as can be seen fromFIGS. 22 and 23.
• A connectingmember200 is preferably associated with the holdingportions184 to selectively maintain the holdingportions184 in the holding position and for releasing them therefrom after the implantation. The preferred connectingmember200, shown inFIG. 24, is configured as a forceps with ahinge202 that pivotally connects the holdingportions184. A scissor linkage withhandles204 hinged at thehinge202 move the holding portions into and from the holding position. Alocking mechanism206 is provided, such as anactuate arm208 that extends from one side of the scissor linkage and that has ridges to engage corresponding ridges on theother side210 of the scissor linkage.
• To implant theprosthesis10 in an endoscopic or laparoscopic procedure, a surgeon preferably performs a disk resection or incises the annulus of the disk to create a window into which theprosthesis10 can be inserted. The nuclear gelatinous core of the disk is removed, and the faces of the endplates of the vertebral bodies are cleared of cartilage, exposing the cortical bone of the vertebral endplate. The cortex can be breached in the center of the vertebral endplate, exposing cancellous bone.
• The surgeon then inserts the prosthesis through an incision with theinsertion device182, preferably in the anterior side of a patient's body. Once theprosthesis10 is positioned between the vertebrae, the bone is drilled if fasteners are to be used, using adrill guide194 fitted in theinsertion device182. Thefasteners24 are preferably sequentially inserted into theinsertion device182 and inserted into the bone, such as by rotating with adriver196 placed in theinsertion device182.
• In procedures in which the implantation is not conducted from an anterior side of the spine, contacting members can be used withflanges18 andfasteners24 that are oriented an angle between the anterior and lateral sides, for instance. The fasteners can also be offset from the anterior side and can enter the bone at an angle from the anterior-posterior directions, when viewed along the spinal axis.
• The preferred arthroplasty prosthesis is tolerant of implantation off-center or out of alignment, as the contacting portions can be self-centering or aligning due to the bias by the ligaments and surrounding soft tissue.
• While illustrative embodiments of the invention are disclosed herein, it will be appreciated that numerous modifications and other embodiments may be devised by those skilled in the art. For example, while the preferred embodiments of the invention are described with a configuration for their use between vertebrae, another embodiment can be used at the end of the spine, such as adjacent the skull or between other articulated bones, such as in the appendicular skeleton. The features of different embodiments can be interchanged depending on the desired characteristics of the assembled prosthesis. Therefore, it will be understood that the appended claims are intended to cover all such modifications and embodiments that come within the spirit and scope of the present invention

Claims (29)

1-45. (canceled)

46. A vertebral arthroplasty prosthesis, comprising:

a first support member having a first anterior-posterior and lateral pivotal axis;

a second support member having a second anterior-posterior and lateral pivotal axis; and

an articulation member including:

a first articulation portion having a first pivotal joint member in pivotal association with the first support member for pivoting at the first pivotal axis, and

a second articulation portion having a second pivotal joint member in pivotal association with the second support member for pivoting at the second pivotal axis,

wherein the first and second articulation portions are associated with each other for translation with respect to each other at a location between the first and second articulation portions to translate the first support member, first pivotal joint member, and first pivotal axis with respect to the second support member, second pivotal joint member, and second pivotal axis;

wherein the first support member, articulation member, and second support member are configured for cooperatively supporting vertebrae on either side of the prosthesis of a spinal column; and

wherein the prosthesis is configured such that, when implanted in the spinal column, the articulation member is disposed in a location corresponding to an intervertebral disk.

47. The prosthesis ofclaim 46, wherein the articulation member is configured for limiting a translational movement along lateral and an anterior-posterior directions to a predetermined range.

48. The prosthesis ofclaim 47, wherein the articulation member is configured for limiting a pivotal movement along both the first pivotal axis and the second pivotal axis to a predetermined range.

49. The prosthesis ofclaim 46, wherein the first and second articulations portions are translatable with respect to each other to translate the first and second support members and pivotal axes with respect to each other substantially uncoupled from pivotal movement of the first and second support members.

50. The prosthesis ofclaim 46, wherein the first and second pivotal joint members are configured to provide universal pivoting of the first and second support members about the first and second pivotal axes, respectively.

51. The prosthesis of claim,46, wherein the support members have corresponding joint members that are associated with the first and second pivotal joint members to provide a ball and socket joint for pivoting about each of the first and second pivotal axes.

52. The prosthesis ofclaim 46, wherein the articulation member is configured to permit relative axial rotation between the contacting members.

53. The prosthesis ofclaim 46, wherein the second support member comprises a body prosthetic portion, the prosthesis having an axial height corresponding approximately to the height of a vertebra.

54. The prosthesis ofclaim 46, wherein the first support member comprises a first bone contacting member configured for engaging first vertebra of the spinal column, the first contacting member comprising:

a fastener mount portion configured for attaching a bone fastener thereto; and

vertebral contacting surfaces disposed and oriented for positioning an apophyseal ring of the first bone with respect to the fastener mount portion in an attachment position for attaching the fastener from the fastener mount portion through the apophyseal ring to attach the first contacting member to the first bone.

55. The prosthesis ofclaim 54, wherein the fastener mount portion defines an opening for receiving a threaded surgical fastener therethrough.

56. The prosthesis ofclaim 55, wherein the fastener mount portion is oriented for inserting the fastener diagonally into the apophyseal ring.

57. The prosthesis ofclaim 54, wherein the vertebral contacting surfaces are oriented to capture axial and radial surfaces of the vertebral body for positioning the apophyseal ring in the attachment position.

58. The prosthesis ofclaim 46, wherein the first support member comprises a vertebral contacting member.

59. The prosthesis ofclaim 46, wherein the second support member comprises a vertebral body prosthetic portion.

60. The prosthesis ofclaim 46, wherein the second pivotal axis comprises an upper body anterior-posterior and lateral pivotal axis of the second support member, and the second support member comprises a third pivotal axis comprising a lower body anterior-posterior and lateral pivotal axis of the second support member.

61. the prosthesis ofclaim 60, further comprising:

a third support member having a fourth anterior-posterior and lateral pivotal axis;

a second articulation member, including:

a third articulation portion having a third pivotal joint member in pivotal association with the second support member for pivoting at the third pivotal axis, and\

a fourth articulation portion having a fourth pivotal joint member in pivotal association with the third support member for pivoting at the fourth pivotal axis.

62. The prosthesis ofclaim 61, wherein the third support member comprises a vertebral contacting member.

63. The prosthesis ofclaim 62, wherein the third and fourth articulation portions are translatable with respect to each other at a location between the third and fourth joint members to translate the second and third support members and pivotal axes with respect to each other.

64. The prosthesis ofclaim 46, wherein the first and second articulation portions are in sliding contact against each other to allow the translation.

65. An arthroplasty prosthesis, comprising:

first and second support members configured for cooperatively supporting opposing articulated bones, the first support member having a first at anterior-posterior and lateral pivotal axis, and the second support member having a second anterior-posterior and lateral pivotal axis; and

first and second articulation portions, the first articulation portion having a first pivotal joint member in pivotal association with the first support member for pivoting at the first pivotal axis, and the second articulation portion having a second pivotal joint member in pivotal association with the second support member for pivoting at the second pivotal axis, wherein the first and second articulation portions are in sliding contact with each other between the first and second pivotal joint members to permit translation of the first and second support members and pivotal joint members with respect to each other,

wherein the prosthesis is configured such that, when implanted in the spinal column, the articulation portions are disposed in a location corresponding to an intervertebral disk.

66. The prosthesis ofclaim 65, wherein one of the first support member and the first articulation portion defines a protrusion extending generally along an axis extending between the support members, and the other defines a recess configured for receiving the protrusion to pivotally associate the first support member and the first articulation portion.

67. The prosthesis ofclaim 66, wherein one of the second support member and the second articulation portion defines a protrusion, and the other defines a recess configured for receiving the protrusion to pivotally associate the second support member and the second articulation portion.

68. The prosthesis ofclaim 66, wherein at least one of the recess and protrusion is tapered substantially about a spinal axes that extends axially between the support members.

69. The prosthesis ofclaim 65, wherein the first and second articulation portions comprise blocking members juxtaposed radially with respect to a spinal axes that extends axially between the support members for abutting each other to limit the translational movement therebetween.

70. The prosthesis ofclaim 65, wherein the second support member comprises a body prosthetic portion, such that the support members are pivotally and translationally moveable with respect thereto.

71. The prosthesis ofclaim 65, wherein the opposing articulated bones comprise first and second vertebra bodies, each having a respective apophyseal ring, and wherein the first and second support members comprise:

an axial contacting surface oriented to abut and support an axial face of a respective one of the first and second vertebra bodies;

a radial contacting surface configured to abut a radial side of the respective one of the first and second vertebra bodies; and

an apophysis receiving area between the axial and radial contacting surfaces defining an apophysis groove that is disposed and configured for receiving the apophyseal ring of the respective one of the first and second vertebra bodies.

72. An arthroplasty prosthesis for implantation in an implantation site between two non-adjacent bones of the axial skeleton, comprising:

a vertebral body prosthetic portion configured for replacing at least one vertebral body of a patient, the body prosthetic portion having an upper body anterior-posterior and lateral pivotal axis and a lower body anterior-posterior and lateral pivotal axis; and

upper and lower disk prosthetic portions, configured to replace at least portions of two intervertebral disks disposed adjacent the replaced portion of the vertebral body, the disk prosthetic portions configured to contact and support axial skeleton bones adjacent the implantation site and being articulated with the body prosthetic portion, the upper and lower disk prosthetic portions respectively having a upper and lower anterior-posterior and lateral pivotal axes,

wherein the upper disk prosthetic portion comprises:

an upper support member having an upper first anterior-posterior lateral pivotal axis,

an upper first articulation portion having an upper first pivotal joint member in pivotal association with the upper support member for pivoting at the first pivotal axis, and

an upper second articulation portion having an upper a second pivotal joint member in pivotal association with the vertebral body prosthetic portion for pivoting at the upper body pivotal axis, in contact with the upper first articulation portion between the upper joint members such that the upper first and second articulation portions are translatable with respect to each other

wherein the lower disc prosthetic portion comprises:

a lower support member having a second anterior-posterior lateral pivotal axis,

a lower first articulation portion having a lower first pivotal joint member in pivotal association with the lower support member for pivoting at the second pivotal axis, and

a lower second articulation portion having a lower second pivotal joint member in pivotal association with the vertebral body prosthetic portion for pivoting at the lower body pivotal axis, in contact with the lower first articulation portion between the lower joint members such that the lower first and second articulation portions are translatable with respect to each other; and

wherein the body and disk prosthetic portions and the articulation members are associated for cooperatively carrying spinal loads at the implantation site.

73. The prosthesis ofclaim 72, wherein both of the of the support members are configured for engaging a respective axial skeleton bone adjacent the implantation site.

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