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US Patent # 5,609,634. Intervertebral prosthesis making possible rotatory stabilization and
flexion/extension stabilization - Patents.com
United States Patent 5,609,634
Intervertebral prosthesis making possible rotatory stabilization and
flexion/extension stabilization
A prosthesis including (a) a flexible ligament (1) with a first narrowed
thinner portion (2) and a second wider portion (3) forming an extension
of, and having a greater width and thickness (e2) than, the first portion,
which portion may be passed around the spinous processes (12) of two
adjacent vertebrae (L5, L4) in a figure eight pattern, whereas the second
portion circles around the processes; (b) a semi-flexible interprocess
block (6) with two pairs of through-channels (7, 8) having differing
cross-sections and receiving the respective portions of the ligament; and
(c) members (4, 5) for joining the ends of the ligament. The prosthesis
prevents sagittal and frontal lumbar vertebral rotational instability.
Inventors: Voydeville; Gilles (Nancy, FR) Appl. No.:
08/362,583
PCT/FR93/00664
PCT Pub. No.: WO94/01057
Foreign Application Priority Data Jul 07, 1992
92 08391
623/13.11 ; 606/248; 606/263; 606/74; 623/17.11
Current International Class: A61B 17/68 (20060101); A61B 17/84 (20060101); A61B 17/70 (20060101); A61F 2/08 (20060101); A61F 2/00 (20060101); A61B 19/00 (20060101); A61F 2/30 (20060101); A61F 2/44 (20060101); A61F 002/44 (); A61B 017/56 ()
Field of Search: 606/61,60 623/13,17,18
Claims I claim:1. An intervertebral prosthesis which comprises:
a flexible ligament having a first thin part of small width and thickness, and a second wide part in continuation of said first part, of greater width and thickness than said first part, wherein said ducts are adapted for passage of each of said
first and second parts, respectively, of the ligament such that said first part is adapted to be laced through one of said pair of ducts in a figure eight around the spinous processes of two adjacent vertebrae; and the second part of the ligament is
adapted to be laced through the other of said pair of ducts for perispinous encircling, and
3. An intervertebral prothesis as claimed in claim 1, wherein the two ducts for passage of the thin part are juxtaposed in a central part of the block and intercommunicate through a central opening which makes it possible to cross two strands of
the thin part of the ligament, and the two ducts for passage of the wide part are arranged on each side of the ducts for passage of the thin part. Description FIELD OF THE INVENTION
Various types of intervertebral retention prostheses have previously been made, either rigid or flexible, the function of which is to eliminate lumbar vertebral frontal and sagittal rotatory instability. The rigid prostheses comprise plates,
rods with hooks, and the flexible prostheses are formed by ligaments associated with rigid or flexible blocks.
a) a flexible ligament comprising a first, thin part of small width and of small thickness, and a second, wide part in continuation of the first, of greater width and thickness than the first part, the first part being intended to make possible
lacing in a figure of eight around the spinous processes of two adjacent vertebrae, while the second part is adapted to carry out a perispinous encircling,
According to an advantageous embodiment of the invention, the two ducts for passage of the thin part are juxtaposed in the central part of the block and intercommunicate via a central opening which makes it possible to cross two strands of the
thin part of the ligament.
The prosthesis according to the invention therefore makes it possible to carry out simultaneously stabilization of the vertebrae in flexion/extension by virtue of the perispinous encircling of the wide part of the ligament and stabilization in
rotation by virtue of oblique passage between the spinous processes of the thin part of the ligament.
The latter can be made of an appropriate material, for example polyester or the material known under the trade mark "DACRON" (polyethylene terephthalate), made of a braiding in different directions. BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 9 is a view in rear elevation of the lumbar vertebrae provided with the intervertebral prosthesis in FIG. 8. DETAILED DESCRIPTION OF THE INVENTION
The prosthesis to which the invention relates comprises a flexible ligament 1 consisting of two parts: a first, thin part 2, of small width and of small thickness, and a second, wide part 3, in continuation of the first part 2, of greater width
and thickness than the part 2. By way of non-limiting indicative numerical example, the width 11 (FIG. 2) of the thin part 1 may be 4 mm and its thickness el 1 mm, while the width 12 of the wide part 3 may be 8 mm, its thickness e2 being 2 mm.
The prosthesis also comprises an interspinous block 6 (visible in particular in FIGS. 4 to 6) which is semi-flexible and in which two pairs of continuous ducts of different sections are cut: a first pair of ducts 7 juxtaposed in the central part
of the block and of small section corresponding to the section of the narrow part 2 of the ligament 1, and two ducts 8 each placed on one side of the two ducts 7 and of very much greater section than that of the ducts 7 and intended to receive the wide
part 3 of the ligament 1. The two central ducts 7 intercommunicate via a central opening 9 made in the separation partition of the two ducts 7 (FIG. 9). The ducts 7 and 8 are approximately parallel with one another and pierce the block 6 right through. The block 6 may have different heights so as to set the vertebrae in slight distraction.
In FIGS. 7 to 9, the final four lumbar vertebrae L5, L4, L3, L2 and the sacrum S can be seen, the prosthesis being intended to be fitted on the first two lumbar vertebrae L5, L4. The surgeon first of all arranges the block 6 between the spinous
processes 12 so that the ducts 7 extend on either side of the central plane of the spinous processes. The surgeon then carries out lacing in a figure of eight around the spinous processes 12 by means of the thin part 2 of the ligament 1, making this
thin part pass successively into one of the ducts 7 and then into the central orifice 9 and from there into the second duct 7. The surgeon then carries out a first encircling of the spinous process 12 of the vertebra L4 and reintroduces the end of the
thin part 2 into one of the ducts 7, the orifice 9 and the second duct 7, finishing the lacing with a final loop around the spinous process 12 of the vertebra L5. At this stage, a suture is made between the two strands of the thin part 2 by means of the
The surgeon then carries out an interspinous encircling by means of the wide part 3 around the two spinous processes 12, making the wide part 3 pass through the lateral ducts 8. Once complete looping of the spinous processes 12 has been carried
out, the surgeon finishes the fitting by carrying out a suture of the two ends of the wide part 3 one on the other by means of the thread 5.
By way of non-limiting numerical examples, completing the indications given above relative to the section of the narrow 2 and wide 3 parts of the ligament 1, the latter can be of two types: one for short mounting, one for long mounting. For
short mounting, the ligament 1 measures, for example, 40 cm divided into 20 cm for the thin part 2 and 20 cm for the wide part 3. For long mounting, the ligament 1 measures 60 cm, 30 cm for the thin narrow part 2, 30 cm for the wide part 3. The
corresponding blocks 6 have a width 13 of 15 mm (FIGS. 4 to 6) and a length 14 of 15 mm, while their height h may vary between 8 and 22 mm.
The intervertebral prosthesis according to the invention makes it possible, by virtue of its shape and the restricted volume which it occupies, to fix the vertebrae L5, L4 both in rotation and in flexion/extension. In fact, previously used
ligaments do not make it possible to carry out lacing in a figure eight around the vertebrae and then to make this ligament pass around these again.
The indications for fitting the ligament 1 and the block 6 of the prosthesis to which the invention relates are in particular lumbar instabilities. Lumbar instability is an ailment relative to all types of pathological rachides, in particular
narrow lumbar ducts, isthmian lyses and slipped discs.
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