# Patent

## Title
Equipment for surgical treatment of two vertebrae

## Abstract

The equipment (1) includes:

    
    
        bone anchor elements (2) that will be anchored in a first of the two treated vertebrae (100), and
        two rigid walls (3) that can be connected to the bone anchor elements (2), that will be arranged on each side of the spinous process (101) of the second treated vertebra (100) with no connection to it and sized to extend over at least the height of the spinous process (101), these walls (3) thus being capable of limiting pivot movements of this second vertebra (100) about an axis approximately perpendicular to the intervertebral disk.

## Background
This invention relates to equipment for the surgical treatment of two vertebrae.
It is known that movements of vertebrae about the axis of the spinal column, in other words in torsion about the spinal column, are known to cause serious pathologies. Due to its structure, the intervertebral disk is particularly vulnerable to this type of torsion stresses which become irreversible beyond a certain amplitude. This weakness is obvious, particularly within the framework of disk facet degeneration phenomena.
These pathologies may apply to two vertebrae only, particularly the fourth and fifth lumbar vertebrae. A degeneration of retention elements, particularly ligaments and/or posterior joint bone masses, leads to a number of disorders including a disorder known under the term “rotational spondylolisthesis”.
The following therapeutic solutions are available at the present time to deal with such a rotational instability:
1—cauterisation of disk fibres that generate pain, or nerve ramifications of the posterior joints by heat or radio frequencies;
2—osteosynthesis systems by pedicle screws and junction rods;
3—placement of an implant between vertebral bodies;
4—placement of rigid or shock absorbing inter-process prostheses;
5—posterior joint prostheses.
The disadvantage of these therapeutic solutions is that they do not usually genuinely satisfy the double requirement for the treatment of pain and respect of controlled amplitude movements, which cannot be dissociated. They also have the specific disadvantages mentioned below:
1—cauterisation: this technique is not reliable. Percutaneous identification is very uncertain, and all that is supposed to be taken into account is perception of pain.
2—osteosynthesis systems: this type of set up cannot give good biomechanical control of torsions, and screws have to be placed in the pedicles of the upper vertebra (for example L4) to neutralise two vertebrae (for example L4-L5); but these pedicles belong to the superjacent functional unit, that is thus damaged or at least compromised.
3—implant between vertebral bodies: placement of such an implant cannot be stable in torsion; it is counter-indicated with arthropathy of the facets and cannot prevent degeneration phenomena of posterior joint bone masses, but may even accelerate them. These techniques are also affected by a non-negligible number of complications.
4—inter-process prostheses: doubtful biomechanical efficiency, regarding torsion movements that are badly retained.
5—posterior joint prostheses: still at a design stage, particularly because it appears very difficult to take account of the complex parameters that they induce in terms of material definitions, implantation technique and particularly durability.
This invention is designed to correct all the disadvantages of existing techniques.
Document US 2003/040746 describes a rigid element 58 bearing either only on the spinous process of the two vertebrae (see FIGS. 1, 9), or at the spinous process of two vertebrae and the sacrum or vertebral pedicles of the superjacent vertebra (see FIG. 22). It is considered that systems according to this document do not overcome disadvantages of existing techniques.
Therefore the main objective of this invention is to provide vertebral contention equipment capable of treating two vertebrae, particularly lumbar vertebrae, in order to enable the possibility of an indolent movement.
Consequently, this equipment comprises:

    
    
        bone anchor means that will be anchored in a first of the two treated vertebrae, and
        two rigid walls that can be connected to the bone anchor means, that will be arranged on each side of the spinous process of the second treated vertebra with no connection to it and sized to extend over at least the height of the spinous process, these walls thus being capable of limiting pivot movements of this second vertebra about an axis approximately perpendicular to the intervertebral disk.
    
    


The equipment according to the invention thus comprises two rigid walls that will be arranged on each side of the spinous process and the lamina of one of the treated vertebrae, particularly the superjacent vertebra, and will maintain contention for lateral and torsional movements of this vertebra, and is implanted near only one other vertebra, preferably the subjacent vertebra.
Consequently, this equipment is capable of conserving said lateral and torsional movements while limiting them so that they remain within physiological amplitudes, by replacing or assisting the defective natural retention elements, particularly ligaments and/or posterior joint bone masses, and disk annulus elements. Furthermore, this material does not limit other joint movements between the two vertebrae concerned.
Excessive movements beyond the physiological amplitude, that are the source of pain and joint degeneration, are eliminated, and the natural torsional movement of the vertebrae is respected, and also controlled.
Furthermore, the equipment according to the invention may be qualified as being a “posterior shock absorbing disk facet controlling prosthesis”, since it is capable of firstly protecting the front and back of the disk, and secondly reducing impaction and trapping phenomena between joint facets in contact so as to control their clearance.
The indications of the equipment according to the invention are particularly:

    
    
        cases of facet arthropathies, regardless of which they are primitive or consecutive to disk degeneration, or even a diskectomy;
        rotational spondylolisthesis;
        prevention of degeneration syndromes occurring between vertebrae located above vertebrae on which arthrodesis has been done;
        treatment of recurrent disk post-arthroplasty lumbago.
    
    


Preferably, said walls are sized so as to extend forwards after implantation, as far as the junction of the spinous process of second said vertebra with the lamina of the posterior arc.
Therefore, after implantation said walls are located at the base of said spinous process, such that conservation of movement according to the equipment according to the invention respects the torsion axis of the vertebra.
The equipment preferably comprises elastic or viscoelastic means for damping lateral and torsional movements of said second vertebra. “Viscoelastic” means material with a stiffness which varies with the state of compression of this material, this material tending to become increasingly rigid as it is compressed. Putting the elastic or viscoelastic means into compression, when the walls are moved towards the spinous process, prestresses said means, providing it with this programmed control characteristic.
These elastic or viscoelastic means are preferably located between said walls and said spinous process. In other words, they clad the median face of the walls.
Advantageously in this case,

    
    
        said walls extend beyond the spinous process of said second vertebra towards the spinous process of said first vertebra, and
        the elastic or viscoelastic means are shaped so that they are present between the spinous process of said second vertebra and the spinous process of said first vertebra.
    
    


Thus, in addition to control of said lateral movements, the equipment according to the invention dampens the bending/extension movement of the vertebrae and restores good alignment of the facets, particularly by raising the posterior arc of said second vertebra, leading to control over the joint clearance of the facets thus raised.
Said walls preferably surround the elastic or viscoelastic means to assure longitudinal support of these elastic or viscoelastic means. In particular, they may be in the form of shells with concave shapes on their sides that will face the spinous process that is under contention by the shells.
The elastic or viscoelastic means may be made in a single piece or they may be made of two symmetric parts, being positioned on each side of the spinous process of said second vertebra.
Making these elastic or viscoelastic means in two symmetric parts has the advantage of conserving the supraspinous ligament. Furthermore, each part can be put into compression independently.
The anchor means are preferably polyaxial pedicle screws, in other words including articulations between their parts that will be anchored in the vertebral pedicles and their parts that will be connected to said walls.
These walls may thus be positioned independently of the position of said parts that will be anchored in the vertebral pedicles.
The two walls may or may not be connected to each other. If they are connected, the elastic or viscoelastic element may be in a single-piece and it may click inside the housing formed by the two walls.
The invention will be clearly understood and other characteristics and advantages of the invention will become clear with reference to the appended diagrammatic drawing showing two possible embodiments of the equipment that it concerns as non-limitative examples.



FIG. 1 is a partial sectional elevation of said equipment according to a first embodiment;
FIG. 2 is a partial view showing an exploded perspective;
FIG. 3 is a partial sectional view after assembly;
FIGS. 4 to 6 are posterior views of two vertebrae during three successive equipment implantation steps;
FIG. 7 is a sagittal view of the equipment after implantation;
FIG. 8 is an elevation and partial sectional view of this equipment according to the second embodiment;
FIG. 9 is an exploded partial perspective view;
FIGS. 10 and 11 are partial views of the equipment similar to FIG. 8, before and after the elastic elements included in it are put into compression, respectively;
FIG. 12 is a view after implantation on a vertebra along the apico-caudal axis.
FIG. 13 is a view similar to FIG. 12, of one variant.



For simplification reasons, parts or elements of one embodiment identical to or similar to parts or elements of another embodiment will be identified with the same numeric references and will not be described further.
FIG. 1 shows a surgical treatment equipment 1 of two vertebrae that includes two pedicle screws 2, two shells 3, two connecting rods 4, 5 of the shells 3 and pedicle screws 2, two elements 6 made of an elastic or viscoelastic material, and two screwable plugs 7.
Each pedicle screw 2 comprises a threaded bone anchor part 10 and a flared head 11. As shown in FIGS. 2 and 3, this head 11 is open at the proximal end and delimits a cavity 12 on the inside. It comprises a lateral notch 13 and has a proximal internal thread 14.
The shells 3 are made of a rigid material, and particularly a metallic material. As shown in FIGS. 5 to 7, they will be placed on each side of the spinous process 101 of the superjacent vertebra 100, and are sized to extend over the entire height of this spinous process 101 and beyond it, towards the spinous process 102 of the vertebra 100 subjacent to it, as far as the level of the upper edge of this spinous process 102.
The shells 3 have concave parts on their sides that will face the spinous process 101 and surround the elastic elements 6, to provide longitudinal support of these elements.
One of the shells 3 is drilled with a hole 15 through which it is engaged free to slide on the connecting rod 4 that corresponds to it, while the other shell 3 is fixed to the connecting rod 5 that corresponds to it.
The connecting rod 4 may be engaged free to move in the notch 13 of the corresponding head 11 and comprises a sphere 16 that may fit free to move in the cavity 12 delimited by this head 11. The connecting rod 4 on the side opposite this sphere 16 comprises an axial threaded part 17 with a diameter less than its own diameter. In its approximately median zone, the connecting rod 4 also comprises a collar 18 acting as a stop fixing the position of the shell 3 with respect to the connecting rod.
The connecting rod 5 may be engaged in the notch 13 of the corresponding head 11, also free to move, and comprises a sphere 16 identical to that mentioned above that can also fit free to move into the cavity 12 delimited by the head 11. On the side opposite the sphere 16, the connecting rod 5 projects beyond the concave face of the shell 3 and includes an axial threaded reaming 19 opening into its free end, into which said axial threaded part 17 of the rod 4 can be fitted by screwing.
Each element 6 made of an elastic or viscoelastic material has an external convex face adapted to the concaveness of the face of the corresponding shell 3. Each element 6 comprises an upper part on its inner face forming a recess into which the spinous process 101 fits, and a lower part forming a plane face, bearing in contact with the homologous plane face of the other element 6.
Each element 6 also has a drilling 20 in it opening up at these plane faces, into which the connecting rods 4 and 5 will fit.
The threaded plugs 7 will be screwed into the proximal part of the heads 11 of the screws 2, as shown in FIG. 3.
In practice, as can be seen in FIGS. 4 to 6, screws 2 are firstly placed in the subjacent vertebra 100 and then the element 6 in which the rod 5 will be fitted is placed in contact with the spinous process 101 (see FIG. 4). The shell 3-rod 5 assembly is then put into place with the corresponding plug 7, and the second element 6 is then put into position in contact with the spinous process 101 symmetric with the first element 6 put into place (see FIG. 5). The second shell 3 is then put into place on this second element 6 and the rod 4 is then engaged through this shell 3 and into the element 6, and is then screwed in so as to introduce its threaded part 17 into the threaded riming 19.
Screwing is continued until the sphere 16 of the rod 4 faces the corresponding head 11, and this sphere is then engaged in the cavity 12 of this head 11 before the corresponding plug 7 is put into place. As shown in FIG. 6, this screwing compresses the two elements 6, which then clamp the spinous process 101, with slight creep at the upper and lower ends of the shells 3.
After implantation, as can easily be understood, the shells 3 limit the lateral movements of the spinous process 101, and this limitation is dampened by compression of the elements 6. Due to the presence of the elements 6 between the spinous processes 101 and 102, the equipment 1 also dampens the movement of these spinous processes towards each other.
Furthermore, the equipment 1 is implanted only at the subjacent vertebra 100 and as shown in FIG. 7, the shells 3 are located at the bottom of the spinous processes 101 and 102.
Consequently, this equipment 1 is capable of keeping natural movements of the superjacent vertebra while limiting these movements so that they remain within physiological amplitudes. The equipment 1 thus replaces or assists defective natural retention elements, particularly ligaments and/or posterior joint bone masses.
Furthermore, the equipment 1 does not limit other joint movements between the two vertebrae 100 concerned, and respects the torsion axis of the vertebra which, at the lumbar level, is located at the base of the spinous processes 101, 102.
Furthermore, once the lower edges of the two elements 6 have moved towards each other, they form a fixed assembly along a globally horizontal lower line with slight concaveness at the bottom; the assembly can thus bear against the upper edge of the subjacent spinous process 102.
FIG. 8 shows equipment 1 similar to that described above, and operating in the same way.
In this case, the pedicle screws 2 are polyaxial, in other words they comprise a body 10 terminating by a sphere 25 on the proximal end, onto which an independent flared proximal head 11 is engaged, capable of multi-directional movement.
As shown in FIG. 9, each head 11 in this case comprises two diametrically opposite notches 13, and the rods 4, 5 are not provided with spheres 16.
The notches 13, rods 4, 5 and threaded plugs 7 are sized such that the plugs 7 clamp the rods 4, 5 and the spheres 25 together, thus immobilising the rods 4, 5 by sliding with respect to the heads 11 and immobilising these heads 11 with respect to the threaded bodies 10.
In this second embodiment, both of the shells 3 are fixed to the rods 4 and 5.
The rod 4 comprises a stop 18, enabling a distraction instrument 50 to bear firstly on this stop 18, and secondly against the corresponding head 11, as shown in FIG. 18. As can be seen by comparing FIGS. 10 and 11, the instrument 50 is used to slide the rod 4 with respect to the screw 2 so as to put the two elements 6 into compression, before complete tightening of the plug 7. Once this compression has been applied, the plug 7 is fully tightened so as to immobilise the rod 4 in this compression position.
The equipment 1 according to this second embodiment thus includes shells 3 not connected to each other as shown in FIG. 12.
FIG. 13 shows that the walls or shells 3 may be provided with flared areas 3a near their edges, located along the laminae of the vertebral arc 103 after implantation, conformed to match the transition zone between the spinous process 101 and these laminae.
As can be seen from the above, the invention provides equipment for surgical treatment of two vertebrae used for contention of lateral movements of the spinous process 101 of a superjacent vertebra, being implanted at a single vertebra and with contention walls 3 located at the base of said spinous process 101.
This equipment 1 can thus be used to treat two vertebrae, particularly lumbar vertebrae, both for pain and for restoration of the natural movement, particularly in the case of facet arthropathies, rotational spondylolisthesis, degeneration syndromes occurring between vertebrae located above the vertebrae affected by the arthrodesis, or recurrent post-disk arthroplasty lumbago.
Obviously, the invention is not limited to this embodiment described above as an example, but it is extended to include all forms of embodiments covered by the attached claims. In particular, the elastic elements may be made in two parts as shown, or in a single piece.

## Claims

1. Equipment for the surgical treatment of two adjacent vertebrae comprising:
first and second bone anchors;
a first rod assembly mounted at the first bone anchor; the first rod assembly comprising:
a first rod section extending away from the first bone anchor along a first rod longitudinal axis; and
a first wall disposed in spaced relation to the first bone anchor with the first rod section therebetween; the first wall extending generally normal to the first axis and having a first concave face that is concave in a direction away from the first bone anchor parallel to the first axis;

a second rod assembly mounted at the second bone anchor; the second rod assembly comprising:
a second rod section extending away from the second bone anchor along a second rod longitudinal axis; and
a second wall disposed in spaced relation to the second bone anchor with the second rod section therebetween; the second wall extending generally normal to the second axis and having a second concave face that is concave in a direction away from the second bone anchor parallel to the second axis;

wherein the first and second concave faces are disposed in spaced relation generally facing towards each other;
a first resiliently deformable body associated with the first rod assembly and disposed both proximate the first wall and generally opposite to the first bone anchor relative to the first concave face;
a second resiliently deformable body associated with the second rod assembly and disposed both proximate the second wall and generally opposite to the second bone anchor relative to the second concave face;
wherein the first and second walls provide a compression force that compresses the deformable bodies toward each other between the first and second walls;
wherein the first and second rod assemblies are configured to be arranged on each side of spinous processes of the adjacent vertebrae to limit relative pivoting movement therebetween about an axis approximately perpendicular to an invertebral disc connecting the adjacent vertebrae.

2. The equipment of claim 1 wherein the first deformable body is viscoelastic.

3. The equipment of claim 1 wherein the first and second deformable bodies jointly form a recess configured to receive a spinous process of the adjacent vertebrae.

4. The equipment of claim 1:
wherein the first rod assembly further comprises a male threaded section;
wherein the second rod assembly further comprises a female threaded section;
wherein the male and female threaded sections are inter-engaged to couple the second rod assembly to the first rod assembly.

5. The equipment of claim 1 wherein the first and second assemblies are interconnected only through the male and female threaded sections and the first and second deformable bodies.

6. The equipment of claim 1 wherein the first and second deformable bodies abut against each other.

7. The equipment of claim 1 wherein the first and second walls include flared areas offset from the first and second rod longitudinal axes respectively.

8. The equipment of claim 1 wherein the second rod assembly further comprises a flange disposed between the second bone anchor and the second wall.

9. The equipment of claim 8 wherein the second wall is slidable relative to the flange.

10. The equipment of claim 8 wherein the flange is fixed relative to the second rod section and the second wall.

11. The equipment of claim 1 wherein the first and second bone anchors each include first and second sections that are pivotable relative to each other and lockable relative to each other in a desired angular orientation.

12. An assembly for the surgical treatment of two adjacent vertebrae comprising:
first and second bone anchors;
a first rod assembly mounted at the first bone anchor; the first rod assembly comprising:
a first rod section extending away from the first bone anchor along a first rod longitudinal axis; and
a first wall disposed in spaced relation to the first bone anchor with the first rod section therebetween; the first wall extending generally normal to the first axis;

a second rod assembly mounted at the second bone anchor; the second rod assembly comprising:
a second rod section extending away from the second bone anchor along a second rod longitudinal axis; and
a second wall disposed in spaced relation to the second bone anchor with the second rod section therebetween; the second wall extending generally normal to the second axis;

wherein the first and second walls are disposed in spaced relation generally facing towards each other;
a first resiliently deformable body associated with the first rod assembly and disposed both proximate the first wall and generally opposite to the first bone anchor relative to the first wall;
a second resiliently deformable body associated with the second rod assembly and disposed both proximate the second wall and generally opposite to the second bone anchor relative to the second wall;
wherein the first and second walls provide a compression force that compresses the deformable bodies against each other between the first and second walls in a direction parallel to a line extending through the first and second bone anchors;
wherein the first and second rod assemblies are configured to be arranged on each side of spinous processes of the adjacent vertebrae to limit relative pivoting movement therebetween.