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

Posterior spinal arthroplasty-development of a new posteriorly inserted artificial disc and an artificial facet joint Download PDF

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Publication number
US20060085076A1
US20060085076A1 US10/970,091 US97009104A US2006085076A1 US 20060085076 A1 US20060085076 A1 US 20060085076A1 US 97009104 A US97009104 A US 97009104A US 2006085076 A1 US2006085076 A1 US 2006085076A1
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United States
Prior art keywords
disc
prosthesis
prosthesis according
members
facet joint
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US10/970,091
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English (en)
Inventor
Manoj Krishna
Tai Friesen
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Disc Motion Technologies Inc
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from GB0422963A external-priority patent/GB0422963D0/en
Application filed by Individual filed Critical Individual
Priority claimed from GB0516258A external-priority patent/GB0516258D0/en
Priority to US11/203,259 priority Critical patent/US20060089717A1/en
Priority to US11/397,756 priority patent/US20060265074A1/en
Publication of US20060085076A1 publication Critical patent/US20060085076A1/en
Assigned to DISC MOTION TECHNOLOGIES, INC. reassignment DISC MOTION TECHNOLOGIES, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: FRIESEM, TAI, KRISHNA, MANOJ
Assigned to DISC MOTION TECHNOLOGIES, INC. reassignment DISC MOTION TECHNOLOGIES, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: FRIESEM, TAI, KRISHNA, MANOJ
Priority to US11/852,020 priority patent/US8852235B2/en
Priority to US13/346,955 priority patent/US8673008B2/en
Priority to US13/347,202 priority patent/US8673009B2/en
Abandoned legal-status Critical Current

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Definitions

  • This invention relates to devices and surgical methods for the treatment of various types of lumbar spine pathologies. It is specifically directed to the different types of degenerative pathologies in the lumbar spine. It deals with the development of an artificial facet joint, and an artificial lumbar disc replacement that is specifically designed to be inserted from a posterior approach to the spine.
  • Degeneration occurs in a spinal segment.
  • the spinal segment consists of the lumbar disc anteriorly and two facet joints posteriorly. This is therefore called a three joint complex. Degenerative changes in the disc can lead to changes in the facet joint and vice versa. In patients with significant lumbar disc degeneration, the facet joints are also usually degenerate.
  • the facet joint is in fact a synovial joint and suffers from the problems that are known to affect other synovial joints in the body like the hip and the knee.
  • the facet joint particularly contributes to degenerate spondylolisthesis and commonly occurs at levels where the facet joints are sagittally orientated, for example at the L4/5 level.
  • inter-body stabilisation procedure The two types of inter-body stabilisation procedure currently available are an artificial disc replacement performed anteriorly and inter-body fusions performed anteriorly and/or posteriorly. These inter-body stabilisation procedures are often combined with decompression of the spinal canal and the nerve roots if there is nerve root impingement.
  • inter-body fusions there are two basic strategies that surgeons adopt. The first is to perform an anterior inter-body fusion combined with posterior stabilisation externally of the spinal canal. Anterior inter-body fusion on its own is still questioned because it does not provide a posterior tension band.
  • An alternative strategy is a posterior lumbar inter-body fusion, where the entire inter-body fusion procedure is performed from behind and it is combined with neural decompression as well as removal of the degenerative facet joints. Posterior lumbar inter-body fusion also provides a posterior tension band. This strategy therefore deals with all three joint components which can generate possible pain at the disc level, including the lumbar disc, the neural structures and the facet joints.
  • anterior lumbar arthroplasty One of the disadvantages of anterior lumbar arthroplasty is that the facet joints at this level continue to move and also continue to act as a pain generator. In addition, if there is any neural impingement, these symptoms can continue.
  • anterior lumbar arthroplasty is that the majority of spine surgeons are not familiar with the anterior approach, and although complications are uncommon, they can be life and limb threatening when they do occur.
  • a lumbar disc prosthesis including a pair of disc members, the first member of said disc pair having a vertebral endplate contact surface and a recessed portion on an opposing surface thereof, the second member of said disc pair having a vertebral endplate contact surface and a protruding portion on an opposing surface thereof, the protruding portion of the second member engaging with the recessed portion of the first member in use, and wherein the spinal disc prosthesis includes a further pair of disc members, said further pair of disc members also including first and second members.
  • the disc pairs are mirror images of each other.
  • the present invention provides a lumbar disc prosthesis having two disc member pairs and thus two separate articulating portions, one articulating portion on each pair of disc members.
  • the disc member pairs are each independently inserted into the disc space on either side of the dural sac in use through the trans-foraminal or posterior route bilaterally and are provided a spaced distance apart in use to allow accommodation in accordance with the anatomy of the lateral aspect of the disc space.
  • the disc prosthesis can be inserted through the posterior route whilst taking into account the neural anatomy posteriorly.
  • the lumbar disc prosthesis of the present invention can be inserted at all levels between L2 and the sacrum, typically depending on the level of expertise of the operating surgeon.
  • each disc pair is provided in the left and right areas of the disc space respectively in use.
  • the second members of each disc pair are also provided in the left and right areas of the disc space respectively in use.
  • each pair of members constitutes a left and right lumbar disc prosthesis.
  • the recessed portion of the first member is substantially curved and the curvature of the medial part of said recessed portion is asymmetrical to the curvature of the lateral part of said recessed portion.
  • This asymmetry in the medial-lateral plane is to allow “capture” of the protruding portion of the second member. such that when two pairs of disc prostheses are placed in the patient, the two vertebrae can move from side to side as well as anteriorly and posteriorly.
  • the lateral part of the recess has curvature corresponding to an arc of a circle which has a radius greater that of an arc of a circle corresponding to the curvature of the medial part of the recessed portion.
  • the radius of the lateral part is at least twice as big as the radius of the medial part.
  • an anterior part of the recessed portion is substantially symmetrical to a posterior part of the recessed portion.
  • the protrusion portion of the second member is typically of different shape and/or dimensions to the recessed portion of the first member.
  • the protrusion portion is asymmetrical or forms an asymmetrical fit with the recessed portion.
  • the protrusion portion is substantially dome shaped and makes contact with only a part of the recessed portion when assembled.
  • the recessed portion is substantially an inversed dome shape.
  • the protrusion portion is typically symmetrical in the anterior-posterior plane and in the medial to lateral plane.
  • the curvature in the medial to lateral plane can be the same or different to that in the anterior to posterior plane.
  • each of the first and second disc members are provided with at least three sections; a middle section and at least two end sections, the recessed and protruding portions being provided in the middle section of the respective disc members.
  • the thickness or depth of the first disc member is less adjacent the middle section or recessed portion compared to the two end sections thereof.
  • each disc member is typically arranged transversally along the length thereof, i.e. the boundaries of adjacent sections are provided between the medial to lateral sides of the disc members.
  • one or both ends of the first and second disc members have a narrowing taper (i.e. the prosthesis as a whole has a narrowing taper).
  • This narrowing taper is as a result of the outer or vertebral end plate contact surface of said first and/or second disc member being provided at an acute angle with respect to the horizontal at one or both ends.
  • These angled surfaces are preferably substantially planar in form.
  • the outer or vertebral end plate contact surface of the first disc member slopes downwardly towards the ends of the disc member and/or the outer or vertebral end plate contact surface of the second disc member slopes upwardly towards the ends of the disc member.
  • the narrowing taper of the prosthesis allows easy insertion of the prosthesis in the disc space via a posterior route.
  • the narrowing taper is provided at an anterior end of the prosthesis.
  • the outer surfaces or vertebral endplate contact surfaces of the disc member(s) slope towards the opposing surfaces thereof at the anterior end of the disc member(s). This provides a “lead in” feature which increases the ease with which the front of the prosthesis can be inserted via a posterior route into the disc space.
  • a narrowing taper is provided at the posterior end of the prosthesis.
  • the outer surfaces or vertebral endplate contact surfaces of the disc member(s) slope towards the opposing surfaces thereof at the posterior end of the disc member(s).
  • the posterior angled surface allows the prosthesis in the neutral position to be placed such that the vertebral end plates are in lordosis.
  • the posterior end of the prosthesis typically slopes or tapers in an opposite direction to the anterior end.
  • anterior end slope is substantially smaller than the posterior end slope.
  • one or both end sections of the inner or opposing surfaces of said first and/or second members are provided at an acute angle to the horizontal.
  • the inner end section surface of said first member can slope downwardly towards one or both ends of said member.
  • the inner end section surface of said second member can slope downwardly towards the one or both ends of said member.
  • outer and inner surfaces of said second disc member form a narrowing taper towards one or both ends of said disc member.
  • the outer and inner surface of said first disc member form a narrowing taper adjacent an end of said disc member in which attachment screws are to be located therethrough.
  • the geometry of the middle and end sections of the first and second disc members allow contact to be made between the recessed and protrusion portions thereof and for a gap to be formed adjacent the end sections of the disc members when the prosthesis is in a neutral position.
  • extension or flexion i.e. the upper or first disc member moves towards the posterior or anterior end of the lower or second disc member
  • the gap between the end sections at the opposite end increases, thereby causing the annulus in which the disc prosthesis is located to tighten.
  • Due to the geometry of the planar slopes within the prosthesis the annulus will tighten not only posteriorly in flexion but laterally as well.
  • the vertebral endplate contact surface of the first and/or second members of each disc pair is provided with attachment means for allowing attachment of the disc member to an adjacent disc in use.
  • the attachment means can include one or more apertures for the location of screws and/or any other suitable attachment device therewith, one or more tapered members or fins and/or any other conventional attachment apparatus.
  • the first and second members of each pair typically correspond to upper and lower disc members.
  • the superior surface of the lower disc member has a protrusion thereon and the inferior surface of the upper disc member has a captive recess or socket thereon.
  • the recessed portion has two sloped surfaces associated therewith, typically corresponding to the end sections thereof, one surface leading anteriorly to the edge of the inferior surface and one surface leading posteriorly to the edge of the inferior surface.
  • These sloping surfaces can be planar or can be slightly concave in form.
  • the lumbar disc prosthesis can be used in conjunction with a facet joint prosthesis also provided posteriorly to provide a system which can work together as a single unit to replace the painful disc, overcomes neural impingement and painful facet joints.
  • the facet joint prosthesis typically includes a first member for attachment to a first vertebra of a corresponding disc and a second member for attachment to a second vertebra of a corresponding disc in use, and wherein at least a part of said first member is telescopically mounted in at least a part of said second member in use.
  • first and second members are elongate members and the provision of one telescopically mounted in the other allows the distance between parts of the first and second members to be increased and/or decreased as required.
  • the first vertebra is typically an upper vertebra and the second vertebra is typically a lower vertebra.
  • the facet joint prosthesis allows replacement of existing facet joints to be undertaken at all lumbar levels from T12 to the sacrum.
  • the interconnecting first and second members are formed such that they can articulate to allow flexion-extension, small degrees of rotation and side to side flexion.
  • securing means are provided for insertion of the first and second members into each of the vertebral bodies above and below the disc between which the facet joint prosthesis is to be located.
  • the first and second members can then be secured to said securing means.
  • a plurality of first and second members can be attached to the securing means if required to form a stack, thereby allowing facet joint replacement at multiple levels within the spine.
  • the securing means can include any suitable type of surgical securing device, such as a pedicle screw.
  • a lumbar disc prosthesis including a pair of disc members, the first member of said disc pair having a vertebral endplate contact surface and a recessed portion on an opposing surface thereof, the second member of said disc pair having a vertebral endplate contact surface and a protruding portion on an opposing surface thereof, the protruding portion of the second member engaging with the recessed portion of the first member in use, and wherein the recessed portion of the first member is substantially curved and the curvature of the medial part of said recessed portion is asymmetrical to the curvature of the lateral part of said recessed portion.
  • a facet joint prosthesis said prosthesis including a first member for attachment to a first lumbar disc in use and a second member for attachment to a second lumbar disc in use, and wherein at least a part of said first member is telescopically mounted in at least a part of said second member in use.
  • the facet joint prosthesis can be used alone or in combination with the lumbar disc prosthesis of the present invention or with any other lumbar disc prosthesis.
  • the facet joint replacement procedure of the present invention alone will have a role in the treatment of patients with spinal stenosis and adjacent level disc disease, where some stability is required at the disc level without fusing a particular disc segment.
  • the facet prosthesis can partially constraining certain degrees of motion.
  • a prosthesis system including a lumbar disc prosthesis and a facet joint prosthesis as hereinbefore described; a first or upper disc member for inclusion in a lumbar disc prosthesis pair; a second or lower disc member for inclusion in a lumbar disc prosthesis; a method of insertion of a lumbar disc prosthesis in a patient via a posterior route; and a method of insertion of a facet joint replacement prosthesis in a patient via a posterior route.
  • the present invention overcomes the problems and disadvantages associated with current disc replacement strategies. It has all the benefits associated with posterior lumbar inter-body fusion surgery, but at the same time it allows movement at that level and reduces the strain on adjacent discs and the risks of adjacent segment disc failure. This invention also address all three pain generators at the lumbar disc level including the degenerative disc, the impingement of the neural structures, and the facet joint.
  • FIGS. 1-30 relate to a lumbar disc prosthesis according to embodiments of the present invention and FIGS. 31-50 relate to a facet joint replacement prosthesis according to embodiments of the present invention.
  • FIG. 1 is a side view of a lumbar disc prosthesis according to one embodiment of the present invention
  • FIGS. 2-4 show the prosthesis in FIG. 1 with the upper disc member in extension, flexion and in a neutral position respectively;
  • FIGS. 5 and 6 show the superior surfaces of the upper members of the left and right lumbar prosthesis pairs respectively
  • FIGS. 7 and 8 show rear views of the left and right lumbar prosthesis pairs respectively
  • FIGS. 9 and 10 show front views of the left and right lumbar prosthesis pairs respectively
  • FIGS. 11 and 12 show oblique views of the left and right lumbar prosthesis pairs respectively
  • FIGS. 13 and 14 show the superior surfaces of the lower members of the left and right lumbar prosthesis pairs respectively;
  • FIGS. 15 and 16 show rear views of the lower members of the left and right lumbar prosthesis pairs respectively;
  • FIG. 17 is a side view of the lower member of a lumbar prosthesis
  • FIGS. 18 and 19 show front views of the lower members of the left and right lumbar prosthesis pairs respectively;
  • FIGS. 20 and 21 show oblique views of the lower members of the left and right lumbar prosthesis pairs respectively;
  • FIG. 22 is a side view of an upper member of a lumbar prosthesis pair to illustrate the angulations and geometry of the inferior surface thereof;
  • FIG. 23 is a front view of the upper member of the lumbar prosthesis pair to illustrate the radius in the medial and lateral part of the curvature of the inferior surface;
  • FIG. 24 is an oblique view of the upper member of the lumbar prosthesis pair to further illustrate the shape of the inferior articulating surface thereof;
  • FIG. 25 shows a perspective view of the inferior surface of the upper members of the left and right lumbar prosthesis pairs respectively;
  • FIGS. 26 a - d illustrates a) a solid inverse representation of the recess portion shape on the inferior surface of the upper member of the prosthesis b) an axial view of the prosthesis c) a side view and d) a front view showing the medial/lateral asymmetry of the prosthesis;
  • FIG. 27 is a cross section through the upper member of a lumbar prosthesis pair showing the medial lateral curvature of the articulating surface
  • FIG. 28 show front views of the left and right lumbar prosthesis pairs respectively in an alternative embodiment with the screws replaced by fin members;
  • FIGS. 29 a and 29 b illustrate oblique views of the left and right lumbar prosthesis pairs in FIG. 28 joined together and spaced apart respectively;
  • FIGS. 30 a - 30 f show a) superior surfaces of the upper members of the left and right lumbar prosthesis pairs in FIG. 28 b ) a side view c) a front view d) a further side view e) inferior surfaces of the lower members of the left and right lumbar prosthesis pairs and f) oblique views of the pairs;
  • FIG. 31 is a side view of a facet joint replacement prosthesis according to an embodiment of the present invention.
  • FIGS. 32-36 show a front view, end view, side view, rear view and oblique view respectively of the second or female member of the facet replacement prosthesis
  • FIG. 37 is a cross sectional view of the second or female member of the facet replacement prosthesis taken along the line marked A-A in FIG. 34 ;
  • FIGS. 38-42 show a front view, end view, side view, rear view and oblique view respectively of the first or male member of the facet replacement prosthesis
  • FIG. 43 is a cross sectional view of the first or male member of the facet replacement prosthesis taken along the line marked A-A in FIG. 40 ;
  • FIGS. 44 a - 44 d illustrate a side view, front view, perspective view from the rear and perspective view from the front of the facet joint replacement prosthesis in FIG. 31 ;
  • FIGS. 45 a and 45 b illustrate the ability of the male member to move within the female member and produce a flexion and extension movement of the vertebral body respectively;
  • FIG. 46 illustrates end views of the facet replacement prosthesis showing the ability of the male and female components to undergo limited relative rotational movement
  • FIG. 47 illustrates front views of the facet replacement prosthesis showing the ability of the male and/or female components to undergo side to side flexion
  • FIGS. 48 a - 48 d show a side view, front view, perspective view from the rear and perspective view from the front of facet joint prostheses when stacked respectively;
  • FIG. 49 is an enlarged view of the ends of the female and male members of the facet joint prosthesis.
  • FIG. 50 is a cross sectional view taken through a pedicle screw attached to a female member of a facet joint prosthesis.
  • FIGS. 1-30 there is illustrated a lumbar disc prosthesis 2 which can be inserted into a lumbar disc space via a posterior route as a replacement for a diseased and/or damaged lumbar disc.
  • the disc prosthesis 2 includes two pairs of disc members, each pair including an upper disc member 4 , 4 ′ and a lower disc member 6 , 6 ′.
  • disc member 4 refers to the first prosthesis pair upper member
  • disc member 4 ′ refers to the second prosthesis pair upper member.
  • the upper and lower disc members 4 , 6 ; 4 ′, 6 ′ of each pair constitute a left and right disc prosthesis respectively.
  • These disc members are shaped and dimensioned such that they can be inserted into a lumbar disc space either side of the dural sac whilst taking into account the posterior neural anatomy.
  • Each upper disc member 4 , 4 ′ includes a vertebral endplate contacting surface or superior surface 8 , 8 ′ and an inferior surface 10 , 10 ′.
  • Each lower disc member 6 , 6 ′ includes a superior surface 12 , 12 ′ and a vertebral endplate contacting surface or inferior surface 14 , 14 ′.
  • a dome shaped protrusion 16 is formed substantially centrally of superior surface 12 of lower disc member 6 . Protrusion 16 is received in a substantially central recess 18 on inferior surface 10 of upper disc member 4 as will be described in more detail below.
  • each prosthesis pair has a lordosis or narrowing taper angle towards the posterior or rear end 26 of the prosthesis members between the inferior surface 14 of the lower disc member 6 and superior surface 8 of the upper member 4 of approximately 6 degrees (this angle or any other angle mentioned hereinafter is for exemplary purposes and does not limit the invention in any way), as shown in FIG. 1 .
  • outer surfaces of the disc prosthesis pairs at the posterior and anterior ends substantially wedge shaped or tapered to allow ease of insertion into the disc space.
  • the taper or angle of the outer surfaces at the posterior end is in an opposite direction to the taper or angle of the outer surface at the anterior end.
  • the superior surface of upper disc member 4 and the inferior surface of lower disc member 6 have attachment means in the form of screws 28 to allow attachment of the disc prosthesis to adjacent vertebrae when positioned in a patient.
  • Apertures 30 are provided on the inferior and superior surfaces 10 , 12 of the upper and lower disc members 4 , 6 respectively of the prosthesis pairs to allow the insertion of screws 28 through the prosthesis disc members.
  • the screws are typically fitted from the posterior end 26 and the screws and interior walls defining apertures 30 are provided at an acute angle to the vertical to allow ease of attachment. Apertures 30 and screws 28 within each pair diverge outwardly away from each other towards anterior end 24 .
  • the inferior surface on which these apertures are provided on the upper disc member is angled such that it slopes upwardly towards the superior surface of the upper disc member.
  • the superior surface on which these apertures are provided on the lower disc member is angled such that it slopes downwardly towards the inferior surface of the lower disc member, thereby forming a narrowing taper at the posterior end of the lower disc member.
  • These angled surfaces typically form, at least in part, the posterior end segments of the inferior and superior surfaces 48 , 38 of the upper and lower disc members 4 , 6 respectively. This feature is to allow ease of insertion of screws or other attachment means to anchor the prosthesis into the vertebra.
  • the protrusion 16 on lower member 6 located in recess 18 of upper member 4 when the prosthesis is assembled, relative movement between the upper and lower members 4 , 6 allows the prosthesis to undergo extension and flexion.
  • the substantially dome shaped protrusion 16 contacts only a part of the recess 18 due to differences in symmetry and geometry.
  • the upper member 4 can move with respect to the lower member 6 through approximately 10 degrees in a posterior direction to allow extension of the prosthesis, as shown in FIG. 2 .
  • Due to the nature of the inferior surface 10 of upper disc member 4 as the upper member 4 goes into extension there is an increased distance adjacent anterior end 24 between the upper and lower members 4 , 6 . This results in a tightening of the annulus anteriorly, as is seen in physiological extension in the disc.
  • the upper member 4 can also move with respect to lower member 6 through approximately 10 degrees in an anterior direction to allow flexion of the prosthesis, as shown in FIG. 3 . Again, due to the nature of inferior surface 10 , as upper member goes into flexion there is in an increased distance adjacent posterior end 26 between the upper and lower members 4 , 6 . This results in a tightening of the annulus posteriorly and serves as a natural block to further flexion.
  • FIGS. 13-21 there are shown more detailed views of lower disc prosthesis member 6 , 6 ′.
  • the dome shaped protrusion 16 is located in a central or intermediate section of superior surface 12 in the anterior to posterior plane.
  • the anterior and posterior end sections 36 , 38 either side of the dome section 40 , as shown by dotted lines 42 , are provided at an acute angle to the horizontal sloping downwardly from intermediate section 40 towards ends 24 , 26 respectively.
  • the angled surfaces 36 , 38 are typically substantially planar in form. This downwards incline is to accommodate the flexion and extension of the upper disc member 4 without impingement therewith.
  • protrusion 16 extends substantially the entire distance between the sides of the prosthesis member or from the medial to the lateral edges 32 , 34 respectively.
  • FIGS. 22-27 there is illustrated more detailed views of upper disc member 4 showing in particular the curvature and complex geometry of the inferior surface 10 .
  • the surface 10 is divided into three distinct regions as with the superior surface of lower disc member 6 ; a substantially central or intermediate section 44 and anterior and posterior end sections 46 , 48 respectively. Each section typically occupies approximately one third of the inferior surface.
  • the central section 44 is substantially curved and forms an asymmetrical inverse dome shaped recess 18 .
  • the curvature of the recess in the medial half (i.e. portion adjacent medial edge 32 ) of the central section differs to the curvature of the recess in the lateral half (i.e. portion adjacent the lateral edge 34 ) of the central section. More specifically, the medial half of the dome has a curvature corresponding to the arc of a circle having a radius of approximately 15 mm as shown by arrow 50 , whereas the lateral half of the dome has a curvature corresponding to the arc of a circle having a radius of approximately 40 mm, as shown by arrow 52 in FIG. 23 .
  • the curvature of the lateral half of the central section corresponds to an arc of a circle having a radius at least double that of the arc of a circle corresponding to the curvature of the medial half of the central section.
  • the purpose of this asymmetry in the medial/lateral plane is to allow capture of the “dome” shaped protrusion 16 of the lower disc member, but still allow some medial and lateral movement of the disc members. This contributes to stability and prevents dislocation of the upper and lower disc members during movement.
  • the shorter curvature of the medial half of the central section relative to the lateral half helps in the medial and lateral movement of the two vertebral bodies on the right and left prosthesis.
  • the anterior and posterior end sections 46 , 48 are provided at an acute angle to the horizontal, typically approximately 12-14 degrees as shown in FIG. 22 , and provide an incline sloping downwardly from the central section 44 to the anterior and posterior ends 24 , 26 of the inferior surface respectively.
  • the surface of the anterior and posterior end sections that runs from the central section to the edge of the anterior and posterior sections, as seen in FIG. 25 is generally planar, although a mild curvature or concavity to the surface can be provided. It is to be noted that the slope of the anterior section 46 , 46 ′ ends before the anterior end, thereby leaving a small planar surface 54 adjacent anterior end 46 , 46 ′.
  • the edge of the anterior and posterior surfaces is substantially planar, and does not include a radius, so that the distance between the vertebrae increases in flexion and extension.
  • the curvature of the central section recess on the anterior to posterior axis corresponds to an arc of a circle having a radius of approximately 17 mm, as shown by arrow 56 in FIG. 22 .
  • This is designed so that in combination with the other geometric features of the prosthesis, anterior and posterior movement of the upper disc member is allowed with respect to the lower disc member of approximately 10 degrees, as previously described in relation to FIGS. 2 and 3 , even if the prosthesis pairs are not exactly parallel to each other.
  • This geometry is also designed to allow limited sideways (medial/lateral plane) tilt of the upper disc member on the lower disc member, allowing sideways movement of the two disc members on each other, such that the right and the left prosthesis move in tandem.
  • the geometry of the inferior surface of the upper disc member is also designed to allow limited rotation of the right or left prosthesis pairs. This means that if the upper disc member of the right prosthesis pair moves anteriorly, the upper disc member on the left prosthesis pair moves posteriorly allowing limited rotation of the two vertebral members to occur.
  • the aim of the surgical procedure for the disc replacement is to insert the left and right prosthesis pairs as parallel to each other as possible within the disc space.
  • anterior and posterior movement of the pairs will still be possible and the upper and lower disc members will remain articulated during this movement.
  • one disc pair is located at one side of the disc space and the other disc pair is located at the opposite side of the disc space (i.e in the medial lateral plane).
  • alternative attachment means can be provided in the form of fin members 58 on the superior surface 8 of the upper disc member 4 and on the inferior surface 14 of the lower disc member 6 , as shown in FIGS. 28-30 f. Fin members 58 anchor the disc prosthesis to adjacent vertebrae.
  • Fins 58 are substantially triangular in shape and are provided longitudinally of the prosthesis (i.e. between the posterior and anterior ends) towards the medial edge 32 of the disc members, so as to avoid the exiting nerve root which goes across the disc laterally. More specifically, the fins are located adjacent posterior end 26 and end before the lead in feature 20 , 22 at the anterior end to avoid the exiting lumbar nerve root above the disc on the lateral side (i.e. they extend for approximately two-thirds of the disc surface). The fin has a narrowing taper from posterior end 26 towards anterior end 24 .
  • the upper disc members typically move substantially symmetrically on the lower disc members as the upper vertebral body moves forward on the lower vertebral body.
  • the anterior and posterior translations of these upper disc members are limited by a tightening of the anterior and posterior annulus in flexion and extension. This is designed to reflect the physiological process by which the anterior and posterior annulus tightens in flexion and extension in a normal lumbar disc.
  • the end parts of the lateral side 34 of the disc members are curved to accommodate the lateral aspect of the disc space which is similarly curved, thereby allowing better anatomical placement.
  • the lateral side includes an intermediate substantially straight/linear/planar surface with the end portions either side thereof curving inwardly towards the posterior and anterior ends respectively.
  • the medial side 32 of the disc members is substantially straight/linear/planar.
  • Apertures 60 are defined in the posterior end 26 of the upper and lower disc members of each prosthesis pair to allow engagement of an insertion tool therewith so that the prosthesis pairs can be inserted into the disc space. Apertures 60 are typically a spaced distance apart and the apertures on the upper disc member are substantially aligned with the apertures on the lower disc member.
  • Facet joint replacement prosthesis 102 can be used alone, or in combination with the lumbar disc prosthesis described above to form a single unit system. It is designed to replace the entire facet joint on both the right and the left side of the vertebrae.
  • Prosthesis 102 includes a first member or male member 104 and a second member or female member 106 . Both male and female members 104 , 106 are substantially elongate in form.
  • Male member 104 has a first end 108 with securing means in the form of an aperture 110 defined therein and a second end 112 .
  • End 108 is in the form of a flat or planar plate portion 113 and a curved arm portion 114 is provided between this plate portion 113 and end 112 .
  • Female member 106 has a first end 116 with securing means in the form of an aperture 118 defined therein and a second end 120 .
  • End 116 is in the form of a flat or plate portion 117 and a curved channel portion 122 is provided between this plate portion 117 and end 120 .
  • the facet prosthesis 102 is inserted by removing the entire existing facet joint and placing pedicle screws 124 into the vertebral body above and below the disc.
  • End 112 of male member 104 is inserted into end 120 of channel 122 of female member 106 and the ends of the pedicle screws 123 are threaded through apertures 118 and 110 and secured with a nut 126 .
  • the edge of plate portions 113 and 117 which define apertures 118 and 110 are tapered inwardly so as to allow a good fit with a tapered or conical shaped locking nut 126 , as shown in FIG. 50 .
  • a further spacing or locking nut 127 can also be provided.
  • Male member 104 has a rear or posterior 128 and a front or anterior surface 130 .
  • the anterior surface 130 of arm portion 114 is typically substantially concave in shape and the posterior surface 128 of arm portion 114 is typically substantially convex in shape. As such, when member 104 is fitted to pedicle screw 124 in use, anterior surface 130 typically faces the vertebrae to which it is to be attached.
  • Female member 106 has a rear or posterior surface 132 and a front or anterior surface 134 .
  • the anterior surface 134 of channel portion 122 is typically substantially concave in shape and the posterior surface of channel portion 122 is typically substantially convex in shape. As such, when member 106 is fitted to pedicel screw 124 in use, anterior surface 134 typically faces the vertebrae to which it is to be attached.
  • the prosthesis curves outwardly from the vertebrae and outwardly of the plate portions 117 and 113 .
  • Arm portion 114 of male member 104 is freely slidable or movable in channel portion 122 of female member 106 .
  • the curvature of the male and female members is substantially the same.
  • the male member 104 is of slightly smaller dimensions than the interior dimensions of channel portion 122 , such that there is a small gap therebetween to allow some sideways movement, as shown by arrows 150 in FIG. 47 , and rotation of the male member in the female member, as shown by arrows 152 in FIG. 46 .
  • the male member can also move longitudinally in the female member to allow flexion and extension of the prosthesis and thus the vertebral body, as shown by arrows 154 in FIGS. 45 a and 45 b.
  • End 120 of channel portion 122 has curved ends 136 and straight side walls 138 or side walls of less curvature than said curved ends to form a flattened oval shape, as shown in FIG. 49 .
  • Preferably side walls 138 form part of an arc, the radius of which is larger than for the arc of the curved ends 136 .
  • End 112 of arm portion 114 is substantially complementary in shape to end 120 having curved ends 140 and straight side walls 142 or side walls of less curvature than said curved ends.
  • Preferably side walls 142 form part of an arc, the radius of which is larger than for the arc of the curved ends 140 .
  • the provision of the shaped ends allows a small degree of rotation of the male component in the female component.
  • the anterior surface 134 of channel portion 122 has a slot 144 provided longitudinally thereof. Slot 144 is of such a width that the channel portion encloses approximately 70% of the male member 104 when interconnected therewith and is provided to allow some lateral flexion and/or extension and rotation between the male and female members.
  • a left and right pair of facet joint prostheses are located between the disc on each side thereof. It is irrelevant whether the female or the male member is uppermost and thus the position of the members is interchangeable.
  • the facet prosthesis can be used at two adjacent levels, and anchor into pedicle screws, as seen in FIGS. 48 a - 48 d.
  • a middle pedicle screw 124 ′ can be used to accommodate two plate portions of the male and/or female members to form a stack. Any number of members can be attached to a pedicle screw as required.
  • the prosthesis can be formed from any suitable material, such as for example, stainless steel, ceramics, titanium, carbide or other suitable metal alloys.
  • the surface of the prosthesis can be provided slightly roughened so as to increase bonding of the same with bone and/or one or more surface coatings can be provided thereon, such as for example, hyroxyapitite or plasma spray.
  • the two pairs of lumbar disc prosthesis and the two pairs of facet joint prosthesis can be used to form a system designed to allow an arthroplasty to be performed through the posterior route, allowing movement between the vertebral bodies as well as restoring stability between the two vertebral bodies by allowing normal load transmission across the disc, freeing up the neural structures and replacing the facet joints as well.

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US10/970,091 2004-10-15 2004-10-21 Posterior spinal arthroplasty-development of a new posteriorly inserted artificial disc and an artificial facet joint Abandoned US20060085076A1 (en)

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US11/203,259 US20060089717A1 (en) 2004-10-15 2005-08-12 Spinal prosthesis and facet joint prosthesis
US11/397,756 US20060265074A1 (en) 2004-10-21 2006-04-04 Posterior spinal arthroplasty-development of a new posteriorly inserted artificial disc, a new anteriorly inserted artifical disc and an artificial facet joint
US11/852,020 US8852235B2 (en) 2004-10-15 2007-09-11 Posteriorly inserted artificial disc and an artificial facet joint
US13/346,955 US8673008B2 (en) 2004-10-21 2012-01-10 Posterior spinal arthroplasty system
US13/347,202 US8673009B2 (en) 2004-10-21 2012-01-10 Spinal prosthesis and facet joint prosthesis

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GB0422963A GB0422963D0 (en) 2004-10-15 2004-10-15 Posterior spinal arthroplasty-development of a new posteriorly inserted artifical disc and an articial facet joint
GB0516258A GB0516258D0 (en) 2005-08-08 2005-08-08 Posterior spinal arthroplasty-development of a new posteriorly inserted artificail disc,a new anteriorly inserted artificial disc and an artificial facet

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US11/852,020 Division US8852235B2 (en) 2004-10-15 2007-09-11 Posteriorly inserted artificial disc and an artificial facet joint

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EP1738721A3 (fr) 2009-12-02
EP1738721A2 (fr) 2007-01-03
EP1738722A3 (fr) 2009-12-02
EP1738722A2 (fr) 2007-01-03
US8852235B2 (en) 2014-10-07
US20060089717A1 (en) 2006-04-27
US20080033562A1 (en) 2008-02-07
EP1647243A2 (fr) 2006-04-19
EP1647243A3 (fr) 2006-06-21

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