PROSTHETIC IMPLANT WITH BIPLANAR ANGULATION AND COMPOUND ANGLES
A prosthetic implant, and more particularly, with a prosthetic implant having biplanar angulation and that can be inserted into a disk area generally straight using a posterolateral approach.
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This application is a continuation of U.S. patent application Ser. No. 12/336,753, filed Dec. 17, 2008, which is incorporated herein by reference and made a part hereof.
BACKGROUND OF THE INVENTION1. Field of the Invention
This invention relates to a prosthetic implant, and more particularly, with a prosthetic implant having a biplanar angulation to permit insertion straight along a diagonal angle into a disk space.
2. Description of the Related Art
Spinal fusion is a commonly performed procedure. In a typical spinal fusion operation, a surgeon places a mechanical container, commonly known as a cage, between at least two adjacent vertebrae of the spine. This container contains or is later filled with bone graft which eventually incorporates into the adjacent vertebrae and creates a solid fusion. Interbody cages are placed in the disk space following removal of the disk. The cage can be surgically placed via several approaches, such as anteriorly through the abdomen, posteriorly through the spinal canal, posterolaterally through the neuroforamen of the vertebra, and transversely from a side of the spine. A goal of the surgical approach is to minimize trauma to adjacent structures and incision size.
A challenge to the placement of cages is the attainment of proper fitment between the adjacent vertebrae. It is important that a cage surface fits flushly against the endplates of the adjacent vertebrae. If a cage fits poorly, the cage could loosen, causing poor fixation and potential re-operation. The disk space, where the cage is placed, is not parallel. The space is angulated such that it is wider anteriorly than posteriorly. This angulation is termed lordosis.
Several cage designs have been proposed in the prior art. Brantigan (U.S. Pat. No. 4,834,757) describes a square shaped cage which is impacted in between vertebrae. Michelson (U.S. Pat. No. 5,015,247) describes a straight threaded cage which is screwed into the disk space. Brantigan (U.S. Pat. No. 5,425,772) and Michelson (U.S. Pat. No. 6,302,914) describe a cage with a built in single-plane lordotic angle to improve fitment between adjacent vertebrae. These cages are designed for posterior or anterior placement.
The placement of cages from posterior, lateral, and anterior approaches raise concerns about potential impingement upon important anatomical structures. Such structures are the spinal canal, the spinal nerves, and the abdominal vasculature, respectively. The posterolateral approach, also called the transforamenal approach, is gaining popularity as the preferred approach for the placement of intervertebral fusion cages. Typically, cages designed for this approach are “banana shaped,” as exemplified by Varga, et al (U.S. Pat. No. 6,579,318).
A significant difficulty with banana-type cages is that their placement requires cage rotation at the time of placement to seat the cage in place. The cage is inserted at a 45 degree lateral angle into the disk space (the maximum angle limited by anatomical structures) and is then rotated a further 45 degrees within the disk space for proper placement. This rotational step is difficult in that it occurs blindly inside the disk space. Incomplete rotation frequently occurs, resulting in poor cage fitment, with potential loosening and reoperation.
If a Brantigan (U.S. Pat. No. 4,834,757) cage were inserted in a diagonal or non-straight trajectory, it would not have flush contact with the adjacent vertebrae due to the lordotic angle of the disk space. Furthermore, a standard lordotic cage, such as Michelson (U.S. Pat. No. 6,302,914), would have its lordotic angle in the incorrect orientation for proper fitment if placed diagonally.
What is needed is a cage that can be placed via the posterolateral approach in a straight manner and that does not require a further rotation for placement. Desirably, such a cage will be placed at a straight angle relative to an anterior-posterior axis and, preferably, at a diagonal or angle, such as approximately 45 degrees and reside in a diagonal configuration within the disk space.
SUMMARY OF THE INVENTIONAccordingly, one object of the invention is to provide a cage having a biplanar angulation.
Another object of the invention is to provide a cage that has a biplanar angulation and that may be inserted straight into a disk space, at an angle or diagonally relative to the anterior-posterior axis of the spine.
Still another object of the invention is to provide a cage having a biplanar angulation and that minimizes or eliminates the need for rotation after the cage is inserted into the disk space.
Yet another object of the invention is to provide a cage having lateral slots or channels for insertion of a tool or instrument to facilitate placement of the cage.
In one aspect, this invention comprises a fusion cage comprising a cage body having a plurality of surfaces, the plurality of surfaces cooperating to define a multi-planar angulation adapted to achieve substantially flush fitment in a disk space between adjacent vertebrae when the fusion cage is inserted in the disk space.
In another aspect, this invention comprises a method for fusing bones, the method comprising the steps of providing a cage adapted to be inserted into a disk area substantially diagonally or in an angled direction with respect to an anterior-posterior axis, the cage having a first surface lying in a first plane and a second surface lying in a second plane, and inserting the cage in the substantially diagonal or angled direction such that the first and second surfaces engage a surface of a first vertebrae and a second vertebrae substantially flush.
These and other objects and advantages of the invention will be apparent from the following description, the accompanying drawings and the appended claims.
Referring now to
Notice in
As illustrated in
The rear surface or end 30 comprises an interior wall 30a having a threaded aperture 40 for receiving an instrument or bone graft material after the cage 10 is inserted substantially straight or linearly into the disk area 11 using the posterolateral or transforamenal approach.
The cage 10 further comprises a side or third surface 42 and a generally opposing side or fourth surface 44 as shown. Note that the third surface 42 comprises a plurality of interior walls 42a and 42b that define apertures 46 and 48, respectively. Similarly, fourth surface 44 comprises interior walls 44a and 44b that define apertures 50 and 52, respectively, as shown. As illustrated, the apertures 46 and 48 are generally opposed to the apertures 50 and 52, respectively, and provide lateral openings adapted to permit graft material to be inserted into an open cage area 54 for fusing the vertebrae 12 and 14 together. Thus, it should be understood that the bilateral openings or apertures 46, 48, 50 and 52 facilitate insertion of bone graft material (not shown) and for bone ingrowth. The inferior and superior openings 24 and 26 further facilitate bone ingrowth.
The surfaces 42 and 44 each comprise a plurality of generally U-shaped walls or surfaces 42c, 42d and 44c, 44d, respectively, to define a first lateral slot 60 and a second lateral slot 62, respectively, for facilitating the placement of the cage 10 using an insertion tool or a surgical instrument 61 (
The insertion tool or surgical instrument 61 has a hollow tubular portion 61 a that receives a rotatable shaft extension 67 having an end 69 that is threaded so that it can be screwed or threaded into the threaded aperture 40, as illustrated. During use, the surgeon would place the rotatable shaft extension 67 until the cage 10 becomes secured or fixed to the insertion tool or surgical instrument 61.
After placement of the cage 10, the rotatable shaft extension 67 is rotated counterclockwise from the cage 10. Note that the insertion tool or surgical instrument 61 or tubular portion 61 a may have indicia 71 for indicating to the surgeon or user the proper orientation of the cage 10, thereby reducing or eliminating the chance that the cage 10 would be improperly placed, for example, upside down into the disk area 11.
Referring now to
Returning to the description in the illustration of
Stated another way, the cage 10 comprises a longitudinal axis LA (
One important feature of the cage 10 is that the opposing surfaces 18 and 20 in the illustration provide, are arranged or are adapted to cooperate to define one or more compound angles or a biplanar angulation so that the surfaces 18 and 20 become in substantially flush contact with the surfaces 12a and 14a, respectively, when the cage 10 is inserted substantially straight or linearly on a diagonal or angle into the disk area 11 using a posterolateral or transforamenal approach and, if necessary, rotated as described herein.
During a surgical procedure it should be understood that the cage 10 is inserted generally straight or linearly at an angle or on a diagonal trajectory relative to the anterior-posterior axis AP (
As a size of the cage 10 increases, a length difference, for example, between segments EF-CD will be greater as the cage 10 gets larger because a larger amount of the lordotic angle is covered by the cage, and segments or dimensions AB-GH will also be greater.
In the illustration in
Continuing with the illustration, a cage 10 is shown in
Advantageously, the implant, system and method provides means for adapting and selecting a cage 10 in response to the relationship between the surfaces 12a and 14a as well as the placement of the cage 10 using a posterolateral approach and the position of the cage 10 in the disk area 11. In some cases, it may be necessary to use a cage 10 having larger or smaller longitudinal angles BA3 and BA4 and smaller cross-sectional angles BA1 and BA2, while in other environments it may be desired to use a cage 10 having relatively larger cross-sectional angles BA1 and BA2 and smaller biplanar angles BA3 and BA4. The angles BA1 and BA2 can be changed relative to each other as can angles BA3 and BA4.
Thus, it should be appreciated that the invention provides a cage 10 having biplanar and angulation defining compound angles that can adapt to various environments such that the surfaces 18 and 20 provide a snug fit against the surfaces 12a and 14a, respectively.
As alluded to earlier herein, the cage 10 could assume different shapes, such as trapezium, ellipsoid, circular, oval, arcuate or other shapes. In this regard, and as described earlier herein, the embodiment of
In this illustrative embodiment, the cage 10 is not symmetrical about the longitudinal horizontal plane LHP illustrated in
As illustrated in
Thus, it should be understood that the cage 10 is selected and/or adapted to comprise a biplanar angulation and to permit a posterior-lateral insertion into the disk area 11. The cage 10 is selected or adapted such that it will provide a flush fitmet in a lordotic disk space when placed diagonally via a posterolateral approach. Advantageously, the cage 10 provides biplanar angulation to allow for full surface contact with the surfaces 12a and 14a of the adjacent vertebrae 12 and 14, respectively, when placed at the angled or diagonal trajectory. Note that the cage 10 is inserted in the angled or diagonal trajectory and that the superior and inferior cage surfaces 18 and 20 are in flush or substantially flush engagement with the surfaces 12a and 14a.
It should be understood that while the embodiments illustrated in
During use, the insertion tool or surgical instrument 61 (
Advantageously, the prosthetic implant or fusion cage 10 provides many advantages, some of which include:
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- a fusion cage wherein the plurality of surfaces cooperate to define a biplanar angulation;
- a fusion cage wherein the cage body has a first surface generally opposed to a second surface, the first and second surfaces cooperating to define a compound angle and defining a biplanar angulation;
- a fusion cage wherein the at least one of the first or second surfaces are arcuate or convex in cross-section;
- a fusion cage wherein the first surface and the second surface converge along a longitudinal axis and in a direction generally perpendicular to the longitudinal axis, the first and second surfaces cooperating to define the compound angle;
- a fusion cage wherein the first surface lies in a first plane and the second surface lies in a second plane, the first and second planes being non-parallel in cross-section along a longitudinal axis and in cross-section along an axis generally perpendicular to the longitudinal axis;
- a fusion cage wherein the cage body comprises a longitudinal plane along a longitudinal axis and a cross-sectional plane along a cross-sectional axis that is generally non-parallel to the longitudinal axis, the cage body being non-symmetrical about either of the longitudinal plane or the cross-sectional plane;
- a fusion cage wherein the cage body comprises a first surface and a second surface coupling the plurality of surfaces, the first surface defining a first surface area and the second surface defining a second surface area, wherein the first and second surface areas are different;
- a fusion cage wherein the cage body defines a trapezoid or trapezium in a cross-sectional plane that is generally perpendicular to a longitudinal axis;
- a fusion cage wherein the trapezoid or trapezium gets smaller along the longitudinal axis from a first end to a second end;
- a fusion cage wherein the cage body defines a second trapezoid or trapezium in a second cross-sectional plane that is generally perpendicular to a longitudinal axis, the cross-sectional plane and the second cross-sectional plane being different in shape or area;
- a fusion cage wherein a first surface of a first vertebrae cooperates with a second surface of a second vertebrae to define the disk space, the cage body comprises a top defining a top surface for engaging the first surface of the first vertebrae and a bottom surface for engaging the second surface of the second vertebrae, wherein the cage body is adapted to cause the top and bottom surfaces of the cage body to engage the first and second surfaces substantially flush after the fusion cage is inserted into the disk space at an angled or diagonal trajectory;
- a fusion cage wherein the cage body comprises at least one channel or slot generally parallel to a longitudinal axis of the cage body, the at least one channel or slot being adapted for receiving an insertion instrument;
- a fusion cage wherein the cage body comprises at least one aperture adapted for receiving an insertion instrument;
- a fusion cage wherein the insertion instrument comprises indicia to facilitate proper placement of the fusion cage;
- a fusion cage wherein the plurality of surfaces comprise a first surface that lies in a first plane and a generally opposed second surface that lies in a second plane, the first and second surfaces cooperating to define a compound angle;
- a fusion cage wherein the compound angle is adapted to cause the first and second surfaces to engage the first and second vertebrae substantially flush when the fusion cage is inserted at an angled or diagonal trajectory into a disk area;
- a fusion cage wherein each of the plurality of surfaces comprises an opening, the cage body having at least one of a longitudinal slot or an opening adapted to receive a surgical instrument;
- a fusion cage wherein the cage body comprises a longitudinal axis and a cross-sectional axis, each of the first and second surfaces cooperating to define a first angle along the longitudinal axis and a second angle along the cross-sectional axis, each of the first and second angles being an acute angle;
- a fusion cage wherein the first and second angles are different;
- a fusion cage wherein the cage body is adapted such that when it is inserted substantially diagonally or angled with respect to an anterior-posterior axis, the first and second surfaces engage the first and second vertebrae substantially flush;
- a fusion cage wherein the first and second vertebrae cooperate to define a second compound angle, the second compound angle being adapted so that the first and second surfaces engage the first and second vertebrae substantially flush when the cage body is inserted into s disk area substantially diagonally or angled with respect to an anterior-posterior axis;
- a fusion cage wherein the first and second angles are different;
- a fusion cage wherein the cage body comprises a shape that is polygonal and non-circular in any plane;
- a fusion cage wherein the plurality of surfaces comprises a first planar surface and a generally opposed second planar surface, the cage body is symmetrical about a diagonal axis across the first planar surface;
- a fusion cage wherein the fusion cage is symmetrical about a longitudinal horizontal plane;
- a fusion cage wherein the fusion cage is asymmetrical about a longitudinal horizontal plane;
- a fusion cage wherein the fusion cage is asymmetrical about a longitudinal vertical plane;
- a fusion cage wherein the fusion cage is asymmetrical about a longitudinal vertical plane;
- a fusion cage wherein the at least one aperture defines a plurality of lateral slots;
- a fusion cage wherein the plurality of lateral slots comprise different dimensions to receive a plurality of projections, respectively, of a surgical instrument, the plurality of projections being adapted or sized to generally complement a size of the plurality of lateral slots;
- a method for fusing bones wherein the method further comprises the step of providing a cage having the first and second surfaces that cooperate to define a compound angle to provide a biplanar angulation;
- a method for fusing bones wherein the method further comprises the step of providing a cage having a cage body comprising a longitudinal plane along a longitudinal axis and a cross-sectional plane along a cross-sectional axis that is generally perpendicular to the longitudinal axis, the cage body not being volumetrically symmetrical about either of the longitudinal plane or the cross-sectional plane;
- a method for fusing bones wherein the method further comprises the step of providing a cage having a first surface and a second surface and a first side and a second side coupling the first and second surfaces, the first side defining a first side area, the second side defining a second side area, wherein the first and second side areas are different;
- a method for fusing bones wherein the method further comprises the step of providing a cage that defines a trapezoid or trapezium in a cross-sectional plane that is generally perpendicular to a longitudinal axis;
- a method for fusing bones wherein the method further comprises the step of providing a cage having a first surface generally opposed to a second surface, the first and second surfaces defining a compound angle and cooperating to define a biplanar angulation;
- a method for fusing bones wherein the method further comprises the step of providing a cage with the first surface lying in a first plane and the second surface lying in a second plane, the first and second planes being non-parallel and defining a plurality of acute angles;
- a method for fusing bones wherein the inserting step occurs during a posterolateral approach;
- a method for fusing bones wherein the method further comprises the step of providing a plurality of different sized cages from which a user selects the cage;
- a prosthetic implant system wherein the fusion cage has a plurality of slots and the insertion tool comprises a plurality of projections adapted for receiving in the plurality of slots;
- a prosthetic implant system wherein the plurality of slots have different dimensions and the plurality of projections generally complement the shape of the plurality of slots;
- a prosthetic implant system wherein the fusion cage comprises a threaded aperture, the insertion tool comprising a threaded member for screwing into the threaded aperture to secure the fusion cage to the insertion tool;
- a prosthetic implant system wherein the insertion tool comprises indicia to facilitate proper placement of the fusion cage;
- a prosthetic implant system wherein the fusion cage has a plurality of slots and the insertion tool comprises a plurality of projections adapted for receiving in the plurality of slots;
- a prosthetic implant system wherein the plurality of slots have different dimensions and the plurality of projections generally compliment the shape of the plurality of slots;
- a fusion cage wherein the plurality of surfaces cooperate to define a biplanar angulation;
- a fusion cage wherein the cage body has a first surface generally opposed to a second surface, the first and second surfaces cooperating to define a compound angle and defining a biplanar angulation;
- a fusion cage wherein the at least one of the first or second surfaces are arcuate or convex in cross-section;
- a fusion cage wherein a first surface and a second surface converge along a longitudinal axis and in a direction generally perpendicular to the longitudinal axis, the first and second surfaces cooperating to define a compound angle; and
- a fusion cage wherein a first surface lies in a first plane and a second surface lies in a second plane, the first and second planes being non-parallel in cross-section along a longitudinal axis and in cross-section along an axis generally perpendicular to the longitudinal axis.
While the method herein described, and the form of apparatus for carrying this method into effect, constitute preferred embodiments of this invention, it is to be understood that the invention is not limited to this precise method and form of apparatus, and that changes may be made in either without departing from the scope of the invention, which is defined in the appended claims.
Claims
1. A fusion cage comprising:
- a cage body having a plurality of surfaces;
- said plurality of surfaces cooperating to define a multi-planar angulation adapted to achieve substantially flush fitment in a disk space between adjacent vertebrae when said fusion cage is inserted in said disk space.
2-31. (canceled)
32. A method for fusing bones, said method comprising the steps of:
- providing a cage adapted to be inserted into a disk area substantially diagonally or in an angled direction with respect to an anterior-posterior axis, said cage having a first surface lying in a first plane and a second surface lying in a second plane; and
- inserting said cage in said substantially diagonal or angled direction such that said first and second surfaces engage a surface of a first vertebrae and a second vertebrae substantially flush.
33. The method as recited in 32 wherein said method further comprises the step of:
- providing a cage having said first and second surfaces that cooperate to define a compound angle to provide a biplanar angulation.
34. The method as recited in 32 wherein said method further comprises the step of:
- providing a cage having a cage body comprising a longitudinal plane along a longitudinal axis and a cross-sectional plane along a cross-sectional axis that is generally perpendicular to said longitudinal axis, said cage body not being volumetrically symmetrical about either of said longitudinal plane or said cross-sectional plane.
35. The method as recited in claim 32 wherein said method further comprises the step of:
- providing a cage having a first surface and a second surface and a first side and a second side coupling said first and second surfaces;
- said first side defining a first side area, said second side defining a second side area, wherein said first and second side areas are different.
36. The method as recited in claim 32 wherein said method further comprises the step of:
- providing a cage that defines a trapezoid or trapezium in a cross-sectional plane that is generally perpendicular to a longitudinal axis.
37. The method as recited in claim 32 wherein said method further comprises the step of:
- providing a cage having a first surface generally opposed to a second surface, said first and second surfaces defining a compound angle and cooperating to define a biplanar angulation.
38. The method as recited in claim 37 wherein said method further comprises the step of:
- providing a cage with said first surface lying in a first plane and said second surface lying in a second plane, said first and second planes being non-parallel and defining a plurality of acute angles.
39. The method as recited in claim 32 wherein said inserting step occurs during a posterolateral approach.
40. The method as recited in claim 32 wherein said method further comprises the step of providing a plurality of different sized cages from which a user selects said cage.
41. A prosthetic implant system comprising:
- a fusion cage comprising a cage body having a plurality of surfaces, said plurality of surfaces cooperating to define a multi-planar angulation adapted to achieve substantially flush fitment in a lordotic disk space between adjacent vertebrae when said fusion cage is inserted in said lordotic disk space; and
- an insertion tool for securing to said fusion cage to permit a user to insert and place said fusion cage into a disk area using a posterolateral approach.
42-52. (canceled)
Type: Application
Filed: Jun 11, 2012
Publication Date: Nov 15, 2012
Applicant: X-SPINE SYSTEMS, INC. (Miamisburg, OH)
Inventor: David Louis Kirschman (Dayton, OH)
Application Number: 13/493,032
International Classification: A61F 2/44 (20060101);