The present invention relates to medical devices such as spinal intervertebral implants implanted between adjacent vertebral bodies of a spinal column section, and methods of use, and more particularly to a metal coated implant for intervertebral stabilization comprising radiolucent and radiopaque properties to thereby facilitate visualization of the implant's orientation and/or position during or subsequent to vertebral disc space insertion in a spinal surgical procedure.
The spine is divided into four regions comprising the cervical, thoracic, lumbar, and sacrococcygeal regions. The cervical region includes the top seven vertebral bodies or members identified as C1-C7. The thoracic region includes the next twelve vertebral members identified as T1-T12. The lumbar region includes five vertebral members L1-L5. The sacrococcygeal region includes nine fused vertebral members that form the sacrum and the coccyx. The vertebral members of the spine are aligned in a curved configuration that includes a cervical, thoracic and lumbosacral curve. Within the spine, intervertebral discs are positioned between the vertebral members and permit flexion, extension, lateral bending, and rotation. An intervertebral disc functions to stabilize and distribute forces between vertebral bodies. The intervertebral disc is comprised of the nucleus pulposus surrounded and confined by the annulus fibrosis.
Intervertebral discs and vertebral members are prone to injury and degeneration. Damage to the intervertebral discs and/or vertebral members can result from various physical or medical conditions or events, including trauma, degenerative conditions or diseases, tumors, infections, disc diseases, disc herniations, aging, scoliosis, other spinal curvature abnormalities or vertebra fractures. Damage to intervertebral discs can lead to pain, neurological deficit, and/or loss of motion. Damaged intervertebral discs may adversely impact the normal curvature of the spine, and/or lead to improper alignment and positioning of vertebrae which are adjacent to the damaged discs. Additionally, damaged discs may lead to loss of normal or proper vertebral spacing.
Various known surgical procedures, treatments and techniques have been developed to address medical problems associated with damaged or diseased intervertebral discs. One treatment is a fusion procedure which partially removes the center or nuclear area of a damaged disc and fuses adjacent vertebral members to prevent relative motion between the adjacent vertebral bodies. A section of the disc, annulus and nucleus, is removed or cut out to allow insertion of an implant. The spacer may be used in conjunction with bone graft or allograft material which enables the adjacent vertebrae to grow and fuse together. The spacer assists in maintaining the adjacent vertebrae at a desired spacing height between the vertebrae during the fusion process. The spacer may also assist in imparting desired alignment or lordosis of the adjacent vertebral bodies.
As is well known to persons of skill in the art, there are a variety of structures and configurations which can be used to obtain the desired vertebral body spacing and alignment such as spacers, implants or cages. These structures come in a variety of configurations, features, contours, geometries and sizes depending on the specific medical application or use. Further, as is well known to those of skill in the art regarding established surgical procedures, implants can be inserted from a variety of insertion approaches, including for example anterior, posterior, anterolateral, lateral, direct lateral and translateral approaches.
Known surgical techniques and approaches can be complex, difficult and time consuming depending on implant configuration, and delivery instruments and surgical approaches used. Also, the surgeon must be careful not to injure the spinal cord and neighboring nervous system. During the implant procedure access to the affected disc area may be limited by the person's anatomy, the delivery approach, or the implant's configuration and physical properties. Additionally, it may be difficult for a surgeon to visualize the implant's position and orientation during and after the surgical procedure.
One known approach for implant visualization or fusion assessment is the use of fluoroscopy to visualize an implant with embedded radiopaque tantalum markers during or after a spinal surgical procedure. The implant is typically non-metallic while the tantalum markers are a radiodense metal that is substantially opaque to radiation, and thus more visible relative to the host implant. The tantalum markers typically small rod shaped devices with dimensions that permit imbedding in the host implant. The markers are typically imbedded at implant locations that can convey spatial implant information when viewed with a medical imaging device. The use of fluoroscopy and implants with tantalum markers provides limited visualization of the implant's location and orientation. Subsequent to a surgical implant procedure, computed tomography (CT) scanning or other medical imaging techniques may be used for post-operative imaging, examination and diagnosis of implant position and orientation or vertebral fusion assessment.
A drawback of implants with tantalum markers in post-operative imaging is that visualization remains difficult and limited in part due to the small markers size and the small radiopaque marker image in an X-ray imaging device. Also, the markers do not enable a surgeon to visualize the interface between the vertebrae end plates and the implant, which prevents a surgeon from detecting potential end plate damage or violation of the endplate or endplates due to insertion of the implant into the disc space during the implant procedure. An additional drawback is that the tantalum markers often cause X-ray CT scatter which degrades the images and makes post-operative fusion assessment more difficult.
There is thus a need for an improved implant and method for restoring an intervertebral disc space which addresses the problem of limited visualization of the implant during implant insertion during a spinal surgical procedure, and reduces or eliminates post-operative X-ray CT scatter. There is also a need for an improved intervertebral implant, and method for inserting the implant, between adjacent vertebral bodies using minimally invasive surgical techniques that overcome drawbacks and difficulties in visualizing the orientation and position of the implant during and after implant insertion and in relation to the vertebral body end plates.
There is provided a spinal implant for insertion into an intervertebral disc space, the implant comprising a polymer substrate and a metallic coating layer wherein the metallic coating layer is attached to the polymer substrate. There is also provided a metal coated implant where the polymer substrate is a biocompatible radiolucent polyetheretherketone (PEEK) material, and the metallic coating layer is either titanium (Ti) or gold (Au).
There is provided a spinal implant for insertion into an intervertebral disc space, the implant comprising a radiolucent polymer substrate and a radiopaque metallic coating layer attached to the polymer substrate, wherein a spinal implant image is visible via a medical imaging device to thereby determine position or orientation of the spinal implant relative to the vertebral disc space. In a preferred aspect, the polymer substrate is polyetheretherketone (PEEK) and the metallic coating layer is either titanium (Ti) or gold (Au).
There is provided a metal coated implant for insertion into an intervertebral disc space, the metal coated implant comprising a polyetheretherketone (PEEK) polymer substrate having a first surface and a second surface discontinuous from the first surface. The metal coated implant also comprises a biocompatible radiopaque metallic coating layer attached to the polymer substrate covering the first surface and the second surface such that a metal coated implant image is visible via a medical imaging device to thereby enable improved positioning and orienting of the metal coated implant in the vertebral disc space.
There is also provided a method for expanding an intervertebral disc space by inserting a metal coated implant between adjacent vertebrae comprising the steps of removing a portion of an intervertebral disc to create a disc insertion area between the adjacent vertebrae. Selecting a biocompatible metal coated spinal implant comprising a polymer substrate comprising a first surface and a second surface discontinuous from the first surface, and a biocompatible metallic coating layer attached to the polymer substrate and covering the first surface and the second surface. And, inserting the spinal implant into the disc insertion area in the intervertebral disc space to thereby expand the intervertebral disc space.
Disclosed aspects or embodiments are discussed and depicted in the attached drawings and the description provided below.
The present invention relates to medical devices such as spinal intervertebral implants implanted between adjacent vertebral bodies of a spinal column section, and methods of use, and more particularly to metal coated implants for intervertebral stabilization comprising radiolucent and radiopaque properties to thereby facilitate visualization of the implant's orientation and/or position during or subsequent to vertebral disc space insertion in a spinal surgical procedure. For purposes of promoting an understanding of the principles of the invention, reference will now be made to one or more embodiments or aspects, examples, drawing illustrations, and specific language will be used to describe the same. It will nevertheless be understood that the various described embodiments or aspects are only exemplary in nature and no limitation of the scope of the invention is thereby intended. Any alterations and further modifications in the described embodiments or aspects, and any further applications of the principles of the invention as described herein are contemplated as would normally occur to one skilled in the art to which the invention relates.
The metal coated implant 15 of the present disclosure possesses advantageous radiolucent and radiopaque properties and characteristics which enable or lead to distinct and improved implant visualization when viewed using medical imaging technologies or procedures which use X-rays or other electromagnetic radiation. The metal coated implant's 15 improved visualization enhances a surgeon's ability to distinctly visualize and better maneuver the delivery, insertion, trajectory, position and orientation of the metal coated implant 15 into the vertebral disc space 12 and through the surrounding patient anatomical environment. Also, the distinct visualization enhances a surgeon's ability to determine the implant's location, orientation and position during or subsequent to the implant's 15 insertion into a vertebral disc space 12. The radiolucent and radiopaque properties of the metal coated implant 15 also provide improved visualization which permits a physician to visualize the interface of the implant 15 and vertebral body end plates 6 and 8. The ability to distinctly visualize the interface between the implant 15 and vertebral body end plates 6 and 8 permits a physician to detect (e.g., via fluoroscopy) and minimize or prevent end plate damage or violation of the endplate or end plates caused by or resulting from insertion and deliver of the implant into the disc space 12 during the implant procedure.
Subsequent to implantation of the metal coated implant 15, the radiolucent and radiopaque properties of the metal coated implant 15 also result in the minimization or prevention of X-ray CT scatter when using medical imaging technologies which use X-rays or other electromagnetic radiation. Having images substantially free of X-ray scatter improves visualization which permits improved post-operative assessment capability by a physician, including fusion assessment at the vertebral joint section 100 where the metal coated implant was inserted.
The implant substrate 20 is preferably a solid material with physical properties and characteristics such that the substrate provides sufficient rigidity and structural integrity to substantially maintain desired expansion or separation of the intervertebral disc space 12 when inserted between the vertebral bodies 2 and 4. The implant substrate 20 may be molded, machined, or otherwise manufactured into any shape, geometry, configuration or size that would be needed by a surgeon for a spinal implant procedure. Those of skill in the art will recognize that the implant substrate 20 may take on any shaped desired or required for a particular medical use or application. The implant substrate 20 is preferably sufficiently solid for spinal use and to be able to withstand internal or external forces typically encountered or applied to the spinal joint 100. In one aspect, the implant body or implant substrate 20 is preferably formed of a biocompatible polymer material which has a material stiffness or Modulus of Elasticty (MOE) between cortical bone and cancelleous bone, or similar to cortical bone and cancelleous bone. The biocompatible polymer material is preferably of a kind that will not be reabsorbed during the fusion process. In a preferred aspect, the implant substrate 20 is made of a uniform or homogeneous biocompatible polymer material. However, the implant substrate 20 may, in certain applications, be a mixture or composite of biocompatible materials.
In a preferred aspect, the implant substrate is a polyetheretherketone (PEEK) polymer material. A PEEK material is a radiolucent material which permits transmission of electromagnetic radiation, such as X-rays, emitted by a medical imaging device through the PEEK substrate 20 thereby making the PEEK material radiolucent. Those of skill in the art will recognize that there are other biocompatible radiolucent polymer type materials that can also serve as an implant substrate 20, including, among others, homopolymers, co-polymers and oligomers of polyhydroxy acids, polyesters, polyorthoesters, polyanhydrides, polydioxanone, polydioxanediones, polyesteramides, polyaminoacids, polyamides, polycarbonates, polylactide, polyglycolide, tyrosine-derived polycarbonate, polyanhydride, polyorthoester, polyphosphazene, polyethylene, polyester, polyvinyl alcohol, polyacrylonitrile, polyamide, polytetrafluorethylene, poly-paraphenylene terephthalamide, polyetherketoneketone (PEKK); polyaryletherketones (PAEK), cellulose, carbon fiber reinforced composite, and mixtures thereof.
The metallic coating layers 22 and 24 are preferably comprised of a biocompatible and radiopaque material attached, formed, deposited, sprayed or bonded to the implant polymer substrate 20. In the embodiment shown in
In a preferred aspect, the implant coating layer 22 and 24 is comprised of a biocompatible metal such as titanium (Ti) or Gold (Au), or a combination or mixture of these two metals. The radiodensity of these metals absorb or block electromagnetic radiation, such as X-rays, from passing through the metallic coating comprised of one or both of these metals. Other biocompatible and radiopaque metals are contemplated for the attachment of a metallic implant coating layer 22 and 24 onto an implant substrate 20 including, but are not limited to, Stainless Steel, Cobalt Chrome, Tantalum, Platinum, Tungsten, Silver, Palladium, as well as any mixture, composite, combination an/or alloy of the aforementioned biocompatible metallic materials. The metallic implant coating layers 22 and 24 can be attached, deposited or bonded to a spinal implant substrate 20 of any physical size, shape or configuration.
The radiopaque aspect of the metal coating layer area 22 and 24 on the implant substrate 20 makes the metallic coating layer distinctly visible in a medical imaging device, e.g., on a fluoroscope or in an x-ray static image. The radiopaque metallic layer 22 and 24 in combination with the radiolucent implant substrate 20 result in a distinct or improved implant image which permits a surgeon to have improved implant maneuvering or control for delivery, insertion, trajectory, positioning and orienting during implant insertion into the vertebral disc space and through the patient's surrounding anatomy. Additionally, the radiodensity characteristics and properties of the metal coated layers 22 and 24 on the implant result in the substantial minimization or prevention of X-ray CT scatter in post-operative medical imaging.
The metallic implant coating 22 or 24 can be attached or bonded on a selected portion, section or surface, interior or exterior, of the implant substrate 20, preferably a PEEK substrate. The metallic implant coating layer 22 and 24 can also be attached or bonded over the entirety of surfaces, interior or exterior, of an implant substrate 20. The final metallic coating layer make-up or configuration on an implant substrate 20 will depend on the needs and requirements of a physician or a particular surgical spinal application. The metallic implant coating layers 22 and 24 can also be deposited or formed on the implant substrate 20 in a selected or needed metallic coating pattern determined by a medical application or a physician needs. As such, an implant substrate 20 may be metallically coated along its side surfaces, top or bottom surfaces, or over the entire implant substrate as needed or required by a physician or medical application. In some instances, the decision where to coat the implant substrate 20 may depend on the cost or availability of the selected coating metal. In the case of high expense and limited availability of a coating metal, the implant's substrate can be coated only as is sufficiently necessary for improved visualization.
Where a metallic coating layer is to be formed on a portion, section or surface of the implant substrate 20 or in a specific coating pattern, use of a pattern or design mask permits coating control on the implant substrate 20. A pattern or design mask provides the ability to cover selected surfaces, sections or portions of the implant substrate 20 during manufacturing of the metal coated implant 15. Where the mask covers the underlying substrate 20, no metallic coating will be deposited or formed on the substrate 20. Where the mask does not cover the underlying substrate, a metallic coating will be deposited or formed on the substrate in accordance with the mask patter or design. In this manner, a pattern mask allows for control of where the implant substrate 20 is metallically coated and where it is not. As is known to those of skill in the art, a pattern or design mask can be a sheet or material with a desired pattern or design which can be attached and positioned on a substrate. Methods and means for attachment and bonding of a pattern or design mask on a substrate are well known to those of skill in the art, and use of such known methods and means for attaching and positioning a pattern mask or design plate cut out is contemplated herein.
The use of metallic coating and pattern masks permits the implant substrate 20 to be metallically coated such that the attached or bonded metallic coating follows or complimentarily takes on the contour, shape and configuration of the implant 15. The metallic coating layer 22 and 24 will be able to take on the contour, shape and configuration of the implant 15 whether the implant's surfaces are planar or curved, whether the implant has soft or sharp surface transitions, whether the implant substrate has a simple or complex geometric shape, whether the implant substrate has surface protrusion or tooth configuration patterns or shapes, or whether the implant substrate is for a small or large size implant. Use of a pattern or design mask provides the ability to metallically coat any portion of a substrate's surfaces or the entirety of a substrate's surfaces.
In an alternate preferred aspect, gold (Au) may instead be used as the metallic coating layer deposited on the PEEK substrate implant 15. In some instances and applications, gold (Au) may be selected as the material for the coating layer. For example, where certain factors may also or instead be considered or come into play, such as material availability, cost and ease of manufacturing, gold (Au) may instead be selected as the metal coating. Further, as discussed above, other metals may be used to form the single metallic layer instead of the preferred titanium (Ti) or alternate Gold (Au) metallic layer.
In one aspect shown in
Where more than one metallic coating layer is used, for example as shown in
The implant's upper and lower walls 202 and 204, and side walls 206 and 208 define an implant aperture 210 which extends from the upper wall 202 to the lower wall 204. The implant's upper and lower walls 202 and 204 also comprise protrusions, projections or teeth 218 which are integrally formed with and which extend away from the upper and lower wall 202 and 204 surfaces. The teeth 218, as will be discussed below are metallically coated. The implant teeth can provide stability for the implant 200 once it is inserted between the adjacent vertebrae, and assist in preventing the implant 200 from being ejected from the disc space 12. In the aspect shown in
The metal coated implant 200 further includes instrument attachment channels 216 which partially extend into the rear wall 217 and the side walls 208 and 210. The instrument attachment channels 216 can be used for insertion and positioning of the metal coated implant 200 in the disc space 12 between the adjacent vertebrae 2 and 4. The instrument attachment channels 216, implant aperture 210, and side wall apertures 212 and 214 could serve to promote bone fusion in-growth once the implant 200 is inserted in place in the disc space 12. Prior to or during implantation of the metal coated implant 200 into the disc space 12, the attachment aspect 216, implant aperture 210, and side wall apertures 212 and 214 may also be filled with a graft material. The graft material may be composed of any type of material that has the ability to promote, enhance and/or accelerate the to promote bone growth and fusion or joining together of the vertebral bodies 2 and 4 by one or more mechanisms such as, osteogenesis, osteoconduction and/or osteoinduction. This may include allograft material, bone graft, bone marrow, a demineralized bone matrix putty or gel and/or any combination thereof. The filler material may promote bone growth through and around the apertures to promote fusion of the intervertebral joint 100. Those of skill in the art will recognize that the use of filler graft material is optional, and it may or may not be used depending on the needs or requirements of a physician or a medical procedure.
The metal coated implant 200, shown in
In alternate aspects and embodiments, the metal coated implant may have upper and lower walls which are angled relative to one another to achieve a desired or selected kyphosis, lordosis, or lateral wedge effect. In other embodiments, an implant wall or surface may extend obliquely from an adjacent wall rather than orthogonally. Also, any of the implant's walls could be tapered, sloped, angled, or curved, including covex, bi-convex and concave curving, depending on a particular medical application need. The metal coated implant may also be made to have any size, shape and geometry for mating with existing insertion or improved instruments.
The metal coated implant 15 and 200 may be implanted in the disc space 12 using known methods, procedures and approaches, including an anterior, posterior, translateral, direct lateral or any suitable oblique direction, as those of skill in the art will recognize. Further, a spinal implant may be delivered and inserted through known surgical technique and procedures, including: open, mini-open, minimal access spinal technologies (MAST) or other minimally invasive surgical (MIS) techniques.
In one approach, the metal coated PEEK implant 15 and 200 is inserted via an anterior approach. In one aspect, the metal coated implant 15 or 200, shown in
Prior to insertion, known medical instruments and tools may be used to prepare the intervertebral disc space 12, including specialized pituitary rongeurs and curettes for reaching the nucleus pulposus or other area in the disc space 12. The disc space 12 may be prepared with a partial or complete discectomy. Ring curettes may be used as necessary to scrape abrasions from the vertebral endplates 6 and 8. Using such instruments, a location which will accept the metal coated implant 15 and 200 is prepared in the disc 10 and disc space 12. Those of skill in the art will recognize that the metal coated implant 15 and 200 may be positioned at any desired location between the adjacent vertebral bodies 2 and 4 depending on the surgeon's need and the performed surgical procedure or medical application.
The implant is then inserted into the prepared disc space 12 using insertion instruments which are appropriate with the shape and configuration of the metal coated implant and surgical procedure to be used. A medical imaging technique and device may be used to distinctly visualize the metal coated implant 15 during the insertion procedure by taking advantage of the metal coated implant's radiolucent and radiopaque properties. During the insertion step, the enhanced metal coated implant visualization will permit the surgeon to better maneuver and control the trajectory, position and orientation of the metal coated implant 15 into the vertebral disc space 12 and through the surrounding patient anatomical environment.
The metal coated implant 15 or 200 is then delivered into the intervertebral disc space 12 and positioned in a selected location and orientation between the end plates 6 and 8 of the adjacent vertebral bodies 2 and 4. The metal coated implant is inserted into the disc space 12 such that the upper wall 202 is positioned adjacent to the upper vertebral endplate 6 and the lower wall 204 is positioned adjacent to the lower vertebral endplate 8. The teeth projections 218 may engage the vertebral endplates 6 and 8 to provide stability to the implant 200. Once implanted, the upper metal coating layer 222 attached to the upper substrate wall 202 will contact the upper vertebral end plate 6 to form an interface between the metal coated implant 200 and the upper vertebral body 2. Also, the lower metal coating layer 224 attached to the lower substrate wall 204 will contact the lower vertebral end plate 8 to form an interface between the metal coated implant 200 and the lower vertebral body 4. After the insertion of the metal coated implant 200 between the vertebral bodies 2 and 4 has been completed, the metal coated device 200 may promote the fusion or joining together of the vertebral bodies 2 and 4.
While embodiments of the invention have been illustrated and described in detail in the present 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 desired to be protected and are to be considered within the scope of the disclosure.