The present invention relates generally to the field of replacing portions of the human structural anatomy with medical implants, and more particularly relates to an expandable implant and method for replacing skeletal structures such as one or more vertebrae or portions of vertebrae.
It is sometimes necessary to remove one or more vertebrae, or a portion of the vertebrae, from the human spine in response to various pathologies. For example, one or more of the vertebrae may become damaged as a result of tumor growth, or may become damaged by a traumatic or other event. Removal, or excision, of a vertebra may be referred to as a vertebrectomy. Excision of a generally anterior portion, or vertebral body, of the vertebra may be referred to as a corpectomy. An implant is usually placed between the remaining vertebrae to provide structural support for the spine as a part of a corpectomy or vertebrectomy.
Many implants are known in the art for use in vertebrectomy and corpectomy procedures. One class of implants is sized to directly replace the vertebra or vertebrae that are being replaced, without in situ expansion. Another class of implants is inserted in a collapsed state and then expanded once properly positioned. Expandable implants may be advantageous because they allow for a smaller incision and entry path when positioning an implant. A smaller incision may be particularly useful with a posterior approach, as illustrated in
Once in position and expanded, it may be advantageous for a corpectomy or vertebrectomy implant to, as nearly as possible, fill the space vertically between the remaining vertebrae and laterally among the remaining soft tissues. Lateral expansion may increase the contact area between the implant and vertebral endplates. This expansion may reduce the potential for subsidence of the device into the adjacent vertebrae. It may be advantageous in some embodiments to provide an implant that will exert a biasing force against remaining vertebrae prior to filling with a material to otherwise expand the implant. It may be advantageous in some embodiments to provide an implant that may be provisionally positioned and held at a surgical site from a grasping point.
Expandable implants may also be useful in replacing long bones or portions of appendages such as the legs and arms, or a rib or other bone that is generally, though not necessarily, longer than it is wide. Examples include, but are not limited to a femur, tibia, fibula, humerus, radius, ulna, phalanges, clavicle, and any of the ribs. Use of the mechanisms described and claimed herein are equally applicable to treatment or repair of such bones or appendages. Similarly, expandable implants may be useful in at least some spinal fusion procedures where a spinal disc is replaced without replacing a vertebral body.
One embodiment of the invention is a method of stabilizing spaced apart skeletal structures. The method may include providing an expandable medical implant with a membrane defining a volume and including an upper surface, a substantially opposite lower surface and a lateral diameter, and a biasing member including a first end, a substantially opposite second end, and a lateral diameter, wherein the biasing member is coupled to the membrane. The method may also include grasping the first end of the biasing member, placing the second end of the biasing member against a second skeletal structure to compress the biasing member, and aligning the first end of the biasing member with a first skeletal structure. Embodiments of the method may include releasing compression of the biasing member to allow the expandable medical implant to contact the first skeletal structure, and introducing fill material into the expandable medical implant to one or both maintain expansion and cause expansion of the expandable medical implant.
Another embodiment of the invention is a method of stabilizing a portion of a vertebral column. The method may include removing at least a portion of one or more vertebrae from a space between a first vertebra and a second vertebra, inserting a medical implant having a length into the space between the first vertebra and the second vertebra, and forcing the medical implant against the second vertebra to decrease the length of the medical implant. The method may also include allowing the medical implant to expand in length to come into contact with the first vertebra, and introducing a fill material into the medical implant to expand the medical implant laterally to occupy a portion of the space between the first vertebra and the second vertebra.
Yet another embodiment of the invention is an expandable medical implant for supporting skeletal structures that are spaced apart along a longitudinal axis. The expandable medical implant may have a membrane defining a volume and including an upper surface, a substantially opposite lower surface, a side between the upper and lower surfaces, and a lateral diameter substantially transverse to the longitudinal axis. The expandable medical implant may also have a biasing member coupled to the membrane and include a first end, a substantially opposite second end, and a lateral diameter substantially transverse to the longitudinal axis. The biasing member in an expanded state may be longer than the distance between the spaced apart skeletal structures to be supported. The lateral diameter of the membrane when at least partially filled in some embodiments is larger than the lateral diameter of the biasing member.
The following documents are incorporated by reference herein in their respective entireties: U.S. patent application Ser. No. 12/424,663, entitled, “VERTEBRAL ENDPLATE CONNECTION IMPLANT AND METHOD;” U.S. patent application Ser. No. 12/424,941, entitled, “MINIMALLY INVASIVE EXPANDABLE VERTEBRAL IMPLANT AND METHOD;” U.S. patent application Ser. No. 12/424,880, entitled, “MINIMALLY INVASIVE EXPANDABLE CONTAINED VERTEBRAL IMPLANT AND METHOD;” and U.S. patent application Ser. No. 12/424,666, entitled, “DEPLOYMENT SYSTEM AND METHOD FOR AN EXPANDABLE VERTEBRAL IMPLANT;” each application filed on Apr. 16, 2009.
An embodiment of an expandable medical implant 1 is illustrated in
The expandable medical implant 1 illustrated in
The membrane 5 of some embodiments is configured to be placed between first and second vertebrae V1, V2 such that the upper surface 6 contacts the first vertebra V1, and the opposite lower surface 4 contacts the second vertebra V2 to provide support between the first and second vertebrae V1, V2. Lateral expansion of the membrane 5 is also accomplished in some embodiments. For example, in
The membrane 5 may be constructed, in whole or in part, of a non-permeable material. The membrane 5 may include compliant or non-compliant balloon materials such as those commonly used to manufacture coronary and Kyphoplasty medical devices. Such materials may include, but are not limited to, mylar, rubber, polyurethane, vinyl, latex, polyethylenes, ionomer, and polyethylene terephthalate (PET), as well as less flexible materials such as Kevlar®, PEBAX®, stainless steel, titanium, nickel-titanium alloys, and other metals and alloys and/or ceramics. A compliant membrane may include reinforcing to limit one or both of the size and shape of the membrane to a clinically advantageous extent. A non-compliant membrane may expand more elastically to more completely fill an irregular opening, depending on the amount of material introduced into the membrane.
The membrane 5 may be constructed, in whole or in part, of a permeable material, which allows a certain amount of a fill material to pass through the membrane 5. All or a portion of the membrane 5 may be made permeable by fabricating a material, including but not limited to, the membrane materials listed above, into a fabric, weave, mesh, composite, bonded fiber assembly, or any other manufacture known to those skilled in the art. For example, all or part of the upper surface 6 and the opposite lower surface 4 may be constructed of a permeable material to allow a fill material to move through the membrane 5 and to come into contact with vertebrae.
A biasing member 20 coupled to the membrane 5 is illustrated in a combination of views in
An example length of the biasing member 20 in an expanded state is shown in
As shown in
In the embodiment illustrated in
In some embodiments, the membrane 5 may be coupled to the biasing member 20 along a side, such as the side 10, of the membrane 5 to restrict lateral expansion of the membrane in at least a first direction. Resistance to lateral forces may be useful in various embodiments for protecting posterior or other neural or vascular structures such as, but not limited to, the spinal cord, spinal canal, and nerve roots. Embodiments directed to coupling along a side of a membrane and laterally rigid devices are described in greater detail in association with U.S. patent application Ser. No. 12/424,880, entitled, “MINIMALLY INVASIVE EXPANDABLE CONTAINED VERTEBRAL IMPLANT AND METHOD,” and are incorporated by reference as noted herein above. Example embodiments include the laterally rigid component of the '880 application replaced by a biasing member and similarly used in combination with a membrane, and any other effective combinations.
As illustrated in
In some embodiments, the expandable medical implant may include a protrusion configured to enter a cavity formed in one or more skeletal structures. For example, in the illustrated embodiments, the outward extents of the first end 21 or the second end 22 of the biasing member may serve as a protrusion configured to enter a cavity formed in one or more skeletal structures. A protrusion may further serve as a nozzle through which fill material may be passed into the one or more skeletal structures. A cavity 32 in a second vertebra V2 is illustrated in
A fill material may be introduced into the expandable medical implant 1 as a fluid, and then harden or cure in the implant. In some embodiments, a non-hardenable and non-curing fluid may be used to fill the implant or one or some of the components of the implant. A fill material 100, as illustrated in
Where the fill material 100 is a hardenable material, the biasing member 20 may serve as a reinforcing element within the hardened fill material 100. For example and without limitation, a steel or titanium alloy biasing member encapsulated within a PMMA fill material would provide additional reinforcement to the PMMA when hardened and bonded to and encapsulating the biasing member. Placement of the biasing member reinforcement alone or in combination with other reinforcement may be arranged to give the expandable medical implant particular strength and deflection characteristics.
Embodiments disclosed herein may be described as a means for occupying a vertebral space. The means for occupying a vertebral space may include a containment means defining a volume, and a linearly biased means coupled to the containment means. The linearly biased means may be substantially located within the volume of the containment means in some embodiments, or may be have a majority of the biasing means outside of the containment means in other embodiments. In some embodiments, the containment means is a membrane that is placed into the vertebral space in an unexpanded state and is then expanded laterally to occupy a desired portion of the vertebral space. The linearly biased means when in an expanded state may be of a greater length than the space into which it is placed. The linearly biased means may also linearly expand the containment means in some embodiments. The containment means may be configured to occupy a vertebral space to the extent of soft tissues that surround the spinal column. These soft tissues may include, but are not limited to, one or more of ligaments, muscles, vessels, arteries, and neural structures.
For embodiments of each of the implants disclosed herein, the size or shape of the membrane may be limited to only fill a particular portion of a vertebral space. For example, and without limitation, an implant may be configured to only occupy a lateral portion of a vertebral space to accomplish a hemi-vertebrectomy. Implants may be alternatively shaped to occupy other, limited portions of a vertebral space.
Embodiments of the implant in whole or in part may be constructed of biocompatible materials of various types. Examples of implant materials include, but are not limited to, non-reinforced polymers, carbon-reinforced polymer composites, PEEK and PEEK composites, low density polyethylene, shape-memory alloys, titanium, titanium alloys, cobalt chrome alloys, stainless steel, ceramics and combinations thereof. If a trial instrument or implant is made from radiolucent material, radiographic markers can be located on the trial instrument or implant to provide the ability to monitor and determine radiographically or fluoroscopically the location of the body in the spinal space. In some embodiments, the implant or individual components of the implant may be constructed of solid sections of bone or other tissues. Tissue materials include, but are not limited to, synthetic or natural autograft, allograft or xenograft, and may be resorbable or non-resorbable in nature. Examples of other tissue materials include, but are not limited to, hard tissues, connective tissues, demineralized bone matrix and combinations thereof.
Some embodiments of the invention may be applied in the lumbar spinal region. Some embodiments may be applied to the cervical or thoracic spine or between other skeletal structures.
Some embodiments may also include supplemental fixation devices in addition to or as part of the expandable medical implant for further stabilizing the anatomy. For example, and without limitation, rod and screw fixation systems, anterior, posterior, or lateral plating systems, facet stabilization systems, spinal process stabilization systems, and any devices that supplement stabilization may be used as a part of or in combination with the expandable medical implant. Embodiments of the invention may be useful in at least some spinal fusion procedures where a spinal disc is replaced without replacing a vertebral body.
An embodiment of the invention is a method of stabilizing spaced apart skeletal structures, such as but not limited to, the first vertebra V1 and the second vertebra V2, as illustrated in
Method embodiments may include grasping the first end 21 of the biasing member 20. The first end 21, or one or more members coupled to the first end 21, may be grasped directly by a user, with a clamp, pliers, other tool, or a specialized instrument or component that interfaces with the first end 21 in any effective manner. In the example illustrated, the first end 21 is grasped by interconnection with the extension 24 and subsequent control of the extension 24. Control or grasping of the extension 24 may likewise be accomplished in any effective manner.
Method embodiments may also include placing the second end 22 of the biasing member 20 against a second skeletal structure, such as the second vertebra V2 to compress the biasing member 20. The second end 22 of the biasing member 20 is shown in
Method embodiments may also include releasing compression of the biasing member 20 to allow the expandable medical implant 1 to contact the first skeletal structure, as illustrated in
As also illustrated in
Another embodiment of the invention is a method of stabilizing a portion of a vertebral column. The embodiment may include removing at least a portion of one or more vertebrae from a space between a first vertebra and a second vertebra. As applied to the embodiment illustrated in
The embodiment may also include inserting a medical implant having a length into the space between the first vertebra V1 and the second vertebra V2. As shown in
The embodiment may include introducing a fill material into the medical implant to expand the medical implant laterally to occupy a portion of the space between the first vertebra V1 and the second vertebra V2. As illustrated in
In some embodiments, a cavity 32 (
The expandable medical implant is shown in
Various method embodiments of the invention are described herein with reference to particular expandable medical implants. However, in some circumstances, each disclosed method embodiment may be applicable to each of the expandable medical implants, or to some other implant operable as disclosed with regard to the various method embodiments.
Terms such as lower, upper, anterior, posterior, inferior, superior, lateral, medial, side, top, and the like have been used herein to note relative positions. However, such terms are not limited to specific coordinate orientations, but are used to describe relative positions referencing particular embodiments. Such terms are not generally limiting to the scope of the claims made herein.
While embodiments of the invention have been illustrated and described in detail in the disclosure, the disclosure is to be considered as illustrative and not restrictive in character. All changes and modifications that come within the spirit of the invention are to be considered within the scope of the disclosure.
Number | Name | Date | Kind |
---|---|---|---|
3875595 | Froning | Apr 1975 | A |
4554914 | Kapp et al. | Nov 1985 | A |
4932975 | Main et al. | Jun 1990 | A |
5002576 | Fuhrmann et al. | Mar 1991 | A |
5123926 | Pisharodi | Jun 1992 | A |
5236460 | Barber | Aug 1993 | A |
5290312 | Kojimoto et al. | Mar 1994 | A |
5336223 | Rogers | Aug 1994 | A |
5423816 | Lin | Jun 1995 | A |
5458642 | Beer et al. | Oct 1995 | A |
5480442 | Bertagnoli | Jan 1996 | A |
6375682 | Fleischmann et al. | Apr 2002 | B1 |
6419704 | Ferree | Jul 2002 | B1 |
7837688 | Boyer et al. | Nov 2010 | B2 |
20020147496 | Belef et al. | Oct 2002 | A1 |
20030083749 | Kuslich et al. | May 2003 | A1 |
20040133280 | Trieu | Jul 2004 | A1 |
20040199252 | Sears et al. | Oct 2004 | A1 |
20050113924 | Buttermann | May 2005 | A1 |
20050251260 | Gerber et al. | Nov 2005 | A1 |
20060200239 | Rothman et al. | Sep 2006 | A1 |
20070093901 | Grotz et al. | Apr 2007 | A1 |
20070173934 | Dickinson et al. | Jul 2007 | A1 |
20070173940 | Hestad et al. | Jul 2007 | A1 |
20070203580 | Yeh | Aug 2007 | A1 |
20070260315 | Foley et al. | Nov 2007 | A1 |
20070270855 | Partin | Nov 2007 | A1 |
20080021556 | Edie et al. | Jan 2008 | A1 |
20080058930 | Edie et al. | Mar 2008 | A1 |
20080058931 | White et al. | Mar 2008 | A1 |
20080147189 | Melkent | Jun 2008 | A1 |
20080161933 | Grotz et al. | Jul 2008 | A1 |
20080167726 | Melkent | Jul 2008 | A1 |
20080188895 | Cragg et al. | Aug 2008 | A1 |
20090270987 | Heinz et al. | Oct 2009 | A1 |
Number | Date | Country |
---|---|---|
20017962 | Aug 2001 | DE |
202005009478 | Jun 2005 | DE |
1212992 | Nov 2001 | EP |
1290993 | Jul 2002 | EP |
0103614 | Jan 2001 | WO |
2008086274 | Jul 2008 | WO |
2008103466 | Aug 2008 | WO |
2008144175 | Nov 2008 | WO |
2008148210 | Dec 2008 | WO |
Entry |
---|
Michael P. Steinmetz, MD, et al. Management of Metastatic Tumors of the Spine: Strategies and Operative Indications, Neurosurg Focus 11(6), American Association of Neurological Surgeons, 2001. |
Thomas J. Errico, MD, et al., A New Method of Thoracic and Lumbar Body Replacement for SPinal Tumors: Technical Note, Congress of Neurological Surgeons Dept. of Orthopedics and Neurosurgery, New York University, Feb. 24, 1992. |
Number | Date | Country | |
---|---|---|---|
20110257688 A1 | Oct 2011 | US |