US20120265247A1 - Flexible stabilization device for dynamic stabilization of bones or vertebrae - Google Patents

Abstract

A flexible stabilization device for dynamic stabilization of bones or vertebrae is provided comprising a rod construct including a rod made of an elastomeric material the rod having a first connection section, a second connection section and a third section therebetween, the first and second connection sections being connectable with a bone anchoring device, respectively, and a sleeve provided on at least a portion of the third section of the rod such that at least the first and second connection sections are exposed.

Description

CROSS-REFERENCE TO RELATED APPLICATION(S)
• This application is a continuation of allowed U.S. patent application Ser. No. 11/642,566, filed Dec. 19, 2006, which claims the benefit of U.S. Provisional Patent Application Ser. No. 60/753,620, filed Dec. 23, 2005, and claims priority from European Patent Application EP05028283, filed Dec. 23, 2005, the entire disclosures of which are incorporated herein by reference.
BACKGROUND
• The present disclosure relates to a flexible stabilization device for the dynamic stabilization of bones or vertebrae.
• A flexible stabilization device for stabilizing adjacent vertebrae is known from EP 0 669 109 B1. In this stabilization device monoaxial bone screws placed in adjacent vertebrae are connected by an elastic strap. The strap is fastened to the bone screws in a pre-stressed manner. A support body which is resistant to compression surrounds the strap between the bone screws to transmit compressive forces. The support body, the heads of the bone screws and the elastic strap form a kind of joint allowing a limited motion of the vertebrae.
• US 2003/0220643 A1 discloses a device for connecting adjacent vertebral bodies in which monoaxial pedicle screws are interconnected by a spring. The spring allows spinal flexion and a limited degree of lateral bending and axial rotation while preventing spinal extension without the need of a transverse member. A sleeve is placed over the spring. Impingement between the sleeve and the pedicle screws assists the spring in preventing spinal extension. The length of the spring is predetermined. An adaptation in length by the surgeon is not possible.
• WO 2004/105577 A2 discloses a spine stabilization system with one or more flexible elements having an opening or slit in form of a helical pattern. Adjustments of the system with regard to its flexible characteristics are not possible during surgery.
• A bone anchoring device comprising a monoaxial bone screw and a flexible rod which is made of an elastic material is known from EP 1 364 622 A2. The elastic characteristics of the bone anchoring device are determined by material and the shape of the rod which cannot be modified by the surgeon. Furthermore, the use of monoaxial bone screws limits the possibility of adjustment of the position of the shaft relative to the rod.
• Based on the above, there is a need for a flexible stabilization device for dynamic stabilization of bones or vertebrae which allows modification of the elastic characteristics of the device and at the same time the adaptation of the length of the rod construct during the surgical operation.
SUMMARY OF THE INVENTION
• A flexible rod assembly including an inner rod and outer rod or sleeve made of an elastomeric material allows an adjustment of the elastic characteristics of the stabilization device to a large extent. By means of selection of a rod and a sleeve with appropriate elastic properties which can be different from each other an adaptation of the elastic properties of the rod construct to the motion of a specific spinal segment is possible. In particular, flexion and compression of the spine can be controlled by means of the elastic properties of the inner rod, whereas extension of the spine can be controlled by selection of an appropriate sleeve. The separation of the damping with regards to flexion/compression and extension movements results in a harmonic behaviour of the vertebral segments under motion control of the construct. As a consequence thereof loosening of the bone screws can be prevented. Additionally, adjustment of the length of the inner rod and of the sleeve is possible. Hence, a modular system is provided which is allows adaptation at the time of surgery. In combination with polyaxial screws the possibilities of adjustment are further increased.
• Further features and advantages of the disclosure will become apparent and will be best understood by reference to the following detailed description of embodiments taken in conjunction with the accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1ashows a perspective exploded view of a rod construct according to an embodiment of the disclosure.
• FIG. 1bshows the rod construct ofFIG. 1ain an assembled state.
• FIG. 2 shows an exploded view of a stabilization device comprising the rod construct ofFIG. 1a.
• FIG. 3 schematically shows in an exploded view the accommodation of the rod ofFIG. 1ain the receiving part of a polyaxial bone screw.
• FIG. 4 shows a sectional view of the assembled parts ofFIG. 3.
• FIG. 5 schematically shows the assembled stabilization device ofFIG. 2 applied to adjacent vertebrae of the spinal column.
• FIG. 6aschematically shows the stabilization device ofFIG. 5 with the spinal column in flexion.
• FIG. 6bschematically shows the stabilization device ofFIG. 5 with the spinal column in extension.
• FIG. 7 schematically illustrates the directions of displacement of the rod construct ofFIG. 1b.
• FIG. 8aschematically shows the rod construct in a state of flexion according toFIG. 6a.
• FIG. 8bschematically shows the rod construct in a state of extension according toFIG. 6b.
• FIGS. 9aand9bshow a further example of application of the stabilization device in a top view.
• FIG. 10 shows modification of the rod construct in section.
DETAILED DESCRIPTION OF THE INVENTION
• As shown inFIGS. 1aand1b, the flexible stabilization device includes a rodassembly including rod20 made of an elastomeric material and asleeve40 which is also made of an elastomer material. In the embodiment shown, therod20 has a cylindrical shape with a smooth surface. Due to the elastomer material, the rod is partially or fully flexible. For example, therod20 can be made of a biocompatible plastic material such as a polymer on the basis of polyurethane, polysilicone or PEEK. A particularly suitable material is Polycarbonate Urethane. The material of the rod includes well-defined elastic properties and the rod shows bending elasticity, compressive elasticity and tensile elasticity.
• The elastomeric material of thesleeve40 can also be a biocompatible plastic material such as a polymer on the basis of polyurethane, polysilicone or PEEK which includes elastic properties which can be selected independently of the elastic properties of therod20. Also for thesleeve40, Polycarbonate Urethane is particularly suitable. Thesleeve40 has a tube-like shape including achannel41 the diameter of which is slightly larger than the outer diameter of therod20 so that therod20 can be inserted into thechannel41 as shown inFIG. 1b. The length of thesleeve40 is selected to be smaller than the length of therod20 such that afirst connection section20aand asecond connection section20bof therod20 protrude from thechannel41 in the assembled state as shown inFIG. 1b. Asection20cbetween thefirst connection section20aand thesecond connection section20bof therod20 is accommodated in thechannel41 of thesleeve40. Preferably the length of thesleeve40 corresponds approximately to the distance between the receiving parts of the bone anchoring devices, or can be slightly larger.
• With reference toFIGS. 2 to 4 the connection of therod20 with thereceiving part6 of a bone anchoring element1 is explained. Although thesleeve40 is omitted in the illustration ofFIG. 3, for the purpose of describing the connection of therod20 with thereceiving part6, thesleeve40 is placed on therod20 before the latter is secured to the respective receivingparts6 of the bone anchoring elements1.
• The bone anchoring element1 in this embodiment is a polyaxial bone screw having ashank2 with a bone thread, atip3 at one end and a spherical head4 at the opposite end. A recess5 for engagement with a screwing-in tool is provided at the side of the head4 which is opposite to the shank. Thereceiving part6 has a first end7 and asecond end8 opposite to the first end and alongitudinal axis9 intersecting the plane of the first end and the second end. Coaxially with the longitudinal axis9 abore10 is provided which extends from the first end7 to a predetermined distance from thesecond end8. At thesecond end8 anopening11 is provided the diameter of which is smaller than the diameter of thebore10. A spherical or otherwise taperingsection12 is provided adjacent of theopening11 which forms a seat for the spherical head4.
• The receivingpart6 further has aU-shaped recess13 which starts at the first end7 and extends in the direction of thesecond end8 to a predetermined distance from saidsecond end8. By means of theU-shaped recess13 twofree legs14,15 are formed extending towards the first end7. Adjacent to the first end7 the receivingpart6 comprises aninternal thread16 on saidlegs14,15.
• As can be seen inFIG. 3, afirst pressure element17 is provided which has a cylindrical construction with an outer diameter which is only slightly smaller than the inner diameter of thebore10 to allow thefirst pressure element17 to be introduced into thebore10 of the receivingpart6 and to be moved in the axial direction. On its lower side facing towards thesecond end8, thepressure element17 includes aspherical recess18 the radius of which corresponds to the radius of the spherical head4 of the bone screw. On the opposite side, thefirst pressure element17 has acylindrical recess19 which extends transversely to thelongitudinal axis9. The lateral diameter of this recess is selected such that theconnection section20aor20bwith a circular cross section, respectively, of therod20 which is to be received in the receivingpart6 can be inserted into therecess19 and guided laterally therein. The depth of thecylindrical recess19 is selected such that in an assembled state when theconnection section20aor20bof therod20 is inserted and pressed against the bottom of theU-shaped recess13, thefirst pressure element17 exerts a pressure on the head5. Further the depth is preferably about half of the diameter of theconnection section20aor20bof therod20. As can be seen inFIG. 3, thefirst pressure element17 has acoaxial bore21 for guiding a screwing-in tool therethrough.
• As shown inFIGS. 3 and 4, the bone anchoring element1 further comprises asecond pressure element23 with afirst end24 and asecond end25. The width of thesecond pressure element23 is such that thesecond pressure element23 can be inserted into theU-shaped recess13 of the receivingpart6. On opposite sides of thesecond pressure element23 twocylindrical projections26 are provided which fit into the space limited by theinternal thread16 to slide along theinternal thread16 when thesecond pressure element23 is inserted.
• As can be seen inFIG. 2, thesecond pressure element23 further includes acylindrical recess27 extending from thesecond end25 in the direction towards thefirst end24 the cylinder axis of which is perpendicular to that of thecylindrical projections26. On the side of thesecond end25, thecylindrical projections26 includelower edges26a. The diameter of thecylindrical recess27 corresponds to the diameter of theconnection section20aor20bof therod20 and its depth to half or less than half of the diameter of theconnection section20aor20b.
• The bone anchoring element1 further includes aninner screw30 which can be screwed-in between thelegs14,15. Theinternal thread16 and the cooperating thread of theinner screw30 can have any known thread shape. Using a flat thread or a negative angle thread can prevent splaying of thelegs14,15.
• The receivingpart6 and thefirst pressure element17 can have corresponding crimp bores32,33 on opposite sides by means of which the screw1, the receivingpart6 and thefirst pressure element17 can be loosely pre-assembled. As shown inFIGS. 3 and 4 thefirst pressure element17 and thesecond pressure element23 can haveprojections22,28, respectively, which can contribute to the fixation of theelastic rod20.
• The other parts of the flexible stabilization device except therod20 and thesleeve40 can be made of the commonly used biocompatible materials, such as stainless steel or titanium or any other material suitable for a bone screw.
• In use, at least two bone anchoring devices are anchored into the bone. Next, therod20 and thesleeve40 are selected and combined to achieve the desired elastic properties of the flexible stabilization device. If, for example, more than two vertebrae are to be connected,different sleeves40 having different elastic properties can be selected and provided between different vertebrae. In this way, the elastic properties of the stabilization device can be adapted at the time of surgery. Preferably, thesleeve40 is selected to have a length corresponding to the distance of the two receiving parts when the pedicle screws are screwed into adjacent vertebrae. Since therod20 and thesleeve40 are made of elastomeric material, shortening during surgery is possible. Then,rod20 with thesleeve40 or, if more that one motion segment shall be stabilized via asingle rod20, with a plurality ofsleeves40 is inserted into the receivingparts6 of the bone anchoring elements. Preferably, in the balanced position of the two adjacent vertebrae, thesleeve40 is in contact with the receivingparts6.
• Thereafter, thesecond pressure element23 is inserted in the receivingpart6 and theinner screw30 is screwed-in between thelegs14,15. After adjusting the angular position of the bone screw, theinner screw30 is tightened. By the pressure exerted by theinner screw30 onto thesecond pressure element23, therod20 is clamped between the first and thesecond pressure element17,23 and simultaneously the head4 of the bone screw is locked in its angular position.
• Next, with reference toFIGS. 5 to 8bthe elastic properties of the flexible stabilization device are described. InFIG. 5 the assembled stabilization device is shown with therod20 and thesleeve40 arranged to connect two polyaxial pedicle screws which are placed in adjacent vertebrae W Ruining a motion segment. The positions of the shanks of the pedicle screws are indicated by dash-dotted lines. As can be seen inFIG. 5, the receivingparts6 of the bone anchoring elements1 have a distance x in the balanced position in which therod20 and thesleeve40 are in an unstressed state.
• FIG. 6ashows the stabilization device when flexion takes place. During flexion, tensile stress is applied to therod20 resulting in an elongation of therod20. The distance between the bone anchoring elements is increased to x+ΔX₁. The increase ΔX₁in the distance is limited by the restoring force produced by therod20 due to its elastic properties. The increase in the distance can be, for example, in the range of approximately 1.5 mm. Hence, flexion/compression is controlled mainly by theinner rod20.
• FIG. 6bshows the stabilization device when extension takes place. During extension, a compressive force is applied to therod20 and thesleeve40 by the receivingparts6 of the bone anchoring elements1. The elasticity of therod20 and thesleeve40 allows the distance between the receivingparts6 to decrease to a distance x−Δx₂. Due to the elastic properties of therod20 and thesleeve40, a restoring force acts on the receivingparts6 which limits the decrease of the distance. The distance can, for example, decrease by approximately 0.5 mm. Hence, extension is controlled by the compressibility of theinner rod20 and is limited by the sleeve.
• In an alternative manner of application, thesleeve40 can be pre-compressed in the balanced state and/or therod20 can be pre-stressed in the balanced state.
• FIG. 7 illustrates the possible deformations which therod20 and thesleeve40 can undergo.FIGS. 8aand8bshow the deformation of therod20 and thesleeve40 in flexion (FIG. 8a) and in extension (FIG. 8b).
• FIGS. 9aand9bshow an example of application of the stabilization device.FIG. 9ashows two adjacent vertebrae V, V′ which are medio-laterally inclined with respect to each other in the case of the presence of scoliosis. To dynamically stabilize and correct such a motion,segment rods200,200′ withdifferent sleeves400,400′ can be used on the left side and on the right side. Thesleeve400 used on theleft side rod200 has a length which is greater than the length ofsleeve400′ used on theright side rod200′. In this manner, it is possible to eliminate the inclination of two vertebrae on the left side. In addition, the outer diameter of thesleeve400 can be different from that of thesleeve400′ in order to have a different motion control with respect to the left side and the right side.
• Further modifications of the above described embodiments are possible. In the embodiment described before, thesleeve40 has the shape of a hollow cylinder; however, different shapes of the sleeve are possible. For example, a barrel-shape is possible. The length of the sleeve can differ from the embodiment shown. Therod20 may also have a rectangular, square, oval or triangular cross-section or any other appropriate shape of the cross-section. In this case, the shape of thesleeve40 is appropriately adapted. In particular, it is possible to form therod20 and/or thesleeve40 with the shape varying in the longitudinal direction. Therod20 and thesleeve40 can be formed to be highly flexible or hardly flexible.
• The surface of therod20 and/or thesleeve40 can be textured or structured.FIG. 10 shows an example of aninner rod201 having a corrugated surface, withcorrugations300 provided in the circumferential direction. The inner wall of thesleeve401 has corresponding corrugations cooperating with that of the rod. This prevents or reduces a displacement of the sleeve relative to the rod.
• In the example of the bone anchoring element described above, the connection of theshanks2 of the bone anchoring elements1 to therespective receiving parts6 is polyaxial. However, it is also possible to provide a monoaxial connection.
• For theinner screw30, all known modifications can be used. This includes also the use of an outer ring or nut.
• In the embodiments described, the bone anchoring element1 is introduced from the top into the receivingpart6. However, the bone anchoring element1 can also be introduced from the bottom of the receivingpart6 if the receivingpart6 is constructed to allow this.
• The head of the bone anchoring element and the shaft can be constructed as separate parts which can be connected.
• The present disclosure is not limited to screws as bone anchoring elements but can be realized with bone hooks or any other bone anchoring element.

Claims (22)

1. A flexible stabilization device for dynamic stabilization of bones or vertebrae comprising:

a rod assembly including

a rod made of an elastomeric material and structured such that its length is adjustable, the rod configured to transmit compressive forces in the axial direction, the rod having a first connection section, a second connection section and a third section therebetween, the first and second connection sections being connectable with a bone anchoring device, respectively, and

a sleeve provided on at least a portion of the third section of the rod, the length of the sleeve being smaller than a length of the rod, such that at least the first and second connection sections are exposed.

2. A flexible stabilization device according toclaim 1, wherein the sleeve is made of an elastomeric material.

3. A flexible stabilization device according toclaim 2, wherein the elastic properties of the rod and the sleeve are different.

4. A flexible stabilization device according toclaim 2, wherein the elastomeric material of any one of the rod and the sleeve is a biocompatible plastic material such as polyurethane or polysilicone.

5. A flexible stabilization device according toclaim 1, wherein the inner wall of the sleeve is in contact with the surface of the rod.

6. A flexible stabilization device according toclaim 5, wherein the inner wall of the sleeve has a structure which engages with a structure on the surface of the rod.

7. A flexible stabilization device according toclaim 1, further comprising at least a first and a second bone anchoring device connected with the rod assembly.

8. A flexible stabilization device according toclaim 7, wherein at least one of the bone anchoring devices is constructed so as to allow a polyaxial connection between a shank of the bone anchoring device and the rod.

9. A flexible stabilization device according toclaim 1, wherein the rod comprises a plurality of connection sections and a plurality of sleeves therebetween.

10. A rod assembly for a flexible stabilization device, the rod assembly comprising:

a rod made of an elastomeric material, the rod having a first connection section, a second connection section and a third section therebetween; and

a sleeve provided on at least a portion of the third section of the rod such that at least the first and second connection sections are exposed;

wherein an inner wall of the sleeve has a structure which engages with an inner structure on a surface of the rod.

11. A rod assembly according toclaim 10, wherein the sleeve is made of an elastomeric material.

12. A rod assembly according toclaim 11, wherein the elastic properties of the rod and the sleeve are different.

13. A rod assembly according toclaim 11, wherein the elastomeric material of any one of the bar and the sleeve is a biocompatible plastic material such as polyurethane or polysilicone.

14. A rod assembly according toclaim 10, wherein the rod comprises a plurality of connection sections and a plurality of sleeves therebetween.

15. A flexible stabilization device for dynamic stabilization of bones or vertebrae comprising:

a rod assembly comprising:

a rod made of an elastomeric material and having a first connection section, a second connection section and a third section therebetween; and

a sleeve provided on at least a portion of the third section of the rod, the length of the sleeve being smaller than a length of the rod, such that at least the first and second connection sections are exposed;

a bone anchoring device connectable with any one of the first connection section and the second connection section of the rod, the bone anchoring device comprising:

a shank portion configured to be anchored in a bone or in a vertebra;

a head portion having a recess including an opening, the recess configured to receive a portion of any one of the first connection section and the second connection section of the rod; and

a securing element configured to secure the portion in the recess by pressure exerted on the portion.

16. A flexible stabilization device according toclaim 15, wherein the sleeve is made of an elastomeric material.

17. A flexible stabilization device according toclaim 16, wherein the elastic properties of the rod and the sleeve are different.

18. A flexible stabilization device according toclaim 16, wherein the elastomeric material of any one of the bar and the sleeve is a biocompatible plastic material such as polyurethane or polysilicone.

19. A flexible stabilization device according toclaim 15, wherein the inner wall of the sleeve is in contact with the surface of the rod.

20. A flexible stabilization device according toclaim 19, wherein the inner wall of the sleeve has a structure which engages with a structure on the surface of the rod.

21. A flexible stabilization device according toclaim 15, wherein at least on of the first bone anchoring device and the second bone anchoring device is constructed so as to allow a polyaxial connection between the shank thereof and the rod.

22. A flexible stabilization device according toclaim 15, wherein the rod comprises a plurality of connection sections and a plurality of sleeves therebetween.

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