Patent Application
20080269899
The present invention relates to surgical implant systems, and more particularly, to allograft implant methods used to fuse cervical vertebrae and surgical kits therefor.
The neck is the upper portion of the spine and is made up of the seven upper vertebrae which are often referred to as the cervical spine. Numerous cervical spine disorders require surgery for relief of painful symptoms. One of the basic underlying factors associated with most spine disorders is the dehydration of the disks. Herniated cervical disk is a common neck pain diagnosis which results when the center of the nucleus bulges through the annulus and presses on a nerve, resulting in neck or arm pain, or weakness in the arm. Cervical fusion involves the stabilization of two or more vertebrae by locking them together. One can approach the cervical spine through a small incision in the front of the neck, usually within a skin fold line under the chin. After retracting neck muscles, the affected intervertebral disk is removed. This is called decompression. After removal, a bone graft may be inserted into the intervertebral region to fuse the upper and lower vertebrae together. However, mechanical fusion of the adjoining vertebrae may also be required.
Anterior cervical plating systems are used for mechanical fusion of the adjoining vertebrae and are well known. All currently available plating systems use a metal plate, usually titanium, screws that go through the plate into the vertebra, and a locking mechanism whereby the screw is locked to the metal plate. Metal plate designs are rigid and prevent loads from being transmitted through bone grafts, which can interfere with fusion and allow for grafts to be reabsorbed. The appearance of metal implants on x-rays tends to have an artificial fuzziness, which makes assessment of fusion, one of the clinical criteria of a successful interbody fusion device, difficult. Moreover, metals tend to have mechanical properties that are unevenly matched to bone. The metal fusion or plating device can break, the screws can back out, and the metal can fatigue. Metal plates often cause pain, requiring further surgery. Metal plating is too rigid by design, not allowing bone to go through normal healing, which can cause bone resorption. Ideal plating needs to be dynamic, allowing microflexion and movement.
What is needed, and is not found in the prior art, is an allograft cervical plating system that overcomes the disadvantages of metal plating systems.
The present invention comprises a surgical kit for use in a method for inserting an allograft implant between adjacent cervical vertebrae to fuse the vertebrae together, preferably comprising an allograft implant, a plurality of bio-absorbable screws, a forceps-type implant inserter tool, a drill, a drill guide, a tapping tool, and a screwdriver. The invention further comprises a method for inserting an allograft implant between adjacent cervical vertebrae to fuse the vertebrae together, preferably comprising the steps of removing an intervertebral disc from between the adjacent vertebrae, inserting a spacer between the adjacent vertebrae, preparing a surface of a vertebra to receive an implant, placing the allograft plate implant against the surface of the vertebra, placing a drill guide against an exposed surface of the allograft plate, inserting a drill though the drill guide and drilling a plurality of holes through the allograft plate and into the vertebra to a predetermined depth, tapping the plurality of holes through the allograft plate and into the vertebra to create screw threads, securing the allograft plate to the vertebra by inserting a bio-absorbable screw into each of the plurality of holes through the allograft plate and into the vertebra, removing any excess portion of each screw outside of the plurality of holes, and removing the spacer from between the adjacent vertebra.
These and other features of the invention will become apparent from the following detailed description of the preferred embodiments of the invention.
The system of the present invention for cervical fusion comprises an allograft implant preferably harvested from human cortical bone as a bone plate with bioabsorbable or metal screws. The system provides stabilization for vertebral bodies that achieves fusion of the vertebrae. The system controls vertebral motion for a period of time to allow for the fusion. The allograft will fuse to the vertebrae because the cortical bone is biologically inert. Fusion happens because the vertebral body is decorticated, causing bleeding, which stimulates a healing process in the vertebra. The decortication, in effect, creates a natural “fracture” with the tendency to heal. The allograft is strong because it is derived from femur and tibia bones, and mimics the elastic properties of bone because it is bone, unlike currently used metal fusion plates. The system has both single level and multilevel applications.
In the multilevel applications, the allografts are attached in an “infinity” (non-contiguous) design. The strength and rigidity of cortical bone are well established. Threaded bioabsorbable screws are preferably used to attach the allograft plate to the vertebrae. Hot loop cautery is used to cut the bioabsorbable screws, resulting in a melting down or waxing technique, which seals the head of the screws. This system and method does not preclude other surgery.
Several devices are used in the system of the present invention, the principals of which are illustrated in
Drills 12 are used to drill holes in the bone plate 10 and vertebra. Taps 13 are used to thread the holes to accommodate the bioabsorbable screws 11. Plate and bone holder pins may be used in opposing corners of the plate to allow for easier drilling of the bioabsorbable screws. The pins are threaded with a stop. Drill and tap guides or sleeves 14 are used to accurately place the drills and taps. An inserter tool or plate holder 15 is preferably forceps-like and is used to grasp and insert the allograft plate into position on the anterior aspect of the vertebrae. A screwdriver is used to operate the taps and to insert the bioabsorbable screws.
According to the surgical method of the present invention, vertebral levels to be fused are first prepared in the usual manner with discectomy and abrasion. A spacer is then put between vertebral bodies that are going to be fused, after which, the anterior surfaces of the vertebral bodies are prepared according to the surgeon's judgment or preference. The allograft bone plate 10 is rehydrated, loaded into the inserter tool 15 and held onto the two vertebral bodies for placement trial and for screw placement orientation. The bone holding pins are placed through the plate into the vertebral bodies above and below at opposing corners. Holes in the plate are prepared by drilling through the plate into the vertebral body to a pre-determined depth specific for the patient's anatomy. Drill guide 14 is used to regulate depth and angle of the hole. Drill holes are tapped using appropriately sized tap 13. Bio-absorbable screws 11 are placed into the plate and through the vertebral body. Excess screw above the plate is severed with hot loop cautery. Hot loop cautery results in melted material that seals the top of the screw providing a bridge between the screw and plate interface. At least 4 bio-absorbable screws are used for each allograft plate. This system could be used for single or multi-level fusions.
Some or all of the following devices can be used to form a surgical kit for allograft anterior cervical vertebral fusion: an allograft plate 10, bio-absorbable screws 11, drills 12, taps 13, holder pins (not shown), drill and tap guides 14, forceps-like plate holders 15, and a screwdriver (not shown).
While the invention has been shown and described in some detail with reference to specific exemplary embodiments, there is no intention that the invention be limited to such detail. On the contrary, the invention is intended to include any alternative or equivalent embodiments that fall within the spirit and scope of the invention as described herein and as recited in the appended claims.
The present application claims priority to U.S. Provisional Application No. 60/914,522, filed on Apr. 27, 2007, the disclosure of which is incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| 60914522 | Apr 2007 | US |
