In humans and other vertebrate animals, the spinal column is made of individual bones or vertebrae that are aligned together and extend along the center of an individual's back. Importantly, the spinal column provides a protective channel for the spinal cord of the central nervous system and supports an individual's weight and posture while enabling a wide range of motion of the upper body. The vertebrate are movably joined at facet joints and, in humans in particular, can be arranged in regions including the cervical region corresponding to the neck, the thoracic region corresponding to the chest, and the lumbar region corresponding to the lower back. The arrangement of vertebrae within the regions can provide the familiar curves and arches of the spinal column. To enable bending, twisting and rotating of the upper body, the individual vertebrae are spaced apart by intervertebral disks. The intervertebral disks are made of a tough, fibrous connective tissue that rings around and surrounds a thick, jelly-like material at the center of each disk. The disks act to dampen shock transmitted along the spinal column and to enable motion.
Intervertebral disks may become damaged or degenerate overtime, due to disease, or due to abrupt injury such that it may become medically necessary or beneficial to surgically remove the damaged disk. To maintain the intervertebral spacing between two adjacent vertebrae from which a disk has been removed, it is known to insert spinal or intervertebral implants into the space. The intervertebral implant preferably promotes bone growth to fuse the adjacent vertebrae across the disk space. A variety of materials, sizes, shapes, and insertion techniques have been suggested for providing and inserting intervertebral implants. For example, it is well known to shape the implants as cylindrical dowels that can be inserted between the vertebrae. In some instances, the implant can be formed of a biocompatible material such as metal or ceramic or can be formed from actual bone tissue harvested from a donor bone. Desirably, the material, size and shape of the implant are selected for ease of implantation, maintenance of the proper spinal curvature, and to provide the necessary biomechanical strength to support the spinal column.
In some instances, screws, braces or fixtures can be utilized to maintain alignment of the spinal column and implant during recovery and fusion of the adjacent vertebrae. In other instances, it may be desirable to incorporate osteogenic material with the intervertebral insert to promote bone tissue growth and fusion of the adjacent columns. Accordingly, there exists a need for an intervertebral spinal implant that can maintain the intervertebral space between and enable rapid fusion of adjacent vertebrae. There exist a further need for a intervertebral implant that is biologically active and biomechanically strong and that can maintain and support the existing curvature of the spinal column. Additionally, the intervertebral implant should remain stable and not be prone to slippage.
The invention provides an intervertebral spinal implant for maintaining intervertebral spacing between and promoting the fusion together of two adjacent vertebrae. In an aspect, the intervertebral implant can have a generally flat body with a first surface and an opposing second surface that is sized and shaped for insertion into the intervertebral space. Disposed into the body can be at least one aperture that can be formed to receive osteogenic or similar medicinal material that promotes bone growth between the vertebrate to fuse those vertebrate together. To optimize retention of the osteogenic material within the body during manipulation of the implant, the aperture in some embodiments can be disposed on a non-perpendicular angle into the first surface of the body. In other embodiments, the aperture can taper or be conically shaped as it extends from the first surface toward the second surface of the body. The tapering of the aperture can be in addition to or besides disposing the apertures on non-perpendicular angles. Another advantage of disposing the osteogenic material receiving aperture on a non-perpendicular angle or on a taper is that the material will tend not to shake or fall loose from the aperture. Another advantage is that the non-perpendicular or tapered apertures can accommodate more osteogenic material.
In another aspect of the invention, an intervertebral implant having a flat body with first and second opposing surfaces can have disposed into at least one surface a plurality of grooves. The grooves can have any suitable shape or pattern, but preferably have a gull-wing shape. To provide the gull-wing shape, the grooves can have a first curve and a second curve that intersect together approximately mid-width of the implant. The gull-wing shaped grooves can retain osteogenic or other medicinal material and can allow for ingrowth of the host bone. In various embodiments, the intervertebral implant can have gull-wing shaped grooves on both the first and second surface and further can include one or more osteogenic material receiving apertures of the above described kind. Another advantage of disposing the gull-wing shaped grooves across a surface of the implant is that grooves provide traction where the implant surface meets the vertebrae thereby preventing slipping or movement of the implant.
In another aspect of the invention, an intervertebral implant having a flat body and first and second opposing surfaces can be formed from the elongated diaphysis or shaft portion of a long donor bone. To form the implant, a plurality of outlines, each of the first surface, are cut or otherwise disposed directly into the outer surface of the bone tissue such that the plurality of outlines are arranged axially along the diaphysis. Accordingly, one surface of the implant corresponds to the outer surface of the diaphysis of the donor bone. This is in contrast to prior art methods, in which allografts or spinal implants are typically formed by disposing cuts perpendicularly into the diaphysis. An advantage of preparing the implants by cutting into the diaphysis parallel rather than perpendicular to its long axis is to conserve donor bone by enabling larger and more implants to be formed from a given bone.
In another aspect of the invention, the intervertebral implant can have a generally flat body generally shaped overall as a question mark. The question-mark shape can be provided by having a peripheral surface of the body include a straight first edge, a curved second edge extending away from the first edge, and a cutout formed into the first edge. In various embodiments, the cutout can receive osteogenic or other medicinal material. An advantage of forming the implant with a question-mark shape is that such a shape helps to fill the entire inter-vertebral.
Accordingly, an advantage of the inventive intervertebral implant is that it provides strong biomechanical support to the spinal column. Another advantage is that the intervertebral implant can retain osteogenic material for promoting fusion of adjacent vertebrae. A related advantage is that the intervertebral implant can include curved grooves of a specific shape to prevent slipping of the implant from between adjacent vertebrae. Yet another advantage is that the intervertebral implant can be shaped to promote and maintain the lordotic curve of the lumbar region in the spine. These and related advantages and features of the invention will become apparent upon review of the following drawing and
Now referring to the drawings, wherein like numbers refer to like elements, there is illustrated in
Replacement of a disk with the intervertebral implant 100 can be illustrated with reference to
Referring back to
The material of the intervertebral implant 100 can be selected from any suitable biocompatible material having the desired biomechanical strength, immune acceptance and toxicity characteristics. For example, the material can be selected from a biologically compatible metal such as titanium, cobalt or chrome steel, gold alloys, stainless steel or similar metals. In other embodiments, the material can be selected from a synthetic, biologically active or bio-absorbable material such as calcium, sulfate, polyglycolic acid, hydroxyapatite, porous ceramics, apatitic bone cement, calcium phosphate, hydroxyproline, hydroxyapatite cement, and methylmetacrylate. In certain embodiments, the implant material can be selected from bio-active or bio-inactive bone tissue. For example, the bone tissue can be primarily cortical tissue such as typically found on the hard, solid outer surface of a donor bone. The bone tissue can also be primarily spongy cancellous bone typically found in the interior of thicker bones. When used in intervertebral implants, cortical bone may be desirable for its biomechanical strength properties but cancellous bone may be desirable for its ability to promote vascularization and new bone growth to fuse the adjacent vertebrae together. Accordingly, to increase biomechanical strength, the implant can be made from 90% cortical bone while to promote bone growth, the implant can be made from about 60% to 98% cancellous bone. When bone tissue is taken from a donor bone to form the intervertebral implant, the donor bone can be selected such that the resulting intervertebral implant can be an allograft (same animal species) or a xenograft (different animal species).
To address the above paradox, the intervertebral implant 100 can be configured to have an implant body 110 of relatively harder material and to retain or include a bioactive osteogenic material or similar medicinal material. To carry the osteogenic material, the implant body 110 can have a first aperture 130 and a second aperture 132 disposed into the first surface 112 and directed toward the second surface 114. The apertures 130, 132 may or may not traverse the entire thickness of the implant body 110. Moreover, in the illustrated embodiment, the apertures can be circular in cross-section but in other embodiment may have different shapes. The osteogenic or medicinal material can be placed or packed into the apertures 130, 132 prior to insertion of the implant into the intervertebral space. As can be appreciated with respect to
The osteogenic material can be selected from any suitable material that helps promote bone growth and thereby speed fusion of adjacent vertebrae. For example, the osteogenic material can be selected from non-de-mineralized particular bone material, de-mineralized bone matrix, partially de-mineralized bone material, partially de-calcified bone material, AAA bone graft, or osteogenic growth factors including BMP. Moreover, the osteogenic material can be provided as a particulate, a jelly, a paste or a putty.
To optimize retention of the osteogenic and/or medicinal material in the aperture during handling and insertion of the implant 100, the apertures 130, 132 can be disposed on a non-perpendicular angle into the first surface 112 and towards the opposing second surface 114. Specifically, as best illustrated in
Continuing to refer to
Referring now to
To retain the osteogenic or medicinal material, the intervertebral implant 200 can include a first aperture 230 and a second aperture disposed into the first surface 212 and directed toward the second surface 214. While in the illustrated embodiment, the apertures are disposed entirely through the implant body 210, it will be appreciated that in other embodiments, the apertures may terminate prior to the second surface 214. To optimize retention, the apertures 230, 232 can have a tapered or conical shape as they are disposed through the implant body 210 from the first surface 212 toward the second surface 214. Specifically, the circular apertures 230, 232 can form a larger diameter hole 236 proximate the first surface 212 and a smaller diameter hole proximate 238 the second surface 214. Tapering the apertures cause more surface area of the implant body 210 to frictionally contact the osteogenic material, thereby preventing the material from shaking or falling loose of the intervertebral implant 200. Additionally, the smaller diameter hole 238 restricts the osteogenic material from passing out the apertures 230, 232 via the second surface 214. In another embodiment, instead of tapering the aperture, the aperture can be formed as a counterbore having a first section of a larger diameter disposed into the first surface and a second section of a smaller diameter disposed into the second surface. Accordingly, in the present embodiment, the intervertebral implant 200 is inserted into the intervertebral space such that the second surface 214 is oriented toward the lower vertebrae.
To further improve osteogenic material retention, the tapered aperture 230, 232 can also be disposed into the first surface 212 on a non-perpendicular angle. Specifically, as illustrated with respect to
Referring now to
To retain the osteogenic or medicinal material, a plurality of apertures 330 can be disposed on non-perpendicular angles to the first surface 312 of the intervertebral implant 300. In particular, four separate apertures 330a, 330b, 330c, and 330d can be disposed along the elongated axis of the implant 300. The first two apertures 330a, 330b, are disposed near to the first lateral edge 312 and further are angled toward the first lateral edge. The second two apertures 330c, 330d are disposed near to the second side 314 and likewise are angled toward that second edge. Accordingly, in the illustrated embodiment the apertures 330 are not parallel to each other. As can be appreciated, all the plurality of apertures 330 could also be tapered, or only a portion of the plurality of apertures could be tapered.
Referring to
In the illustrated embodiment, the plurality of grooves 450 are disposed across the first surface 412 and extend between the parallel first and second lateral edges 420, 422. In other embodiments, the grooves can be oriented in other directions to facilitate different insertion methods. The grooves can be disposed into the first surface any suitable depth, but should not thoroughly alter the strength or integrity of the intervertebral implant. For example, the depth of the grooves into the first surface can be about 1-2 mm and the spacing in between adjacent grooves in the plurality can be about 1 mm. Moreover, any number of grooves 450 can be in the plurality, and preferably the plurality of grooves are arranged in a gull-wing pattern. Specifically, the grooves 450 are parallel to each other and extend between the first and second adjacent lateral edges. To form the gull-wing pattern, the grooves 450 can each include a first curve 452 located proximate to the first lateral edge 420 and a second curve 454 located proximate to the second lateral edge 422. Both the first and second curves 452, 454 are directed towards the fourth curved edge of the implant, and the curves of each groove can intersect approximately mid-width between the first and second lateral edges. The grooves can help maintain position of the intervertebral implant sandwiched between the adjacent vertebrae by providing or encouraging friction between the surfaces of the implant and vertebrae that prevents slipping. In this regard, the gull-wing shaped grooves can be oriented so that the intersection between curves is in the direction of the intervertebral space into which the implant is inserted. This reduces the likelihood that the implant will become displaced before the implant and the vertebrae fuse together. Additionally, as illustrated, the plurality of grooves can also received and retain additional osteogenic material 436. Because the grooves extend across the surfaces 412, 414 of the implants 400, the osteogenic material is advantageously spread across the implant-vertebrae interface.
Described with respect to
Referring to
Disposed into the body 610 from the first straight edge toward the second curved edge 622 can be a cutout 630. The cutout 630 generally extends between and through the first and second surfaces 612, 614. Moreover, the cutout 630 can have any desired shaped and preferably has a rounded shape to conform generally to the shape of the curved edge 622. In various embodiments, the bone tissue proximate the curved edge 622 can be primarily cortical tissue while the bone tissue proximate the cutout 630 can be primarily cancellous tissue. The operation of forming the cutout 630 removes much of the cancellous tissue so that the remaining material of the implant 600 is primarily the biomechanically stronger cortical tissue. The cutout 630 can receive osteogenic material to promote bone growth and fusion of adjacent vertebrae. Moreover, in accordance with the foregoing embodiments, disposed into either or both of the first and second surfaces can be a plurality of grooves that can also prevent slipping of the inserted implant and/or receive osteogenic material.
The intervertebral implants described herein can be formed by any suitable forming operation. For example, a milling apparatus including a rotating end mill can be used to cut the implants from a donor bone and then to form the apertures and/or grooves. Additionally, the milling apparatus can be used with an end mill to plane the first and second surfaces so that the body is generally flat. To automate the process, the milling apparatus can be computer numerically controlled. In other embodiments, the intervertebral implants can be formed by traditional hand tools such as saw and/or osteotomes. After forming, the implants can be inserted freshly or can be stored in a frozen or freeze-dried state.
All references, including publications, patent applications, and patents, cited herein are hereby incorporated by reference to the same extent as if each reference were individually and specifically indicated to be incorporated by reference and were set forth in its entirety herein.
The use of the terms “a” and “an” and “the” and similar referents in the context of describing the invention (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. The terms “comprising,” “having,” “including,” and “containing” are to be construed as open-ended terms (i.e., meaning “including, but not limited to,”) unless otherwise noted. Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein, is intended merely to better illuminate the invention and does not pose a limitation on the scope of the invention unless otherwise claimed. No language in the specification should be construed as indicating any non-claimed element as essential to the practice of the invention.
Preferred embodiments of this invention are described herein, including the best mode known to the inventors for carrying out the invention. Variations of those preferred embodiments may become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventors expect skilled artisans to employ such variations as appropriate, and the inventors intend for the invention to be practiced otherwise than as specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described elements in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context.
This patent application is a divisional of copending U.S. patent application Ser. No. 11/775,656, filed Jul. 10, 2007. This patent application is a continuing application of copending U.S. patent application Ser. No. 12/823,811, filed Jun. 25, 2010, which is a continuation-in-part of U.S. patent application Ser. No. 11/775,656, filed Jul. 10, 2007.
Number | Date | Country | |
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Parent | 11775656 | Jul 2007 | US |
Child | 12874804 | US |
Number | Date | Country | |
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Parent | 12823811 | Jun 2010 | US |
Child | 11775656 | US |
Number | Date | Country | |
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Parent | 11775656 | Jul 2007 | US |
Child | 12823811 | US |