# Patent

## Title
Posterior vertebral support assembly

## Abstract

The invention concerns an assembly (1) comprising an interspinous wedge (5) configured to be inserted between the spinous processes (9) of two vertebrae (2) to be treated, whereof at least one zone designed to be placed between the spinous processes of the vertebrae is made of an elastically deformable material. The assembly (1) further comprises: two compressive lateral elements (6), designed to be placed on either side of the wedge (5) in the longitudinal direction, said compressive lateral elements (6) being deformable between releasing positions, wherein they are relatively spaced apart from the wedge (5) in the transverse direction, and compressive positions, wherein they are relatively close to the wedge (5) in the transverse direction; and two lateral transmission elements (7), placed between the compressive lateral elements (6) and the wedge (5), configured to press against the wedge (5) in the transverse direction thereof, at the interspinous zone (10) of the wedge (5).

## Background
This application is a national phase filing of international application no. PCT/FR2003/002635, filed Sep. 3, 2003, which claims priority to French patent application no. 02 11189, filed Sep. 10, 2002.
The present invention concerns a posterior vertebral support assembly.
In the case of degeneration of the intervertebral disc of two vertebrae and/or of ligament distension, it is known to place a wedge between the spinous processes of the two vertebrae concerned, making it possible to support the vertebrae. In this regard, reference may be made to French Patent Applications Nos. FR 94 03716 and FR 98 02300 filed in the name of the proprietor of the present application.
The wedges according to these earlier patent applications are connected to the spinous processes of the two treated vertebrae by two independent ligaments, each of the ligaments passing through the wedge and tightly surrounding the corresponding spinous process. In the case of flexion of the spinal column in a forward direction, the spinous processes move away from one another, thereby causing longitudinal stretching of the wedge.
A drawback of this longitudinal stretching is that of stressing the wedge in longitudinal traction. The conditions of exertion of this traction can however be perfected, in particular in order to obtain assisted and contained control of the movement of the vertebrae, inasmuch as the repetition of this traction threatens to affect the durability of the wedge.
The present invention aims to remedy this drawback.
The assembly which it concerns comprises, in a manner known per se, an interspinous wedge configured to be inserted between the spinous processes of two vertebrae to be treated, whereof at least the zone designed to be placed between the spinous processes of the vertebrae is made of an elastically deformable material.
According to the invention, the assembly further comprises:

    
    
        two compressive lateral elements, designed to be placed on either side of the wedge in the longitudinal direction, the compressive lateral elements being deformable between releasing positions, which they occupy when the vertebrae are in lordosis or when the spinal column is extended, and wherein they are relatively spaced apart from the wedge in the transverse direction, and compressive positions, which they occupy when the spinal column is in flexion, and wherein they are relatively close to the wedge in the transverse direction; and
        two lateral transmission elements, placed between the compressive lateral elements and the wedge, configured in order, when the compressive lateral elements are displaced in said compressive position, to press against the wedge in the transverse direction thereof, at the zone of the wedge designed to be placed between the spinous processes of the vertebrae.
    
    


The assembly according to the invention thus makes it possible to exert a progressive transverse compression on the wedge during the movement of flexion of the spinal column. This compression will reduce the shear stresses which are exerted on the wedge during intervertebral distancing combining tilting and forward sliding movements, owing to the containment of the displacements effected by the wedge.
The transverse compression of the wedge is preferable to pure longitudinal traction from the point of view of durability of the wedge, since it compensates the stressing of the wedge in the longitudinal direction.
The zone of the wedge designed to be placed between the spinous processes may be made of a material having limit of compressibility in the transverse direction of the wedge, and the assembly may then be configured such that this limit is reached when the treated vertebrae attain a predetermined tilted position.
It is also possible to configure the compressive lateral elements so that the elements have a limit of deformation in the transverse direction, this limit of deformation being reached when the treated vertebrae attain a predetermined tilted position.
The compressive lateral elements may be deformed nonelastically or elastically between said releasing and compressive positions. In the latter case, the return force of the elements to their neutral form contributes to the damping of the tilting movement of the treated vertebrae.
The compressive lateral elements may likewise be elastically deformable in the longitudinal direction of the compressive lateral elements, to the same end.
According to one embodiment of the invention, the compressive lateral elements are independent of one another, and each is connected to one of the treated vertebrae by one end and to the other treated vertebra by its other end. The connection of the ends of the compressive lateral elements to the vertebrae may in particular be effected at the pedicles of the vertebrae, by means of pedicular screws engaged in eyelets or anchorage pieces included in the compressive lateral elements.
The connection of the compressive lateral elements to the vertebrae may also be effected, in the case of the overlying vertebra, by means of the passage of the elements beneath the laminae of that vertebra. This sub-laminal passage makes it possible to preserve the pedicles and to be as central as possible in order, during the longitudinal elongation, to optimize the transverse thrust exerted on the wedge. In the case of the underlying vertebra, these same compressive lateral elements may also be connected to an interpedicular transverse connecting bar, placed in position especially in the case of laminectomy on this vertebra, thus making it possible to reduce the concentration of strains. Similarly, the compressive lateral elements may be connected to a connecting bar joined to a system of arthrodesis of the two underlying vertebrae.
According to another embodiment of the invention, the compressive lateral elements are formed by the two lateral portions of a circular strap engaged round the spinous processes of the two treated vertebrae.
The lateral transmission elements themselves may be constituted by small bars bearing on the one hand against the compressive lateral elements and on the other hand against the wedge, especially via small support plates.
These same lateral transmission elements may likewise be constituted by bosses connected either to the compressive lateral elements or to the wedge. In the latter case, the bosses may be integral with the wedge.
The wedge may be made entirely of an elastically deformable material such as a silicone; it may in particular comprise a core made of such a material and a textile envelope containing the core.
The wedge may also be formed by a band of resilient material, suitably curved.
The wedge may comprise a spring placed transversely at its zone designed to be placed between the spinous processes.



For greater understanding thereof, the invention is described again hereinafter with reference to the appended diagrammatic drawing representing, by way of non-limiting example, several possible embodiments of the assembly concerned.
FIG. 1 is a rear view, very simplified, after the positioning on two vertebrae;
FIG. 2 is a view similar to FIG. 1, according to the second embodiment;
FIG. 3 is a view similar to FIG. 1, according to the third embodiment, only the spinous processes of the vertebrae being shown, and
FIG. 4 is a view similar to FIG. 3, according to a variant.



FIG. 1 represents a posterior vertebral support assembly 1 placed in position on two vertebrae 2 affected by degeneration of the disc 3 and/or ligament distension.
The assembly 1 comprises an interspinous wedge 5, two compressive lateral elements 6 and two lateral transmission elements 7.
The wedge 5 is made of an elastically flexible material and comprises two curved recesses 8 allowing it to be inserted between the spinous processes 9 of the two vertebrae 2. It may in particular conform to the wedge according to French Patent Application No. FR 98 02300, that is to say:

    
    
        comprising a core made of silicone and an envelope made of polyester fabric,
        having an interspinous portion 10 having a height greater than the distance separating the spinous processes 9 when the vertebrae 2 are in lordosis in order to be compressed when the wedge 5 is inserted between the processes 9 and to permit relief of the disc 3 and also restoration of the ligaments to functional tension, and
        having lugs 11 which bound the curved recesses 8, the lugs 11 broadly enveloping the processes 9 and being self-tightened round the processes 9 when said interspinous portion 10 is compressed.
    
    


The wedge 5 shown in FIG. 1 differs, however, from the wedge according to the aforesaid French Patent Application No. FR 98 02300 in that it has domed lateral walls, imparting to it a relatively large width at said interspinous portion 10.
Each element 6 is formed by a lamina 15 made of elastically deformable synthetic material and by two eyelets 16 connected to the ends of the lamina 15. The latter is curved and comprises the element 7 at the median portion of its concave face, the concave face being designed to be turned towards the wedge 5.
The eyelets 16 are designed to receive pedicular screws permitting the anchorage of the elements 6 to the vertebrae 2.
Each element 7 is formed by a small rigid bar 20 fixed to an element 6, and is oriented substantially perpendicularly to the zone of the element 6 to which it is connected. The bar 20 is placed, after implantation, at the interspinous portion 10 of the wedge 5.
Each bar 20 is rigidly connected with a small plate 21 for bearing against the portion 10.
The assembly 1 according to the invention is in the position shown in FIG. 1 when the vertebrae 2 are in lordosis.
In the case of extension of the spinal column, the vertebrae 2 pivot in a direction in which the processes 9 are brought closer to one another, thereby leading to compression of the wedge 5 up to the limit of elasticity of the material constituting the core of the wedge. A damping of the pivoting movement of the vertebrae 2 is thus obtained as long as said limit of elasticity is not reached, then the arresting of that same movement is obtained when the limit of elasticity is reached. During this compression of the wedge 5, the elements 6 are deformed in the direction in which their curvature is increased, contributing to the damping of the movement of the vertebrae 2. The elements 6 likewise provide a perfect guarantee of maintenance of the position of the wedge 5 between the processes 9.
In the case of flexure of the spinal column, the vertebrae 2 pivot in a direction in which the processes 9 are spaced from each other, thereby leading to a reduction in the curvature of the elements 6. The elements 7 then press against the wedge 5 transversely, thereby also making it possible to dampen the movement of the vertebrae 2 then to arrest that movement when the limit of elasticity of the material forming the core of the wedge 5 is reached and/or when the elements come close to a substantially rectilinear form.
FIG. 2 shows an assembly 1 similar to that just described, except that the elements 6 are formed by the two lateral portions of a circular strap 25 engaged round the processes 9 of the vertebrae 2. The other portions or elements already described, which are to be found again in this second embodiment, are not described again and are designated by the same numerical references as before.
The strap 25 may be made of a slightly elastically stretchable material, and thus also contributes to the damping and then blocking of the pivoting movement of the vertebrae 2 in the case of flexion of the spinal column.
FIGS. 3 and 4 show a third embodiment of the assembly 1, in which the latter is similar to that shown in FIG. 2, except that the small bars 20 and plates 21 are replaced by bosses 30 along which pass the lateral portions of the strap 25. The bosses 30 may be fixed to the wedge 5 or be integral therewith, as shown in FIG. 3, or may be rigidly connected with the strap 25 and bear against the wedge 5, optionally at lateral recesses which the wedge includes to receive them, as shown in FIG. 4.
As it appears from the foregoing, the invention provides a decisive improvement on the prior art, by providing a posterior vertebral support assembly which does not stress the wedge in the longitudinal direction during the movement of flexion of the spinal column. Perfect control of the movement of the vertebrae is obtained by means of this assembly, and the durability of the wedge is not affected by the repeated movements of the vertebrae.
It is self-evident that the invention is not limited to the embodiment described above by way of example, but that on the contrary it encompasses all the variants of embodiment coming within the scope of protection defined by the appended claims.

## Claims

1. A posterior vertebral support assembly, comprising:
an interspinous wedge configured to be inserted between the spinous processes of two vertebrae, wherein the wedge includes:
first and second opposing ends, each end comprising a recess shaped to receive the respective spinous processes;
a longitudinal axis extending through said recesses;
first and second lateral sides extending from the first end to the second end; and
at least one elastically deformable zone;

two compressive lateral elements disposed on either lateral side of the wedge in a longitudinal direction, wherein the compressive lateral elements are deformable between releasing positions and compressive positions; and
two lateral transmission elements disposed between the compressive lateral elements and the wedge, and configured to selectively press against the lateral sides of the wedge substantially midway between the first and second ends in a transverse direction near the elastically deformable zone; wherein a force applied by the lateral transmission elements against the wedge varies based on the relative spacing between the compressive lateral elements as they move between the releasing position and the compressive position in response to spinal flexion; each lateral transmission element disposed entirely on a respective lateral side of said longitudinal axis.

2. The support assembly of claim 1 wherein the zone has a limit of compressibility in the transverse direction, and wherein the limit is reached at a predetermined tilted position.

3. The support assembly of claim 1 wherein the compressive lateral elements have a limit of deformation in the transverse direction, and wherein the limit is reached at a predetermined tilted position.

4. The support assembly of claim 1 wherein the compressive lateral elements are elastically deformable between the releasing and compressive positions.

5. The support assembly of claim 1 wherein the compressive lateral elements are elastically deformable generally along an axis of the spine.

6. The support assembly of claim 1 wherein the compressive lateral elements are independent of one another, and wherein each element is connectable to a treated vertebra with one end and to another treated vertebra by its other end.

7. The support assembly of claim 1 wherein the compressive lateral elements include eyelets or anchorage pieces designed to receive pedicular anchorage screws.

8. The support assembly of claim 1 wherein the compressive lateral elements are adapted to pass beneath the laminae of the overlying vertebra.

9. The support assembly of claim 1 wherein the compressive lateral elements are deformable between releasing positions, which they occupy when the vertebrae are in lordosis or when the spinal column is extended, and wherein they are relatively spaced apart from the wedge in the transverse direction, and compressive positions, which they occupy when the spinal column is in flexion, and wherein they are relatively close to the wedge in the transverse direction.

10. The support assembly of claim 9 wherein the two lateral transmission elements are disposed in a manner to press against the wedge in the transverse direction when the compressive lateral elements are displaced in said compressive position.

11. The support assembly of claim 1 wherein displacement of the lateral transmission elements towards each other applies a compressive force to the wedge so as to urge the wedge first and second ends away from each other.

12. The support assembly of claim 1 wherein, when the spinous processes are received in the corresponding recesses, the lateral transmission elements do not cross a sagittal plane defined by the spinous processes in the space between the spinous processes.

13. The support assembly of claim 1 wherein the lateral transmission elements are bosses disposed between the compressive lateral elements and the wedge.

14. A posterior vertebral support assembly, comprising:
an interspinous wedge having:
a first end with a saddle-shaped receiver sized to receive and engage a spinous process of a first vertebra;
a second end longitudinally opposite the first end with a saddle-shaped receiver sized to receive and engage a spinous process of a second vertebra;
a longitudinal axis extending through said saddle-shaped receivers of said first and second ends;
an elastically deformable zone between the saddle-shaped receivers;
a first lateral side adjacent the deformable zone;
a second lateral side adjacent the deformable zone and opposite the first lateral side; the distance between the first and second ends being greater than the distance between the first and second lateral sides;

first and second longitudinally extending compressive lateral elements disposed adjacent to the lateral sides of the interspinous wedge, but entirely spaced away therefrom; the compressive lateral elements being deformable between releasing positions and compressive positions and each being sized to extend from the first vertebra to the second vertebra and being shaped to connect to both the first vertebra and the second vertebra;
two lateral transmission elements respectively disposed between the compressive lateral elements and the lateral sides of the deformable zone;
the two lateral transmission elements being configured to selectively increase and decrease loading against the lateral sides of the wedge near the elastically deformable zone in a direction transverse to the longitudinal axis when the compressive lateral elements move between the releasing and compressive positions.

15. The support assembly of claim 14 wherein the compressive lateral elements include eyelets or anchorage pieces designed to receive pedicle screws that connect the lateral transmission elements to the first and the second vertebrae.