Artificial intervertebral disc
An artificial intervertebral disc for at least partially replacing a diseased or damaged intervertebral disc. The artificial disc includes a concave-convex articulating surface. The artificial disc can be used in the cervical region of the spine, where a concave-convex articulating surface is advantageous for improved anatomical fit and region appropriate kinematics. The artificial disc of the present invention also includes an anchor for attachment to bone.
The present invention generally relates to an apparatus for the treatment of spinal disorders and, in particular, an artificial intervertebral disc, an implant that replaces a diseased or damaged intervertebral disc.
BACKGROUND OF THE INVENTIONThere are many painful disorders of the spine, many relating, at least in part, to diseased or damaged intervertebral discs. Disorders include Degenerative Disc Disease, generally an age related disorder where the intervertebral disc gradually loses its water content, resiliency, and height. With a loss in intervertebral disc height and associated loss of normal spacing between vertebrae, motion of the vertebrae can place pressure on the spinal cord or exiting nerve roots. The intervertebral disc itself can also be a source of pain. Spinal disorders, commonly referred to as disc herniation and bulging disc, place painful pressure on the spinal cord and exiting nerve roots. Abnormal bone growth, called osteophytes, can place pressure on nerves or the spinal cord. Often, a surgeon must at least partially remove an intervertebral disc to access and remove an osteophyte.
A surgical approach to treating chronic spinal disorders relates to bony fusion of two adjacent vertebrae in a treatment called spine fusion. Following the achievement of appropriate spacing and alignment of the vertebral bodies, bone graft material and stabilization provide an environment for spine fusion. Implant systems, to include plate and rod systems and interbody devices, such as, interbody spacers and fusion cages can be used to support the spine during fusion. Concerns persist regarding spinal fusion treatment stemming from modest clinical success rates and the creation of rigid regions along an otherwise flexible spine.
Artificial intervertebral discs, or simply artificial discs, are an alternative to spinal fusion and represent an emerging technology. These spinal implants are designed to restore or maintain the appropriate alignment and spacing of adjacent vertebral bodies. In addition, an artificial disc is also designed for kinematic behavior similar to a healthy natural disc. Known artificial disc concepts use numerous means for providing motion and stiffness similar to a natural healthy disc, to include the adaptation of elastomers, mechanical springs, and articulating surfaces.
Prior art artificial discs often use articulating surfaces to create a joint between adjacent vertebrae. Disc implants using articulating surfaces rely on methodology and proven technology used in total joint arthroplasty of the hip, knee, and shoulder. Numerous prior art artificial discs resemble artificial hip and artificial knee joints. Numerous known artificial disc devices resemble variations of a ball-and-socket. Kuntz, in U.S. Pat. No. 4,349,921 (Sep. 21, 1982) discloses an artificial disc, with two components that articulate by means of a projection on one component pivotally engaging a depression on the second component. An artificial disc resembling an artificial knee joint has also been suggested. Shelokov, in U.S. Pat. No. 6,039,763 (Mar. 21, 2000) discloses an artificial spinal disc, similar in configuration to an artificial knee joint.
Heggeness et. al., in U.S. Pat. No. 5,514,180 (May 1996) categorizes the shape or contours of vertebral endplates into five groups: “ramp”, “saddle”, “irregular”, “bowl”, and “hump”. Heggeness et. al., teaches the importance of endplate shape relating to fit and load distribution of a prosthetic devices within intervertebral disc spaces, but Heggeness et. al. does not discuss endplate shape relating to articulating surfaces or spinal kinematics.
Spine kinematics and anatomical shapes vary by region of the spine (cervical, thoracic, and lumbar), and a need exists for artificial discs addressing specific regions of the spine, especially the unique geometry and kinematics of the cervical spine.
SUMMARY OF THE INVENTIONFor the middle and lower regions of the cervical spine, the artificial disc of the present invention adapts an articulating surface with a concave-convex shape, also called a saddle shape. The artificial disc of the present invention is intended to fit substantially within the intervertebral space bound by adjacent vertebral bodies. A bone anchor for fixation of an artificial disc to vertebra is also disclosed.
A first embodiment of the artificial disc of the present invention for the cervical spine includes a disc body having an articulating concave-convex surface secured to a base plate, which may incorporate a bone anchor. A second embodiment of the artificial disc of the present invention is comprised of an articulating concave-convex surface, bone anchor, and a disc body slidably attached to a base plate to permit additional motion. A third embodiment of the artificial disc of the present invention includes an upper disc body and a lower disc body cooperatively forming a saddle-joint. The upper disc body and lower disc body of the third embodiment are securely anchored to vertebral bodies using bone anchors. Further embodiments of the artificial disc of the present invention include an upper disc body and a lower disc body cooperatively forming a saddle-joint, and bone anchors adapted with a tension element to provide additional stability.
BRIEF DESCRIPTION OF THE DRAWINGS
Consistent with common medical nomenclature, superior is nearer the head in relation to a specific reference point, whereas, inferior is nearer the feet in relation to a specific reference point. Anterior is forward in relation to a specific reference point and posterior is rearward in relation to a specific reference point. The midsagittal plane is an imaginary plane dividing the body into a right side and left side. A frontal plane is any imaginary vertical plane orthogonal to the midsagittal plane.
Primarily addressing the middle and lower cervical spine, the present invention uses a generally concave-convex articulating surface. As will become apparent in subsequent discussion, a concave-convex articulating surface is an essential element of the present invention, providing anatomical and biomechanical advantages. Referring now to
The anatomically aligned shape of the present invention also has biomechanical benefits associated with natural kinematics of the spine. To assist with the analysis of spine kinematics, Panjabi and White established the Instantaneous-Axis-of-Rotation (IAR) for planer motion analysis of vertebrae. Planar motion of vertebrae is fully described by the position of the IAR and the angle of rotation about the IAR. The IAR is an instantaneous measure and therefore may shift within a region through a range-of-motion, such as, but not limited to, flexion/extension range-of-motion. The present inventors have discovered a relation between the shape of a vertebra's inferior endplate and the natural motion of the same vertebra.
Flexion/extension is the most commonly considered degree-of-freedom when evaluating cervical spine kinematics.
Within the scope of the present invention, multiple components may be allowed to articulate to address multiple degrees-of-freedom associated with spinal motion, to include, but not limited to, torsional and translational degrees-of-freedom. Accordingly,
For a number of reasons, to include anatomical variation, the inferior endplate of a superior vertebra may not be suitable as an articulating surface. During treatment of a cervical spine disorders, endplates are often partially or completely removed in order to access and remove offending soft tissue (e.g., extruded disc nucleus) or offending hard tissue (e.g., posterior bone spurs). A total joint artificial disc is often warranted. Accordingly,
Using an anterior approach to the cervical spine, the anterior longitudinal ligament is at least partially resected with associated loss of stability, especially in extension. An artificial disc with a tension element provides stability during extension. Referring now to
Within the scope of the current invention, an artificial disc may have an upper articulating surface and a lower articulating surface for sliding interaction with vertebral bodies.
The present invention, to include, but not limited to the aforementioned embodiments, can be constructed of established orthopaedic materials. Established wear resistant materials for components with articulating surfaces include metals (e.g., stainless-steel, cobalt-chrome, and titanium), plastics (e.g., Ultra-High-Molecular-Weight-Polyethylene), and ceramics (e.g., alumina and zironia). Non-articulating features of an artificial disc of the present invention may have features or material characteristics to facilitate rigid attachment to bone. An artificial disc of the present invention may be adapted additional features known for attachment to bone including, but not limited to, spikes, screws, serration, and plate-like appendages generally exterior to the intervertebral disc space. Components may be made, in part, constructed of substantially porous materials for bone in-growth, yet have smooth non-porous regions for articulating surfaces. Surface treatments commonly practiced, such as beaded-coatings, may also be used for attachment to bone through eventual bone in-growth. In addition, within the scope of the current invention, components may be given flexibility through the use of geometry and materials to replicate the cushioning characteristics of the natural intervertebral disc. Additional components, such as, springs might be added to provide flexibility. In addition, portions of the patient's annulus may remain intact, such that the present invention augments a patient's existing intervertebral disc. Although the utility of the disclosed artificial disc is best achieved in the cervical region of the spine, adaptations for the thoracic and lumbar regions of the spine are also within the scope and spirit of the present invention.
Claims
1. A prosthetic disc comprising:
- A disc body, having a disc body base surface having a center point having a base surface central normal vector extending therefrom; and a disc body articulating surface opposite the disc body base surface, the articulating surface being concave with respect to a first disc body plane parallel to the base plate central normal vector, and being convex with respect to a second disc body plane, parallel to the base plate central normal vector and orthogonal to the first disc body plane.
2. The prosthetic disc of claim 1 wherein the second disc body plane is the midsagittal plane.
3. The prosthetic disc of claim 1 wherein the curve of the articulating surface in the first disc body plane is parabolic.
4. The prosthetic disc of claim 1 wherein the curve of the articulating surface in the first disc body plane is hyperbolic.
5. The prosthetic disc of claim 1 wherein the curve of the articulating surface in the first disc body plane follows a radius.
6. The prosthetic disc of claim 1 wherein the curve of the articulating surface in the second disc body plane is parabolic.
7. The prosthetic disc of claim 1 wherein the curve of the articulating surface in the second disc body plane is hyperbolic.
8. A prosthetic disc comprising:
- A disc body, having a disc body base surface and a disc body articulating surface opposite the disc body surface, wherein at least a substantial region of said disc body articulating surface is concave-convex.
9. The prosthetic disc of claim 9 wherein the disc body articulating surface is a hyperbolic paraboloid.
10. The prosthetic disc of claim 9 wherein the curve of the articulating surface in a first disc body plane is parabolic.
11. The prosthetic disc of claim 9 wherein the curve of the articulating surface in a first disc body plane is hyperbolic.
12. The prosthetic disc of claim 9 wherein the curve of the articulating surface in a first disc body plane follows a radius.
13. The prosthetic disc of claim 12 further comprising a base plate secured to the disc body base surface.
14. The prosthetic disc of claim 13 wherein the base plate comprises an anchor.
15. A method of installing a prosthetic disc comprising the steps of:
- removing a portion of an intervertebral disc, thereby creating an intervertebral disc space, and
- placing a prosthetic disc substantially within said intervertebral disc space;
- wherein the prosthetic disc comprises: a disc body, having a disc body base surface having a center point having a base surface central normal vector extending therefrom; and a disc body articulating surface opposite the disc body base plate surface, the articulating surface being concave along a first disc body plane parallel to the base plate central normal vector, and being convex along a second disc body plane, parallel to the base plate central normal vector and orthogonal to the first disc body plane.
16. A prosthetic disc comprising:
- A first disc body, having a first disc body base surface having a first vector extending normally therefrom, and a first disc body articulating surface opposite the first disc body base surface, the articulating surface being concave along a first disc body first plane parallel to the first vector, and being convex along a first disc body second plane, parallel to the first vector and orthogonal to the first disc body first plane, the outer regions of the first disc body articulating surface along and adjacent to the first disc body first plane defining a first disc body concave region and the outer regions of the first disc body articulating surface along and adjacent to the first disc body second plane defining a first disc body convex region;
- a second disc body, having a second disc body base surface having a second vector extending normally therefrom, and a second disc body articulating surface opposite the second disc body base surface, the articulating surface being concave along a second disc body first plane parallel to the second vector, and being convex along a second disc body second plane, parallel to the second vector and orthogonal to the second disc body first plane, the outer regions of the second disc body articulating surface along and adjacent to the second disc body first plane defining a second disc body concave region and the outer regions of the second disc body articulating surface along and adjacent to the second disc body second plane defining a second disc body convex region;
- the first disc body articulating surface and the second disc body articulating surface being disposed in abutting relationship, and oriented such that at least a portion of the first disc body concave region is mated to at least a portion of the second disc body convex region or at least a portion of the first disc body convex region is mated to at least a portion of the second disc body concave region.
17. An artificial disc suitable for placement between adjacent vertebra comprising:
- a first disc body, having a first disc body base surface and a first disc body articulating surface opposite said first disc body surface, wherein at least a substantial region of said first disc body articulating surface is a hyperbolic paraboloid; and
- a second disc body, having a second disc body base surface and a second disc body articulating surface opposite said second disc body surface, wherein at least a substantial region of said second disc body articulating surface is a hyperbolic paraboloid, and wherein said second disc body articulating surface is substantially reciprocal to first disc body articulating surface, wherein said first disc body articulating surface and said second disc body articulating surface being disposed in abutting relationship and cooperatively form a saddle-joint.
18. An artificial disc suitable for placement between adjacent vertebra comprising:
- an upper body having an upper body base surface and an upper body concave-convex articulating surface opposite said first disc body base surface; and
- a lower body, having a lower body base surface and a lower body concave-convex articulating surface opposite said lower body base surface;
- the upper body and lower body forming a saddle joint by the reciprocal reception of the lower body concave-convex articulating surface with the upper body concave-convex articulating surface.
Type: Application
Filed: Jan 28, 2004
Publication Date: Jul 28, 2005
Inventors: Nabil Muhanna (Gainesville, GA), Lance Middleton (Trumball, CT)
Application Number: 10/766,684