The present invention relates generally to prostheses for vertebra and intervertebral discs, and more particularly, but without limitation, to apparatus and methods of making and methods of treating degenerative spine disorders, diseases of the vertebral body, intervertebral disc, or both, traumatic injury, and tumors of the spinal column.
Problems with the spine are one of the leading causes of pain, suffering, and disability in the United States today. Such pain can be either chronic over months or years, or acute and intense. Its etiologies, or causes, are generally multifactorial and the problems and suffering spinal pain causes may be debilitating. Furthermore, the costs to society in terms of quality-of-life issues due to pain and suffering, medical care costs, and loss of economic productivity are significant.
Whether musculoskeletal with its effects limited to nuisance, neoplastic with a dismal prognosis, or neurological with effects ranging to catastrophic paralysis, spinal pain is treated with either nonsurgical methods, including pain management, such as medication, including epidural steroid injections, physical therapy, meditation, yoga, acupuncture, and homeopathic measures, or surgery, or combinations. At present, surgical intervention is generally reserved for those individuals who have failed multiple interventions of medical (nonsurgical) management, or who are developing rapidly progressing neurological symptoms, which, if left untreated, may result in permanent disability. When surgery is indicated, the customary procedure involves removing a portion of diseased or damaged intervertebral disc or bone, and, if the remaining spine is determined to be unstable, installing connecting reinforcing metal plates, screws, and rods to hold the vertebrae together. This procedure is commonly known as “spinal fusion” and is used to treat such conditions as spondylitis, spondylolisthesis, degenerative joint disease, degenerative disc disease, discitis, disc herniation, central cord syndrome, cervical radiculopathy, tumor removal, arthritis, synovial cyst, trauma stabilization, osteomyelitis, epidural hematoma, epidural abscess, spinal cord metastasis, laminectomy, and revision surgery.
Prosthetic surgical implants designed to replace diseased or injured vertebral bone and diseased or injured cartilaginous discs are disclosed. Particularly, the prosthesis comprises at least one, and preferably two anchors to allow the prosthesis to be secured in place in the spinal environment, one or more articulating elements, such as ball-and-socket joints or couplings operably connected to the at least one anchor to allow at least some degree of multidirectional movement and rotation. Compressible elements may be operably connected to provide stability and flexibility to the prosthesis in use. In cases where one or more vertebrae are removed, the prosthesis may also include one or more spacers to provide proper sizing in the spinal environment. Alternatively, the prosthesis comprises an least one, and preferably two anchors to allow the prosthesis to be secured in place in the spinal environment, one or more elastic elements, such as springs or biocompatible polymers, operably connected to provide stability to the prostheses in use. In use, the prosthesis provides stability to the affected area of the spine while allowing for the natural flexibility of the native spine. Also disclosed are methods of making and methods of implanting said apparatus.
The present disclosure is related to a spinal prosthesis comprising a first anchor, the first anchor including an annular groove; a ball component of a ball-and-socket combination, the ball component including a ball attached to a base and including an annular skirt adapted to mate with the annular groove of the first anchor; and a second anchor, the second anchor including a socket adapted to receive the ball. Interposed between the second anchor and the base of the ball component is a compressible pad, the compressible pad including a hole adapted to accept the ball.
The present disclosure is further related to a spinal prothesis comprising a first anchor, the first anchor including a base adapted to be secured to a vertebra and the ball of a ball-and-socket combination; and a second anchor, the second anchor including a base adapted to be secured to a vertebra and the socket of a ball-and-socket combination, the socket adapted to mate with the ball.
The present disclosure is further related to a spinal prosthesis comprising a vertebral spacer having a first surface and a second surface, first and second spheroid domes attached, respectively, to each of the first and the second vertebral spacer surfaces; first and second anchors, each of the first and the second anchors spaced apart, respectively, from the first and the second vertebral spacer surfaces, each of the first and the second anchors adapted to be secured to a vertebra; and a first and a second spheroidal cup, each of the first and second spheroidal cups operatively attached, respectively, to each of the first and the second anchor by a first and a second spring, each of the first and the second spheroidal cup oriented to and adapted to mate, respectively, with each of the first and the second spheroidal domes. Each of the first spring and the second spring adapted to be elastic in at least compression, but may also be elastic in tension and elastic in torsion.
The present disclosure is further related to a spinal prosthesis comprising a vertebral spacer having a first surface and a second surface; a first spherical dome operatively attached to the vertebral spacer first surface by a first elastic element, and a second spherical dome operatively attached to the vertebral spacer second surface by a second elastic element. The spinal prosthesis further comprises a first anchor adapted to be secured to a vertebra, the first anchor spaced apart from the vertebral spacer first surface, and a second anchor adapted to be secured to a vertebra, the second anchor spaced apart from the vertebral spacer second surface; a first spheroidal cup operatively attached to the first anchor, and a second spheroidal cup operatively attached to the second anchor. The first spheroidal cup oriented to and adapted to mate with the first spheroidal dome and the second spheroidal cup oriented to and adapted to mate with the second spheroidal dome.
The present disclosure is further related to a spinal prosthesis comprising a vertebral spacer having a first surface and a second surface; a first spheroidal dome operatively attached to the vertebral spacer first surface and a second spheroidal dome operatively attached to the vertebral spacer second surface; a first anchor adapted to be secured to a vertebra, the first anchor spaced apart from the vertebral spacer first surface; a second anchor adapted to be secured to a vertebra, the second anchor spaced apart from the vertebral spacer second surface; a first spheroidal cup, the first spheroidal cup operatively attached to the first anchor by a first elastic element, and a second spheroidal cup, the second spheroidal cup operatively attached to the second anchor by a second elastic element, the first spheroidal cup oriented to and adapted to mate with the first spheroidal dome, and the second spherical cup oriented to and adapted to mate with the second spheroidal dome. Each of the first elastic element and the second elastic element adapted to be elastic in at least compression.
The present disclosure is further related to a spinal prosthesis comprising a vertebral spacer having a first surface and a second surface; a first anchor adapted to be secured to a vertebra, the first anchor spaced apart from the vertebral spacer first surface, the first anchor operatively attached to the vertebral spacer first surface by a first elastic element; a second anchor adapted to be secured to a vertebra, the second anchor spaced apart from the vertebral spacer second surface, the second anchor operatively attached to the vertebral spacer second surface by a second elastic element. Each of the first elastic element and the second elastic element adapted to be elastic in compression, tension, and torsion.
The present disclosure is further related to a spinal prosthesis having component parts capable of being assembled in vivo in a spinal environment for replacement of vertebra and adjacent discs to provide stability while allowing for the natural flexibility of the native spine. The spinal prosthesis comprises a first anchor and a second anchor, each anchor adapted to allow the prosthesis to be secured in place in the spinal environment. Operatively connected to the first anchor is a first cup and operatively connected to the second anchor is a second cup. The spinal prosthesis further comprises a spacer, the spacer having first and second opposing sides. Operatively connected to the first side with a biocompatible spring or elastic element is a first dome and operatively connected to the second side with a spring is a second dome. The first cup is capable of being oriented and adapted to mate with the first dome and the second cup is capable of being oriented to mate with the second dome.
The present disclosure is further related to a spinal prosthesis comprising prostheses described herein above and further comprising flexible sleeves enclosing the elastic elements.
The present disclosure is further related to a method of making a spinal prosthesis comprising the steps of fashioning first and second anchors adapted to attach to a vertebra; forming a ball having a base, the base adapted to mate with the first anchor; mating and securing the base to the first anchor; forming a compressible pad comprising an aperture and installing the pad over the ball through the aperture; and mating the second anchor to the ball.
The present disclosure is further related to a method of implanting a spinal prosthesis comprising the steps of exposing the subject vertebrae (e.g., C4-C5-C6) and removing the body (corpus vertebrae) of the subject vertebra (e.g., C5) and optionally adjacent discs; shaping and preparing the anchoring vertebra (e.g., C4 and C6) to accept the anchors; attaching an anchor having an attached ball to the lower vertebra (e.g., C6); attaching a compressible pad over the ball through an aperture in the pad; and mating a second anchor having a socket to the ball; and attaching the second anchor to the upper vertebra.
The present disclosure is not to be limited in terms of the particular embodiments described in this application, which are intended as illustrations of various aspects. Many modifications and variations can be made without departing from its spirit and scope. Functionally equivalent methods and apparatuses within the scope of the disclosure, in addition to those enumerated herein, are possible from the foregoing descriptions. Such modifications and variations are intended to fall within the scope of the appended claims. The present disclosure is to be limited only by the terms of the appended claims, along with the full scope of equivalents to which such claims are entitled.
The following drawings illustrate by way of example and not limitation. For the sake of brevity and clarity, every feature of a given structure is not always labeled in every figure in which that structure appears. Identical reference numbers do not necessarily indicate an identical structure. Rather, the same reference number may be used to indicate a similar feature or a feature with similar functionality, as may non-identical reference numbers. Views in the figures are drawn to scale, unless otherwise noted, meaning the sizes of the depicted elements are accurate relative to each other for at least the embodiment in the view.
While these figures show an embodiment with an initially separate bottom anchor 12 and ball component 32 which are later secured together, it is to be understood that the bottom anchor 12 and the ball component 32 may be formed together, thereby skipping the step of securing the ball component 32 to the bottom anchor 12.
Turning now to
The ball component 28 that will be mated to the anchor 12 (arrow 76) may be formed of medical grade silicone (Class V and VI) using injection molding. Silicones having a Shore Hardness of Shore A between 40-80 would provide the necessary balance between flexibility and rigidity. (The Shore Hardness Scale consists of three overlapping scales (Shore 00, Shore A, and Shore D. The Shore A range is between 0-100.)
Turning now to
Exemplary materials for the spheroidal cup 60 and the spheroidal dome 62 include metal on plastic (MoP) (e.g., polyethylene, Ultra Highly Cross-Linked Polyethylene (UHXLPE), or Ultra High Molecular Weight Polyethylene (UHMWPE)); metal on metal (MoM) (e.g., cobalt-chromium alloy, titanium alloy, stainless steel, tantalum, zirconium); ceramic on plastic (CoP) (e.g., Ultra High Molecular Weight Polyethylene (UHMWPE)); and ceramic on ceramic (CoC).
Exemplary materials for the elastic element 64 such as a helical spring include a suitable biocompatible metal, including, but not limited to, stainless steel, cobalt-chromium alloy, and titanium and its alloys, including, but not limited to nickel-titanium alloy (nitinol).
Turning now to
Exemplary materials for the elastic column 54 include, without limitation, elastic polyurethanes, elastomers, ChronoPrene™ (AdvanSource Biomaterials, Wilmington, Mass.), polylactic acid, and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV).
Making and sizing a prosthesis 10 requires, generally, determining the dimensions of the vertebrae above and below the level to be replaced. These dimensions can then be used to create the anchors 12 (e.g., 3-D printing or CAD development). The vertebral spacer 58 can be custom made utilizing CT scan (computerized tomography) or Mill (magnetic resonance imaging) to determine exact measurements. Or, a kit of standardized measurements may be employed with multiple options readily available in the operating room as is already common in most other medical devices. The elastic elements (e.g., 64) may be fixed, as the case may be, to the spheroidal dome 62 or spheroidal cup 60 or to the spacer 58 or anchor 12 by welding, adhesive, or other biocompatible mode of fixation. The entire prosthesis 10 should be at least the same height, but possibly taller than the material being removed, including the native vertebral body and the disc above and below.
Finally, turning to
To implant the prosthesis 10, the patient is placed on an operating table in supine position with the neck slightly extended. X-ray is used to confirm the appropriate spinal level. A transverse incision is made in the neck and the soft tissue is dissected until the platysma is encountered. The platysma is incised and blunt dissection employed to locate the avascular plane to the sternocleidomastoid. The muscle is swept laterally and the carotid sheath identified. The carotid sheath is retracted laterally and the trachea and esophagus identified medially. Blunt dissection is employed to expose the longus coli muscles. Electrocautery is used to dissect the muscles off the vertebral body. The anterior longitudinal ligament is next dissected with the electrocautery and the vertebral body and intervertebral discs are identified. A needle is inserted into the disc space and X-ray used to confirm correct spinal level. Next, Caspar pins are inserted into the C4 and C6 vertebral bodies. A spacer is attached and used to distract the vertebrae. A drill is next used to remove all of the vertebral body of C5 using the uncus as the lateral border for removal in order to preserve the vertebral arteries. The intervertebral discs are also drilled away and removed. The posterior longitudinal ligament is next identified, and depending on surgeon preference, incised and lifted away to reveal the dura of the spinal cord. Next, a measuring device is hammered into the space left from the removal of the C5 vertebral body. Ideally, the measuring device should fit snugly into the space and err on the side of being too large rather than too small. Once the size of the cavity is confirmed, the device may be assembled.
A kit of multiple sizes of each part is presented. The bottom anchor 12 with the ball component 28 injection molded into place is chosen based on correct sizing. The pad 42 is stretched and fit over top of the ball 30. The top anchor 12 is fitted snugly with the anchor socket 18 mating with the ball 30. An implanting device is affixed to the construct and used to place the device into the space. The endplates of the cervical vertebrae are next shaved with the drill to remove cortical bone to promote bone growth and fusion to the anchors 12 of the prosthesis 10. The prosthesis 10 is next hammered into place and positioning is confirmed with X-ray. The prosthesis 10 is secured to the vertebral bodies with screws, the Caspar pins are removed, and hemostasis is achieved. The wound is closed in multi-layered fashion.
The above specification and examples provide a complete description of the structure and use of illustrative embodiments. Although certain embodiments have been described above with a certain degree of particularity, or with reference to one or more individual embodiments, those skilled in the art could make numerous alterations to the disclosed embodiments without departing from the scope of this invention. As such, the various illustrative embodiments of the methods and systems are not intended to be limited to the particular forms disclosed. Rather, they include all modifications and alternatives falling within the scope of the claims, and embodiments other than the one shown may include some or all of the features of the depicted embodiment. For example, elements may be omitted or combined as a unitary structure, and/or connections may be substituted. Further, where appropriate, aspects of any of the examples described above may be combined with aspects of any of the other examples described to form further examples having comparable or different properties and/or functions and addressing the same or different problems. Similarly, it will be understood that the benefits and advantages described above may relate to one embodiment or may relate to several embodiments.
The claims are not intended to include, and should not be interpreted to include, means-plus- or step-plus-function limitations, unless such a limitation is explicitly recited in a given claim using the phrase(s) “means for” or “step for,” respectively.
This application claims priority to U.S. Pat. App. No. 63/090,341, filed Oct. 12, 2020, entitled “Spinal Prosthesis”, currently pending, which application is incorporated herein by reference.
Number | Date | Country | |
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63090341 | Oct 2020 | US |