Patent Application
20060161154
The present invention relates to prosthetic medical devices and methods. In particular, the present invention relates to prosthetic medical devices and methods for the human vertebral column.
One embodiment provides a device or method for attachment and/or reconstruction of a posterior aspect of the spinal column.
In one embodiment, a prosthetic spinous process device and method are provided for anchoring one or more artificial ligaments, cushions, tensile elements, spinal reconstructive devices, posterior artificial ligaments, posterior dynamic systems, posterior arthrodesis stabilization systems, or the like. A spinous process may be defined as an outward projecting part of a vertebra, sacrum or coccyx.
One embodiment is suited for applications including stabilization and arthrodesis of segments of the vertebral column in degenerative pathologies of the spine. One embodiment may be used with prior laminectomy, removal of the posterior elements, post-laminectomy syndrome, spina bifida, prior resection of the posterior spinal elements, DDD, and post-diskectomy syndrome. In addition, while not being limiting, at the base of the spinal column at the S1 or first sacral vertebra there is often missing bone (spina bifida occulta) or atrophic bone, and one embodiment is suited for use in these cases as well.
One embodiment provides an easily adjustable structure for securely attaching one or more posterior dynamic systems. When in place, the prosthetic spinous process is offset dorsally and in a more caudal position than pedicle screws attaching the prosthetic spinous process to an aspect of the spinal column. In this embodiment, the potential complications associated with conventional systems, e.g., cutting out and penetrating lumbar nerve roots, dura mater, or spinal soft tissue, are reduced or avoided entirely.
As illustrated in
The device additionally contains a member 2, the body of which has a plane of symmetry, e.g., is substantially symmetrical about a single plane. The second plane 4 is substantially coplanar with this plane of symmetry.
In the device, the first plane 3 and the second plane 4 are disposed at a second angle of 80 to 100 degrees relative to one another. This range includes 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, and 100 degrees. In one embodiment of the device, the first plane 3 and the second plane 4 are normal to one another, i.e., they are disposed at right angles with respect to one another.
To solve the problem of varying interpedicular distance, the two crosslinking rods 1 attach to pedicle screws 9 (See
The member 2 further includes at least one opening 5 therethrough. The opening 5 defining an axis can be disposed normal to the second plane and above or below the first plane.
Another embodiment provides a method, which includes contacting the device discussed herein with a part of a human body. For example, the device can provide a prosthetic spinous process at any of the human vertebrae.
In one embodiment, the device provides a prosthetic spinous process for one or more of the lumbar vertebrae L1, L2, L3, L4, or L5, or sacral vertebrae S1, S2, S3, S4, or S5.
The crosslinking rods 1 can be cylindrical, each having an independent length and diameter. The respective lengths and diameters of the crosslinking rods 1 may be the same or different. The lengths can be greater than the diameters. The crosslinking rods 1 can have identical diameters.
The crosslinking rods 1 may have any suitable diameter ranging from 2 to 15 mm. This range includes 2, 3, 3.5, 3.75, 4, 4.25, 4.5, 4.75, 5, 5.25, 5.5, 5.75, 6, 6.25, 6.35, 6.5, 6.75, 7, 7.25, 7.5, 7.75, 8, 8.5, 9, 9.5, 10, 10.5, 11, 12, 13, 14, and 15 mm, and any diameter therebetween. For example, such diameters can include 3/16″, ¼″, ⅜″ and 5.5 mm.
The crosslinking rods 1 may have an aspect ratio of length/diameter ranging from 200 to 1. This range includes 200, 175, 150, 125, 100, 90, 80, 70, 60, 50, 40, 30, 20, 10, 9, 8, 7, 6, 5, 4, 3, 2, and 1, any combination thereof, and any aspect ratio therebetween.
The crosslinking rods 1 may meet at any first angle of from 110 to 170 degrees, which range includes 110, 120, 125, 130, 133, 135, 137, 139, 140, 145, 150, 151, 152, 153, 154, 155, 156, 157, 158, 159, 160, 161, 163, 165, 167, and 170 degrees, and any angle therebetween.
The second plane 4 defined by member 2 may bisect the first angle defined by the crosslinking rods 1. In one embodiment, the second plane 4 bisects the first angle defined by the crosslinking rods and is normal to the first plane 3.
The crosslinking rods 1 and/or member 2 may be made of any material, such as metal, alloy, plastic, composite, biomaterial, or the like. The crosslinking rods 1 and/or member 2 may or may not have one or more coatings to enhance their mechanical or electrical properties, or to enhance their biocompatibility. Non-limiting examples of suitable metallic materials include titanium, stainless steel, cobalt chrome, ceramic, bioabsorable materials, and the like. Non-limiting examples of plastic materials include PEEK (polyetheretherketone), PIIKEK, and other related composites, polycarbonate, polyurethane, silastic, rubber, polyethylene, UHMWPE (ultrahigh molecular weight polyethylene), or plastic. Combinations of materials are possible.
The device may be attached to any part of the body as deemed appropriate to one of ordinary skill in this art. The device can be attached to one or more human bony parts. The device can be attached to one or more bones in the human vertebral column. These include any of the lumbar vertebrae L1, L2, L3, L4, and L5, or sacrum S1, S2, S3, S4, and S5, or any combination thereof.
The device can be attached to the body by any technique known in the art. The attachment means may suitably include one or more pedicle screws, polyaxial pedicle screws, monoaxial pedicle screws, cannulated pedicle screws, solid pedicle screws, screws which are placed or fixed anywhere on the spine, vertebral body screws, iliac crest screws, facet screws, laminar hooks, pedicle hooks, circumferential spinal fixation wires, and any combination thereof. The device may be affixed internally or externally. The device may be inserted percutaneously if desired.
In one embodiment, the device is attached to bone with two or more pedicle screws. Pedicle screws are known in the art and are typically threaded bone screws adapted for placement to and/or through any of the lamina, pedicle and/or the vertebral body. These screws may be affixed internally or externally, and they may be inserted percutaneously, if desired. The pedicle screws may be affixed directly or indirectly to or through one or more of the crosslinking rods 1 of the device. Alternatively, the crosslinking rods 1 are affixed directly or indirectly to or through the screws. The screws are screwed into a bony part along the vertebral column.
The pedicle screw may have a head or tulip that can rotate about many axes to accommodate various anatomical conditions and positions. This type of screw is called polyaxial. Monoaxial screws, e.g., those that do not have a rotating head, may also be used, however. The polyaxial screw may be solid or cannulated. Cannulated screws have a hollow center, which allows the surgeon to place the screw over a previously inserted guide pin. Non-limiting examples of polyaxial pedicle screws include those sold under the names PATHFINDER™, available from Spinal Concepts, a division of Abbott Laboratories, MOSS MIAMI™, MONARCH™, and EXPEDIUM™, available from DePuy Spine, Inc., XIA™, available from Stryker™ Spine, and CD HORIZON™ and CD HORIZON SEXTANT™ systems available from Medtronic Sofamor Danek.
The sacrum affords a much larger diameter pedicle screw than other spinal levels. Accordingly, in one embodiment, a screw-within-a-screw construct may be used, which locks the crosslinking rod 1 to the pedicle screw. The pedicle of S1 can often accommodate a pedicle screw of diameter 8.5 mm. Accordingly, in one embodiment, the pedicle screw may be a cannulated or hollow screw, and a locking screw passing through the crosslinking rod 1 (with, for example, a corresponding 3 mm hole therein), could be fixed by a second 3 mm diameter locking screw which passes through the hole and into the 7.5 mm or 8.5 mm diameter sacral S1 pedicle screw.
The distal end of the crosslinking rod 1, at any distance away from the vertex of the device, may be plain or may be modified to improve its attachment to the pedicle screw. In one embodiment, one or both of the crosslinking rods 1 may be adapted to allow the surgeon to cut off excess crosslinking rod 1 as appropriate. In another embodiment, the distal end of one or both of the crosslinking rods 1 may have a ball 16 (See
In one embodiment, the crosslinking rod 1 may have one or more cannulations 14 (See
The ball-shaped portion or enlargement 16 to the diameter of the crosslinking rod 1 may desirably correspond to a ball-and-socket type receptacle on the tulip 15. For ease of percutaneous insertion, the pedicle screw can be cannulated and the one or both of the crosslinking rods 1 can have a hole, a slot, or an oblong hole where the guide wire or guiding suture or guiding mechanism can be threaded through the (or attached to the crosslinking rod 1 by another mechanism) transverse crosslinking rod 1.
The two pedicle screws may be affixed in a converging, triangular transverse fashion, or they may be affixed in a diverging manner. In one embodiment, the pedicle screws are cross-linked together in a triangular fashion. This triangulation of the pedicle screws improves the pull-out strength because the pull-out strength is determined by the area of bone between the screws rather than simply the bone within the screw threads. Triangulation thus leads to improved cyclical pull-out strength.
In one embodiment, S1 pedicle screws are used. Non-limiting possible attachment points of the screws include the medial aspect of the sacrum at S1, the medial aspect of the sacrum at S2, or the laterally diverging iliac crest (See
The member 2 includes at least one opening 5. The opening 5 defines an axis 6 that is disposed above, below or at the first plane 3, and parallel to the first plane 3. The axis 6 is also substantially normal to the second plane 4, defined by the member 2. The member 2 may optionally include one or more additional opening 5′ (See
The opening 5 can be sufficient to allow one or more tensile elements, e.g., a polyester or P.E.T. band to pass therethrough and connect the device to either to an opening 5 on another prosthetic spinous process device, to another part of the body, to another part of the vertebral column, or to different device entirely. The tensile element may be connected to any combination other connections, parts, and devices as appropriate. In this regard, one embodiment may be suitably used with and/or connected to various types of spinal stabilization systems, intervertebral implants, and the like. Suitable non-limiting examples include the WALLIS™ and DIAM™ Spinal Stabilization Systems from Medtronic, and those such as disclosed in U.S. Pat. No. 6,761,720, and U.S. Patent Application Pub. No. 2004/0024458, for example.
At least a portion of the opening 5 can available either above or below or both the device to enhance applicability to more cranial or cephalad vertebral levels, e.g., L1 to L5. In another embodiment, at least a portion of the opening 5 is available above or below the point on the member 2 where the crosslinking rods 1 attach to the member 2. The opening 5 should be available on the cranial or superior aspect of the prosthetic spinous process as well as on the caudal or inferior aspect of the prosthetic spinous process. In view of improved utility at vertebral levels in the lumbar spine the opening 5 can be available below, above or both above and below (cephalad and caudad) to the prosthetic spinous process.
The shape of the member 2 is not particularly limiting, so long as it has a portion that lies either above, below, or above and below the first plane 3, and has at least one opening 5 that lies either above or below the first plane 3. The member 2 may have shape that, when viewed along a dorsal midline view, increases in thickness in the direction of cephlad to caudad. The increase in thickness may be constant, to effect a triangular projection, or the increase in thickness may be variable, to effect a bulbous projection (See
In one embodiment, the member 2 may additionally include a compressible interspinous or intervertebral distraction, cushion, or fixation, interspinous bumper, wedge, WALLIS™ device, DIAM™ device, or spongy interspinous material (See
One embodiment provides a prosthetic S1 spinous process, wherein the member 2 becomes thicker as the midline dorsal projecting element goes from cephlad to caudad. This desirably gives more compression resistance to a midline “bumper”, sleeve, or interspinous process wedge.
One embodiment provides a crosslink with a posterior projection beyond the axis of the crosslinking rods 1. One embodiment provides a prosthetic spinous process that projects farther posteriorly than the coronal plane of the pedicle screws.
One embodiment provides a prosthetic spinous process in which the apex or vertex of the two transverse crosslinking rods 1 joining together in the midline is more dorsal than the pedicle screw heads. This may give more room for the dura at S1 which is in this location.
One embodiment enables the tulip portion 15 of the connecting pedicle screws to be open and face the transverse direction rather than the longitudinal direction, in contrast to conventional devices.
All or any portion of the device may have one or more coatings to effect a more biocompatibile surface, bioinert surface, or both. Non-limiting examples of coatings include tantalum, niobium, zirconium, titanium, and platinum bioactive glass, hydroxyapatite, recrystallized hydroxyapatite, zirconium oxide, aluminum oxide, resorbable bioceramic, pyrolytic carbon, hydrophilic coating, hydrophobic coating, silicone-based coating, titanium nitride coating, radiopaque coating, ceramic coating, antimicrobial coating, ion implantated surface, radioactive coating, polyurethane, silicone, polyester, polycarbonate, polyethylene, polyvinyl chloride, polypropylene, acrylate, (meth)acrylate, biodegradable copolymer, copolymer surface coating and/or PTFE coating as appropriate. Combinations are possible.
The entire contents of each of the patents, applications, and articles cited herein is hereby incorporated by reference, the same as if set forth at length.
| Number | Date | Country | |
|---|---|---|---|
| 60634807 | Dec 2004 | US |
