Abstract:
At least one connection assembly which this equipment comprises includes a connection piece of open type and a mating component piece positioned one with respect to the other by positioning means. According some disclosed embodiments, the said positioning means include: the hole in the said connection piece; a portion of the said piece, dimensioned so as to be engaged in the interior of this hole in a fit adjusted manner and so as to be slidable in this hole; and the said connection assembly comprises: assembly means for assembling of the connection piece to the mating component piece, and maintaining means for maintaining in place the said mating component piece in the said separated apart position, based on a force that is less than the clamping force exerted by a nut to be screwed on to the proximal threaded pin of an anchoring member.

Description:
BACKGROUND 
       [0001]    The present invention relates to a vertebral osteosynthesis equipment. 
         [0002]    A vertebral osteosynthesis equipment includes, in a manner that is well known per se: 
         [0003]    at least one rigid rod intended to be extending along several vertebrae, and in general two rods intended to be placed on either side of the spinous processes of the vertebrae; 
         [0004]    bone anchoring members, such as screws or laminar hooks, intended for anchoring the rod or rods to the vertebrae to be treated; each bone anchoring member has a proximal threaded pin and a support surface; 
         [0005]    connection pieces to be used for connecting the rod or rods to the bone anchoring members, each connection piece having a hole for the engagement thereof on to the proximal threaded pin of a bone anchoring member and a receiving channel for the engagement of an aforementioned rod; and 
         [0006]    nuts intended to be screwed on to the proximal threaded pins of the bone anchoring members in order to tighten the connection pieces against the said support surfaces. 
         [0007]    A known device of this type is described in particular in the published patent application No. WO 98/55038; in this device, each connection piece is of the “closed” type, that is to say it has a closed portion for delimiting the said receiving channel for receiving one aforementioned rod. Such a rod can thus only be engaged axially in this channel. 
         [0008]    Known equipments also include, in particular as detailed in the published patent applications Nos U.S. 2013/072991 A1, U.S. 2002/169450 A1or FR 2 765 093 A1, devices comprising connection assemblies with each including a connection piece of “open” type, that is to say, having a curved portion that is adapted to only partially enclose a rod as mentioned above, and a mating component piece that, in a closer position relative to the curved portion, makes it possible to close the channel delimited by this curved portion in order to retain a rod engaged in the said channel. The connection piece and the mating component piece are provided with holes for the engagement thereof on to the proximal threaded pin of the anchoring member and comprise positioning means to ensure the positioning of one in relation to the other in a mounting position in which these holes come to be coincident with each other. 
         [0009]    The vertebral osteosynthesis equipment according to the aforementioned prior art documents have the disadvantage of not being very easy to implement as implants due to the fact that the connection pieces and the mating component pieces are to be set in place and positioned one after another, at the bottom of the cavity, and because they have reduced dimensions, which make the risk of their escape quite high. The impact of these drawbacks are felt all the more given that the successive assembly and disassembly of the rods and connection assemblies must be carried out in order to test the curvature of the vertebral rods during the surgical intervention so as to assess whether the form and shape of the rods are such as to allow for the desired correction or adjustment to be obtained. 
       SUMMARY 
       [0010]    The object of the present invention is thus to remedy these essential drawbacks. 
         [0011]    The concerned equipment includes: 
         [0012]    at least one rigid rod intended to be extending along several vertebrae, and in general two rods intended to be placed on either side of the spinous processes of the vertebrae; 
         [0013]    bone anchoring members, such as pedicular screws or laminar hooks, intended for anchoring the said rod to the vertebrae to be treated; at least one bone anchoring member has a proximal threaded pin and a support surface; 
         [0014]    connection assemblies to be used for connecting the rod to the bone anchoring members; at least one connection assembly includes a connection piece of “open” type, that is to say, having a curved portion that delimits a receiving channel for receiving the rod and which is adapted to only partially enclose the rod, and a mating component piece that is movable relative to this said connection piece; the mating component piece is movable between a separated apart position relative to the said curved portion, in which it does not hinder the transverse engagement of the rod in the receiving channel, and a closer position relative to the said curved portion, in which the mating component piece closes the receiving channel and retains the rod in this channel; the connection piece and the mating component piece are provided with holes for engagement thereof on to the said proximal threaded pin and comprise positioning means to ensure their proper positioning in relation to one another in a mounting position in which these holes come to be coincident with each other; and 
         [0015]    at least one nut intended to be screwed on to the said proximal threaded pin so as to clamp the connection piece and the mating component piece between itself and the said support surface and to thereby bring the connection piece and the mating component piece into the said closer position; 
         [0016]    the said positioning means include:
       the hole in the said connection piece;   a portion of the said mating component piece, dimensioned so as to be engaged in the interior of this hole in a fit adjusted manner and so as to be slidable in this hole;       
 
         [0019]    and 
         [0020]    the said connection assembly comprises:
       assembly means for assembling of the connection piece to the mating component piece, thereby causing the connection assembly to have a unitary structure, and   maintaining means for maintaining in place the said mating component piece in the said separated apart position, allowing for the maintaining in place of this mating component piece relative to the connection piece, this maintaining in place being brought about based on a force that is less than the clamping force exerted by the nut during the screwing of this nut on to the said proximal threaded pin.       
 
         [0023]    Thanks to use of the said assembly means, the connection assembly has a unitary structure that enables the easy handling of the equipment according to the invention, without requiring the repeated installing in place and removal of separate pieces, having reduced dimensions. The maintaining means provide the ability to maintain in place the mating component piece in the said separated apart position, in order to facilitate the successive installing in place and removal of the rod or rods from the connection assemblies. When it comes to carrying out the final mounting of the equipment, the nuts are screwed on, which removes the maintained hold created by the maintaining means and makes it possible to bring the mating component pieces into the closer position relative to the curved portions, and to thereby bring about the closing of the engaging channels for engaging the rod. 
         [0024]    The said assembly means and the said maintaining means may be constituted by means of the appropriate sizing of the hole of the connection piece and by the appropriate sizing of the said portion of the mating component piece which would be such that there would exist friction between this connection piece and this portion, thereby enabling the assembly and maintenance in place of these pieces; according to one preferred embodiment of the invention, however, the said assembling means and the said maintaining means are formed by respective engagement portions of the connection piece and of the said portion of the mating component piece brought into engagement with one another, and which are capable of being brought out of engagement when the said nut is screwed on. 
         [0025]    According to a first possible embodiment of the invention, in this case, the said assembling means and the said maintaining means comprise a collar flange formed on to one among the connection piece and the mating component piece and by a groove provided in the other piece, the collar flange being capable of being positioned and retained in the groove in the absence of the clamping force exerted by the nut, and being capable of being extracted from this said groove during the screwing of the nut. 
         [0026]    Preferably, 
         [0027]    the said groove is formed in the connection piece, and 
         [0028]    the said portion of the mating component piece is formed by a series of snapping teeth disposed in a circle, forming together, externally, the said collar flange, the said teeth being resiliently movable between a radially outer position, in which the said collar flange is capable of being engaged in the said groove, and a radially inner position, in which the said teeth are deflected in a manner so as not to be an impediment to the sliding of the mating component piece in the hole that the connection piece includes. 
         [0029]    In addition to maintaining of the mating component piece in the separated apart position, this embodiment provides for the bearing of the teeth against the connection piece along a reduced surface area, and therefore with limited friction, which allows for a relatively easy return, if necessary, of the mating component piece and of the mating component piece in the separated apart position. 
         [0030]    According to a second possible embodiment of the invention, 
         [0031]    one among the connection piece and the mating component piece has an elongated aperture formed parallel to the direction of movement of these pieces during their passage from the said separated apart position to the said closer position; this elongated aperture is delimited by longitudinal edges and at least one of the longitudinal edges has a protuberance projecting out towards the interior of the elongated aperture; this protuberance subdivides the elongated aperture into a hold maintaining housing and a sliding portion; 
         [0032]    the other among the connection piece and the mating component piece includes a pin engaged through the elongated aperture and capable of sliding therein from the hold maintaining housing up to the sliding portion, by crossing over by force the said protuberance during this sliding. 
         [0033]    In the separated apart position where the connection piece and the mating component piece are separated, the pin is located in the hold maintaining housing, which ensures the assembly of the connection piece and the mating component piece and maintains in place these pieces in the separated apart position. When the nut is screwed on to the said threaded pin and moves these two component pieces relative to one another, the pin crosses over the protuberance by force, in a manner such that the hold enabled by this pin and this protuberance is removed and that the two pieces can be brought in said closer position. 
         [0034]    Preferably, the two longitudinal edges delimiting the elongated aperture each have a protuberance and the two protuberances are located so as to be facing one another. 
         [0035]    A clear hard point is thus formed. 
         [0036]    Preferably, the two longitudinal edges delimiting the elongated aperture each have two protuberances and each protuberance is located so as to be facing a protuberance situated on the opposite edge, the two pairs of protuberances delimiting an intermediate hold maintaining zone, thus making it possible to maintain the pin in place therein, and therefore to maintain the connection piece and the mating component piece in an intermediate position between the separated apart position and the closer position mentioned above. 
         [0037]    Preferably, the hold maintaining housing is fit adjusted to the pin in a manner so as to keep this pin immovable within it, and therefore to keep the mating component piece immovable relative to the connection piece. 
         [0038]    Preferably, the mating component piece and the connection piece form stop surfaces which precisely determine the said closer position of these two component pieces. 
         [0039]    Any risk of the excessive tightening of the nut, which is likely to cause deterioration in the mating component piece, is thus eliminated, and the said stop surfaces in addition provide the ability to distribute the clamping force exerted by the nut. 
         [0040]    Preferably, the mating component piece forms a lateral extension that makes it possible to close the receiving channel for receiving the rod and this lateral extension has a cavity in the form of a hollow cylinder formed on it. 
         [0041]    The invention will be better understood and other characteristic features and benefits thereof will become apparent by means of the description that follows, which is provided with reference made to the accompanying diagrammatic drawing; this drawing shows, by way of non-limiting examples, two possible embodiments of relevant equipment. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0042]      FIG. 1  is a perspective view of a connection piece and a mating component piece which this equipment comprises, according to a first embodiment; 
           [0043]      FIG. 2  is a cross section view of these component pieces taken through the axis of holes that the connection piece and the mating component piece include; 
           [0044]      FIG. 3  is a view of these pieces which is similar to that in  FIG. 2 , shown in a separated apart position wherein the mating component piece is separated apart relative to the connection piece; 
           [0045]      FIG. 4  is a view of these pieces which is similar to that in  FIG. 3 , shown in a closer position wherein the mating component piece and the connection piece are locked together relative to each other; this figure also shows, in broken lines, a rod that the equipment also includes; 
           [0046]      FIG. 5  is a partial view, from the side, of a pedicular screw that this equipment also includes; 
           [0047]      FIG. 6  is a view of this screw and the said component pieces set in place on the screw, in the said separated apart position, with this position allowing for the engagement of the rod that the equipment includes, in a receiving channel that is formed by the connection piece; a nut that the equipment also includes is also represented; 
           [0048]      FIG. 7  is a view of the equipment which is similar to that in  FIG. 6 , wherein the nut is shown in a fully tightened position; 
           [0049]      FIGS. 8 and 9  are perspective views, on two different angles, of a connection piece and of a mating component piece that this equipment includes, according to a second embodiment; 
           [0050]      FIG. 8A  is a partial view of the connection piece as shown in  FIG. 8 , at a greatly enlarged scale; 
           [0051]      FIGS. 10A and 10B  are respectively profile and side views of these pieces, wherein the pieces are in a separated apart position; 
           [0052]      FIGS. 11A and 11B  are views of these pieces which are similar to those in  FIGS. 10A and 10B , with the pieces being in an intermediate position; and 
           [0053]      FIGS. 12A and 12B  are views of these component pieces which are similar to those in  FIGS. 11A and 11B , with the component pieces being in a closer position. 
       
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0054]      FIG. 7  shows a rod  1 , a pedicular screw  2 , a connection piece  3 , a mating component piece  4 , and a nut  5  that are included in a vertebral osteosynthesis equipment. 
         [0055]    In a general manner, this equipment includes: 
         [0056]    two rods  1  intended to be placed on either side of the spinous processes of the vertebrae to be treated; 
         [0057]    a plurality of pedicular screws  2 , intended to be anchored in the pedicles of these vertebrae; 
         [0058]    a plurality of connection pieces  3  and mating component pieces  4 , intended to be installed in place on the screw  2 ; and 
         [0059]    a plurality of nuts  5  to be used for clamping the connection assemblies formed by the connection pieces  3  and the mating component pieces  4  on to the screws  2 , as is visible in this  FIG. 7 . 
         [0060]    The rods  1  are of the conventional type, consisting of metal rods that are to be shaped according to the correction of the vertebral column to be achieved. In the illustrated example, the said rods  1  have a substantially circular cross-section. 
         [0061]    Each pedicular screw  2 , as represented, is of the type called “polyaxial”, that is to say comprising (see  FIG. 5 ) a threaded bone anchoring base  6 , a head  7  forming a surface  8  which constitutes a support for the said connection assembly formed by the pieces  3  and  4 , and a proximal threaded pin  9  connected in an articulated manner relative to the base  6 . In the example shown, this articulated joint is obtained in the manner described in the published patent application No. WO 98/55038, that is to say by means of a ball joint formed by a sphere (represented in broken lines in  FIG. 5 ), that is integrally attached to the pin  9 . This sphere is engaged in a cavity provided in the head  7  and is retained in this cavity by means of crimping of the wall forming the said support surface  8 . This wall is shaped in a manner so as to present a peripheral surface formed as an hemisphere. 
         [0062]    With reference to  FIGS. 1 to 4 , it is apparent that the connection piece  3  comprises a body  3   a  and, on one side thereof, a curved portion  3   b . 
         [0063]    The body  3   a  has: 
         [0064]    a hole  10  which passes right through it from one side to the other, thereby enabling the engagement of the connection piece  3  on the said proximal threaded pin  9 , 
         [0065]    a bottom recess  11  that delimits a flat surface  12  around the bottom opening of the hole  10 , and 
         [0066]    a groove  13  that is coaxial with the hole  10 , arranged in a bottom area of this hole  10 , close to the recess  11 . 
         [0067]    It will be understood that the term “bottom” is used to refer to the side of the connection piece  3  that is situated closest to the support surface  8  when the connection piece  3  is in place on the screw  2 . 
         [0068]    The groove  13  is rounded and has a shallow depth, in a manner such that a snapping flange  25  described farther down, designed to be engaged in it as shown in  FIGS. 3 and 6 , may be extracted from it, as may be seen in  FIGS. 4 and 7 , under the effect of the clamping force exerted on the connection piece  3  by the nut  5 . 
         [0069]    The portion  3   b  of the connection piece  3  is curved in a manner so as to delimit a receiving channel  15  for receiving a rod  1 , but only partially encircles this rod, over about 180°, as can be seen in  FIG. 4 . The connection piece  3  is therefore a type of connection piece referred to as “open” type, that is to say, capable of receiving the rod  1  by means of transverse engagement of the rod. 
         [0070]    The mating component piece  4  has a hole  20  passing right through it, which enables its engagement on to the said proximal threaded pin  9 , and includes a bottom portion  4   a  and an top portion  4   b.    
         [0071]    The bottom portion  4   a  is in the form of a flared skirt, internally forming a hemispherical surface  21  for bearing against the support surface  8 , and forming on one side a lateral closing extension  22  for closing the receiving channel  15 . A cavity in the form of a portion of a hollow cylinder  23  having the same radius as the rod  1 , is provided on this lateral extension  22 . 
         [0072]    The said bottom portion  4   a  forms, at its top end, a planar surface  24  adapted to meet the surface  12  in the closer position shown in  FIG. 4  wherein the pieces  3  and  4  are locked together. 
         [0073]    The top portion  4   b  is formed by a series of snapping teeth disposed in a circle, each having an exterior terminal bead. The beads of the different teeth together constitute the snapping flange  25  mentioned above. As it is to be understood with reference to  FIGS. 2 and 3 , these teeth are resiliently movable between a normal position that is radially external, as may be seen in  FIG. 2 , and a radially internal position, as may be seen in  FIG. 4 , in which the teeth are resiliently deflected towards the interior of the hole  20 . 
         [0074]    The top portion  4   b  is designed to be engaged in the hole  10  of the connection piece  3 , by internal deflection of the teeth, until the latching of the collar flange  25  into the groove  13 . This latching defines the aforementioned separated apart position, in which the lateral extension  22  is at a distance from the free end of the curved portion  3   a  which is sufficient to enable a transverse engagement of the rod  1 , as may be seen in  FIG. 6 . 
         [0075]    The internal deflection of the snapping teeth also allows for the said top portion  4   b  to be engaged in the hole  10  beyond the groove  13  and to slide in the latter up until the closer position shown in  FIG. 4 . In this closer position, the lateral extension  22  comes to close the receiving channel  15 , in a manner such that the rod  1  engaged in this channel cannot be extracted from the channel, as can be seen in  FIG. 7 . 
         [0076]    The nut  5  is of a known type and is thus not described in details. 
         [0077]    In practice, the screws  2  ( FIG. 5 ) are set in place in the pedicles of the vertebrae to be treated and then the assemblies of pieces  3 /pieces  4  (with each piece  4  in the separated apart position in relation to each piece  3 ) are engaged on to the pins  9  of these different screws  2 , until the support surfaces  21  of the pieces  4  come up against the support surfaces  8  of the screws  2 . 
         [0078]    The nuts  5  are then screwed on to the pins  9  up to a position of contact with the pieces  3 , in a manner so as to ensure the maintenance in position of the pieces  4  against the support surfaces  8  ( FIG. 6 ); in this position, each rod  1  can be easily engaged in the channels  15  and be removed from the latter, in order to carry out the successive operations of curving and testing of the rods  1 . 
         [0079]    When the rods  1  are completely set in the requisite shape and formed in a manner so as to make it possible to ensure the desired correction of the vertebrae, the screws  5  are tightened in a manner so as to move the pieces  3  in the direction of the pieces  4  and, by bringing close together the extensions  22  and the free ends of the curved portions  3   b , to close the channels  15  around each rod  1  ( FIG. 7 ). 
         [0080]      FIGS. 8 and 9  show the second embodiment of the pieces  3  and  4 . For the purposes of simplification, the parts or elements that have already been described with reference to  FIGS. 1 to 7 , which happen to be found on these pieces, are denoted by the same numerical references and will not be described again. 
         [0081]    In this case, the connection piece  3  has an elongated aperture  30  formed through its body  3   a , parallel to the direction of movement of the mating component piece  4  in relation thereto at the time of the passing of this mating component piece from the said separated apart position to the said closer position. This elongated aperture  30  is delimited by longitudinal edges each having two protuberances  31 , with each protuberance  31  being positioned so as to be facing another protuberance  31  situated on the opposite edge. 
         [0082]    Each protuberance  31  is formed by inclined walls joining together so as to form a rounded top edge and is adapted to be crossed by the body of a pin  40  described further below. 
         [0083]    The lower pair of protuberances  31  delimits, with the bottom portion of the elongated aperture  30 , a hold maintaining housing  32  having appropriate dimensions that are fit adjusted to those of the body of the pin  40 . The upper pair of protuberances  31  delimits, with the top portion of the elongated aperture  30 , a sliding portion  33 , in which the body of the pin  40  is capable of sliding. The two pairs of protuberances  31  delimit between them an intermediate hold maintaining zone  34 , capable of receiving the body of the pin  40  in a fit adjusted manner. 
         [0084]    The mating component piece  4  has a circular top portion  4   b  that is adapted to be received in a fit adjusted manner in the hole  10  of the connection piece  3  but with the capability to slide in this hole. This top portion  4   b  has a threaded hole  35  that comes to be coincident with the elongated aperture  30  in the mounting position and receiving the pin  40  screwed into it. 
         [0085]    This pin  40  has the aforementioned body, which is cylindrical and smooth, and which is intended to be received and slide in the elongated aperture  30 . It also has a threaded head that is intended to be screwed into the hole  35 . 
         [0086]    The connection piece  3  in addition has a notch formed in the curved portion  3   b , coaxially to the hole  35 , and the mating component piece  4  has a hole formed on its side diametrically opposite to the hole  35 , which allows for the engagement of the pin  40  in these pieces  3 ,  4  and the screwing of the head of this pin  40  into the threaded hole  35 . 
         [0087]    In practice, in the space apart position of the lateral extension  22  and of the curved portion  3   b  (see  FIGS. 10A and 10B ), the body of the pin  40  is held in the hold maintaining housing  32 , which maintains the pieces  3  and  4  in this position. When the nut  5  is screwed on to the pin  9 , this body of the pin  40  comes to cross the lower pair of protuberances  31  and be placed in the intermediate hold maintaining zone  34 , which makes it possible to maintain the pieces  3  and  4  in the intermediate position shown in  FIGS. 11A and 11B ; this intermediate position provides the practitioner with the ability to indeed ensure the correct mounting of the rod  1  before the final mounting is carried out. The additional screwing of the nut  5  enables the body of the pin  40  to cross over the upper pair of protuberances  31  and to be placed in the sliding portion  33 , which makes it possible to bring the pieces  3  and  4  into the closer position shown in  FIGS. 12A and 12B . 
         [0088]    As is apparent from the foregoing, the invention provides a vertebral osteosynthesis equipment that presents the decisive advantage of making it possible to facilitate the successive operations of curving and positioning of the rods  1  while also obtaining a good degree of certainty of resistance over the course of time of the connection created between a rod  1  and a connection assembly. 
         [0089]    The invention has been described here above with reference to the embodiments provided by way of examples. However, it goes without saying that it is not limited to these embodiments but indeed extends to all other embodiments covered by the claims appended herewith.