EP1824403A1

EP1824403A1 - Implant for the treatment of lumbar spinal canal stenosis

Info

Publication number: EP1824403A1
Application number: EP05826585A
Authority: EP
Inventors: Horst Döllinger
Original assignee: Dollinger Horst
Current assignee: TIKOM GmbH
Priority date: 2004-12-16
Filing date: 2005-12-16
Publication date: 2007-08-29
Also published as: US8403959B2; WO2006064356A1; US20090254185A1

Abstract

Disclosed is an implant (201) for treating lumbar spinal canal stenosis, comprising a spacer (210) that is provided with an elongate interior space (211) into which an insert part (241) can be inserted. A first retaining element (210) is fixed in the spacer (210) in the inserted state. Said first retaining part (220) can be folded apart by inserting the insert part (241) while a second rear retaining element (230) that is molded onto the insert part simultaneously comes to rest on the vertebral processes, thus making it possible to insert the implant (210) unilaterally while reducing the risk of having to undergo possible postoperative interventions.

Description

Implant for the treatment of lumbar spinal canal stenosis

The present invention relates to an implant according to the preamble of claim 1 for the treatment of lumbar spinal stenosis with a spacer which is attachable between the spinous processes of two adjacent vertebral bodies.

Spinal canal stenosis is any form of constriction of the spinal canal through which the spinal cord passes, excluding inflammation, tumors and complete disc herniation. Most commonly, spinal canal stenosis is found in the lumbar region, ie in the lumbai region, but it also occurs in the area of the thoracic and cervical spine. The most common cause of acquired spinal stenosis is degenerative changes to the spine. Such degenerative changes of the bone and cartilage apparatus occur more frequently, especially in older patients. Therapeutically, one initially intervene with analgesic drugs, such as non-steroidal anti-inflammatory drugs, pain-relieving or by means of bandages or corsets seek deletion bring about. If this is not enough, then you have to intervene surgically, with decompressive surgery in the foreground. Since, as already mentioned, the stenosis patients are often older people, and they also suffer from comorbid conditions, the risk of complications is considerable. Accordingly, it is interesting to be able to perform minimally invasive procedures that reduce the risk of complications.

In place of the very widespread stiffening of several vertebral bodies in the lumbai region, elements have been known for some years that can be used between two adjacent vertebral body processes and that are adjustable in height. Such implants are shown, for example, in US-A-5, 458, 641 or US-A-5, 702, 455. However, the use of these implants requires the surgeon to largely expose the lumbar spinal area in order to insert the appropriate element, and in particular the required one Size adjustment. This problem has been identified and proposed a corresponding solution, which has a simplified implant, which is self-regulating by an elastic intermediate element. Advantageous for this solution is not only the easier adaptation to the physical conditions, but also the simple structure of the element and its fixation on the vertebral body processes. In principle, it would also be possible to use such a solution, with only a unilateral access would be conceivable. For safety reasons, however, this will not be done, as the element will be bolted to the appendages and consequently will work on both sides of the spine for safe control.

Other implants for the treatment of the lumbar spinal canal stenosis are known from EP-O '322' 334 A and FR-2'724'554 A. Particularly advantageous is in particular a solution which has become known from WO99 / 21501. The implant disclosed herein works with a central body on which a sleeve is rotatably mounted eccentrically. On both sides of this sleeve, which is oval in cross-section, wings are provided as arresting means which must rest on the central body on both sides of the spinous processes. This size adjustment by the oval cross-section spacer requires that more space is created and also the design is designed so that on both sides of the spine the surgeon must have access.

The advantage of this solution is also to be seen in the fact that no screwing on the vertebral body is required and the implant itself is relatively simple in construction. The opinion of those skilled in the art of requiring an element that can accommodate the diameter of the situation is different. Certain surgeons are of the opinion that by an exact diagnostic investigation and measurement the size of the can be precisely defined to be used spacers. One would like to start from the smallest necessary diameter of the spacer. The smaller the implant and the smaller the procedure, the lower the risk of postoperative complications.

It is therefore the object of the present invention to provide an implant for the treatment of lumbar Spinalkanalstenose of the type mentioned, which is as small and simple but in particular by a unilateral procedure can be used.

This object _, solves an implant of the type mentioned with the features of the characterizing part of claim 1, with a unilateral supply can be realized.

In the drawing, preferred embodiments are shown in a simplified representation ^■ and explained with ^reference to the following description.

It shows :

FIG. 1 shows the implant arranged between two adjacent spinous processes of a vertebral body in its installed position Figure 2 shows the implant according to the invention alone in the assembled state in a longitudinal section.

Figure 3 shows a realized as rolling elements spacers in side view and

Figure 4 shows the same spacer in the view from above.

Figure 5 shows a variant of the spacer with a pointed head, again in side view, while

Figure 6 shows the same spacer with a view of the pointed end, which is the introduction side

End is and

FIG. 7 shows the same spacer with respect to the rear end, while FIG

FIG. 8 again shows the same spacer in the view from above.

FIG. 9 shows a variant of the spacer with a first retaining element mounted therein

Introductory position and Figure 10 shows the same spacer of Figure 9 with the first retaining element in a slightly advanced position, as well

11 shows the spacer and the retaining element, wherein this is in the retaining position.

FIG. 12 shows a first retaining element in one piece

Execution in perspective view with a tension and / or pressure element hinged thereto.

FIG. 13 again shows in simplified form a spacer with a partially performed first retaining element, this being a two-part retaining element, and FIG

FIG. 14 shows the same element according to FIG. 13 in FIG

Retaining position.

FIG. 15 shows an alternative first retaining element in a partially cut state in a longitudinal section, while FIG

FIG. 16 shows the same two-part element according to FIG. 15 in FIG

Retention position shows. Figure 17 shows a second retaining element in the simplest embodiment in perspective view and

FIG. 18 shows a part of a spacer with a second retaining element which can be attached thereto in a side view.

Figure 19 shows symbolically and simplified a spacer with two inserted jaws of a pair of pliers, which serves for the introduction of the spacer in the side view and

Figure 20 the same situation in the supervision -from the front.

Figure 21 shows a similar spacer with a differently designed insertion pliers whose jaws are designed to scrape past each other. Finally shows

FIG. 22 shows the situation according to FIG. 21 in the plan view of the tip of the clamping jaws of the forceps or on the introduction side of the spacer.

FIG. 23 shows a detailed embodiment according to the variant according to FIG Figures 15 to 17 in a perspective view in the insertion position and

Figure 24 in side view.

Figure 25 shows the embodiment of Figure 23 in the inserted end position, again in perspective and

Figure 26 in side view. Ultimately, one is in the

Handling particularly preferred solution m the

Figure 27 shown in the insertion position in a perspective view.

FIG. 1 shows the situation on a patient. With A two adjacent vertebral bodies, or Vertebrae are shown. Their spinous processes are designated B. The spinal canal C runs between the vertebral bodies A and the spinous processes B. E represents the exit points of the nerve roots. The interspinous ligament D runs between two adjacent spinous processes B. This is traversed by a spacer 10 and held in position by a first retaining element 20 on the one side and secured by a second retaining member 30 on the other side against traversal displacements. This backup will but hardly effective, since the spacer 10 is designed waisted and thus centered between the two spinous processes B.

FIG. 28 shows the same solution as in FIG. 27, but in an intermediate position during installation, the implant being shown in a view. And finally shows

Figure 29 shows the solution in the installed end position.

Implants of this type become necessary when the so-called Baastrup signs occur. The Baastrup sign refers to the touch of two adjacent spinous processes. In this situation, the supraspin ligament bulges toward the spinal canal and causes spinal canal stenosis. In addition, it can then lead to a disc protrusion that further narrows the spinal canal. With the implant according to the invention, the spinous processes are pressed apart and the compressed interspinous ligament is relieved, so that the supraspin ligament reforms and the stenosis is released.

In the figure 2, the implant according to the invention is shown in the assembled state overall and the

Implant as a whole is designated 1. It exists in

Essentially of four elements. The main element is one Spacer 10 which is preferably designed as a rolling element. In principle, this can be a cylindrical element. In the examples shown here, the spacer 10 is oval in cross-section, resulting in the two different sizes of the spacer in Figures 3 and 4, depending on whether the spacer 10 in the side view, as shown in Figures 2 and 3, or in the top view, as shown in Figure 4. The spacer 10 here has a continuous interior 11. This may not be rotationally symmetrical and is rectangular in cross section in the example shown here. Accordingly, in turn, in the side view of Figure 3, the interior is larger and shown in Figure 4 smaller. The cross-sectional shape of the inner space 11 selected here is a preferred form for manufacturing reasons, but the inner space can in principle have virtually any cross-sectional shape as long as the cross-sectional shape is not round. The spacer 10 or the rolling elements has a front side 12 and a rear side 13. As the front side, the front side of the insertion side is referred to, while the side opposite the insertion side is referred to as the rear side 13. The outer lateral surface of the spacer 10 has a sidecut 15. This sidecut is intended to cause self-centering between the two adjacent spinous processes when the spacer is installed. In principle, the two end faces 12 and 13 of the spacer 10 can be designed plan. This results in a certainly extremely inexpensive production. Preferably, however, the front side 12 in the insertion direction is provided with a head, as shown by most of the embodiments to be described below, and in particular as shown in FIGS. 5 to 8. This head 17 is divided into two partial peaks 18 practically. The division is made by a crossing cut 18 '. The transverse cut 18 'serves for the rotationally secured positioning of a first retaining element 20, which will be described later in detail, which comes to rest at least partially in this transverse cut. In order to ensure that the retaining element 20 does not return to its interior 11 when it is pulled back onto the spacer 10, the transverse cut 18 is provided with preferably rounded ramps 18 ".

The spacer 10 may be designed on the back 13 as a simple planar surface, as shown in Figures 3 and 4, but it is possible to provide the back with a groove-shaped recess 19, the positive and rotationally secured positioning of a second retaining element 30th serves. Of course, here again both the transverse cut 18 'and the groove-shaped recess 19 has a different shape have, if appropriate, the retaining elements are adapted thereto.

The first or front retaining element 20 can also have a wide variety of shapes. The shape of the retaining element, in particular the first retaining element is essentially determined by the fact that this must be designed so .that it can be passed through the interior 11 of the spacer 10 therethrough. Accordingly, the first retaining element 20 is at least approximately the same design as the cross section of the inner space 11. In the example shown here, the first retaining element 20 consists of one piece. It has substantially the shape of a flat bar and is pivotally connected to a pulling and / or pushing element 40. The pivotable connection is realized by an axle 41.

Approximately centrally of the longitudinal axis of the first retaining element 20, a receiving groove 21 is formed. In the receiving groove 21 is the tensile and / or pressure element 40 during the introduction phase, so that no protruding element exists, which prevents the implementation. As shown in FIG. 9, the head 17 of the spacer 10 can be asymmetrical or, as shown in FIGS. 10 and 11, symmetrical, as already shown in the earlier figures. The first retaining element 20 has terminal, inclined end faces 22. These faces 22 open into cutting edges 23. When piercing the first retaining element 20 through the interior 11, the inclined end faces with their cutting edges 23 sever the interspinous ligament. By the inclined end faces 22 while a torque is caused, which causes the first retaining member 20 tends to get into a certain pivoting movement. Of course, this pivotal movement only occurs when the first retaining element 20 is completely guided through the spacer 10. Thereafter, a pulling movement is carried out on the tension and / or pressure element 40, the first retaining element pivots and comes with its wide longitudinal surface on the plan here designed partial surface in the transverse incision 18 'between the two partial caps 18 to lie. As will be shown later, you will introduce the actual spacer previously by means of a special pliers and at the same time pierced the interspinous ligament. The cutting edge 23 merely simplifies the insertion when a certain recovery has taken place due to the elasticity.

In addition to the preferred embodiment shown here according to FIGS 9 to 11, it is of course also possible to realize the retaining element 20 in a different form, as shown in FIG 12. Again, it is a one-piece first retaining element 20. This also has an approximately rod-like shape. The cross section However, this first retaining element is smaller than the cross section of the inner space 11. The full cross section it reaches only in the central region, where the rod-shaped part 25 is provided with a bracket 26. The bracket 26 serves to support the already mentioned pivot axis 41. At this pivot axis 41 turn the tension and / or pressure element 40 is formed. In the present case, a torsion spring 42 is also mounted on the pivot axis 41, which rotates the rod-shaped part 25 of the retaining element 20 after complete penetration through the interior 11 of the spacer 10 relative to the tension and / or pressure element, so that when retracting the first retaining element 20 is not pulled back into the interior.

The embodiments according to FIGS. 13 to 16 show two variants of a first retaining element 20, which is designed in two parts. Here, the rod-shaped part 25 is divided into two partial rods 24. In the embodiments according to FIGS. 13 and 14, the first retaining element 20 is designed so that the two partial rods 24 can be inserted in advance with their freely movable ends. The two part rods are pivotally held on the same axis 41, on which also the tension and / or pressure element 40 engages. In this embodiment, de two part rods 24 must be spread apart by means of a relatively strong spring, which then retract only under relative large tractive forces allowed. The great advantage of such a solution is that the unilateral implantation is reversible and consequently, in the case of a postoperative procedure, if necessary, the entire implant can in turn be removed unilaterally.

The unilateral expansion is no longer present in the embodiment according to FIGS. 14 and 16. Otherwise, however, the first retaining element 20 is designed very similar. While in the embodiment according to FIGS. 13 and 14, the pivot axis 41 follows the two part bars 24 in the direction of insertion, here the hinge is laid forwards and thus lies forward in the direction of penetration. Otherwise, the element has the same parts and these are provided with the same reference numerals. Although not shown here, the spacer 10 can of course be provided on the front side with an approximately rounded outlet section, so that even during the pushing through of the folded two-part retaining element 20 in the final phase of the penetration, a certain spreading can already take place. The second retaining element 30 is reasonably always designed in one piece. This also has an approximately rod-like shape. Since this is mounted on the side, which is freely accessible during the operation, the configuration of this second retaining element can be particularly simple. In the present case, it consists of the rod-shaped body 31 with a Consoles attachment 32. The console attachment 32 is designed in the form that it can be positively applied from the rear side, the console 32 positively and non-rotatably in the interior 11 of the spacer 10 recording.

The rod-shaped part 31 and the bracket 32 are penetrated by a centrisehen bore 33 through which the tension and / or pressure element 40 can be guided. This situation is clearly visible in FIG. As FIG. 2 clearly shows, the bracket 26 on the first retaining element 20 can also be designed such that it engages in the interior 11 of the spacer in a form-fitting and rotationally secured manner. The tension and / or pressure element 40 passes through as mentioned with its rod-shaped part 43, the second retaining member 30 and protrudes on the rear side. At the rear end, the rod-shaped part 43 has a thread 44. On this thread 44, a retaining nut 45 is screwed. A threaded hole passing through the retaining nut 43 to the center serves to insert a locking screw 46. If the nut 45 is secured by means of the screw 46, then the rod-shaped part 43 of the tension and / or pressure element 40 will be separated as close as possible to the nut 45. The arrow 47 indicates this separation. Furthermore, a variant of the second or rear retaining element 30 is shown in FIG. This again has a rod-shaped body 31 and also a console attachment 32, which takes place in the interior of the spacer 10. In this solution, a guide head 34 is additionally formed on the rear side, the console attachment opposite. This guide head can guide the rod-shaped part 43 of the tension and / or pressure element 40. The through hole 33 may be configured in this case as a threaded hole. However, this is not mandatory. Since here a larger guide for the locking screw 46 results, the locking screw 46 may be designed as a grub screw which is provided with a tip which enters the rod-shaped part 43 in a form-fitting manner. This can practically occur a cold welding. This is an extraordinarily secure connection feasible.

The invention likewise comprises a forceps preferred for setting the implant. This is overall not shown, but only their jaws 50th Die

Pliers jaws 50 are designed so that they are in the fully superimposed state through the interior 11 of the

Spacer 10 can be guided through. At the same time, the jaws 50 have jaw tips 51. These jaw tips 51 complete the head 17 of the spacer when the

Pliers jaws introduced and spread in this case. If the spacer is placed on the forceps jaws, the spacer is guided with the forceps from one side between two adjacent spinous processes, penetrating the intraspinal ligament. To facilitate the implementation, the surgeon will produce the passage opening by means of a scalpel, at least slit-like. On the jaws 50 also retaining beads 52 are formed, which make it impossible to slippage of the spacer on the jaws 50. The forceps jaws 50, however, also hold the spacer 10 in a force-locking manner and, with their outer surfaces, rest on the inner surfaces of the inner space 11.

FIGS. 21 and 22 show a possible variant of the pliers. Here, the two jaws of the pliers slide over each other in a scissor-like manner. The two jaws 50 in turn have jaw tips 51 which complement the head 17 of the spacer 10 to a point. The jaw tips 51 can be perfectly adapted to the shape of the head. This solution allows a more closed in the direction of penetration of the tip than in the aforementioned embodiment of the forceps. Although the forceps certainly represent a preferred embodiment for the application of the implant, it is of course also possible to realize differently designed introduction means. The embodiment described here merely serves to disclose the full implementation of the invention, thanks to which it is possible to only unilaterally expose two adjacent spinous processes in the region of a lumbar spinal canal stenosis to make what then unilateral installation, the implant can be placed.

FIGS. 23 to 26 show a modified version compared with the previously described embodiments, this implant for treating lumbar spinal canal stenosis solves the same object of the invention, namely to create an implant which can be inserted by a unilateral procedure. However, while the first retaining element 20 is guided through the spacer 10 in all the embodiments described above, a solution is shown in which the first, front retaining element 20, as previously described in the embodiments according to Figures 13 to 16, is made in two parts , The two parts of the retaining element 20 are designated here by the reference numerals 121 and 122. The surface lying in front during insertion of the spacer 10 between the two spinous processes B is shown here as head 117. The head 117 has here a gable-shaped configuration. The gable-shaped head 117 has a transverse incision 118. This incision 118 also has a gable-like shape, the tip of which is, however, ground down. Correspondingly, a planar partial surface 112 remains. The two parts 121 and 122 of the first, two-part retaining element 20 are held pivotably on the tension or pressure element 40 via an axis 123. The Axis 123 passes through the tension or pressure element 40 and the two parts 121 and 122 embrace the tension and / or pressure element 40 configured as a rod. In this case, the first retaining element 20 no longer needs to be guided through the spacer 10 it also not mandatory that the interior 11 must have a deviating from the round shape shape. The rotation is obtained solely by the positive-locking mounting of the two-part first retaining element, which is already in the insertion position, integral in the head 117 of the spacer 10 when setting the implant. After the implant has been correctly placed between the two adjacent spinous processes, it is now sufficient to pull on the tension and / or pressure element 40, whereby the two parts 121 and 122 are automatically moved from the position shown in FIG. 23 into the end position as shown in FIG reach. In this position, the two parts 121 and 122 now lie on the planar partial surface 112 and now remain in this position. Thereafter pushes as a counter element, the second rear retaining element 30 on the tensile and / or pressure element until the second retaining member 30 abuts the spacer 10. It is by no means the case that the first retaining element and the second retaining element bear laterally against the spinous processes, but these serve only as a safeguard in order to prevent displacement from this position. Would the two elements fit snugly against the spinous processes, this would practically one Partial stiffening of the spine come the same and this is not necessary in most cases of lumbar spinal canal stenosis.

Although in the embodiment shown here, the tension and / or pressure element 40 is realized as a round rod, for example as a threaded rod, this is not mandatory. The tensile and / or pressure element can certainly, as before, have a non-round shape and accordingly, of course, the interior 11 would again have the non-round shape. The embodiment shown here is relatively easy to handle and design. In the position, as shown in Figures 23 and 24, the spacer 10 can be inserted while at the same time the second, rear retaining member 30 is held secured on the tension and / or pressure element 40 that the relative positions, as in the figures 23 and 24 are shown. Accordingly, the implants can be delivered in this pre-assembled state. Upon introduction, the pressure can be applied directly to the tension and / or pressure element 40. Once the end position has been reached, tension can now be exerted on the pulling and / or pushing element 40, while at the same time pressure is exerted on the second retaining element 30. As a result, the elements 30 and 40 shift relative to each other and only the securing part, such as a lock nut, must now be screwed to the new position. While the spacer 10 in the form shown here has substantially the shape of an octagon rounded at the corners, this is of course not mandatory. Again, the spacer 10 may in principle have the shape of a rolling element. Likewise, the spacer 10, as the examples described above, have a sidecut to exert a self-centering effect. In principle, a rolling element is understood to mean a spacer which is axisymmetric, but not rotationally symmetrical. The term rolling element only expresses that the spacer in its position of use also serves to allow the spinous processes to roll on it during movement.

The preferred embodiment illustrated in FIGS. 27 to 29 makes use of the idea of designing the entire implant, which is designated here by 201, in such a way that in an insertion position the implant 201 is larger in the longitudinal direction than in the installed state. As a result, additional space is created to more easily accommodate the first, front retaining element 220 in the spacer 210 during the introduction phase, whereby this can also be made more optimal. The spacer 210 then has an inner chamber 211 which has a longitudinal slot which extends over the entire length of the roller 210 until the ^■ end portion which forms the head of the 217th In this open space, represents the interior 211, can now easily arrange the first, front retaining element 220. The first, front retaining element 220 is again divided into two, and the two parts 221 and 222 of the first retaining element 220 are pivotally held about an axis 223. In this case, the axis 223 is mounted from the center of the spacer 210, so that the first, front retaining element is divided into a long retaining element part 221 and a short retaining element part 222.

Furthermore, the implant 201 comprises a tensile and / or pressure element, which is designated here by 240. This tensile and / or pressure element 240 comprises an insertion part

241. Integrally connected thereto is the second, rear retaining element 230, which consists of an upper one

Retaining member 231 and a lower retaining member portion 232 is made. Both parts are integrally formed on the insertion part 241. They are diametrically opposed to each other. In the introduction phase of the implant 201, the insertion part 241 is held in an extended position, as shown in FIG. The insertion part 241 has below and above each a saddle-like sidecut

242, which corresponds in the form of just such a waist 212 on the spacer 210. In the extended state, these two sidepieces are separated by the Ausschubdistanz. In the insertion part 241, a central slot 243 is formed. Through this slot 243 of the shaft protrudes The clamping screw 244 serves to secure the insertion part 241 in a desired pull-in or extended position of the insertion part 241 in the spacer 210. Thanks to the inner space 211 designed as a longitudinal slot, the spacer 210 is located in the end region where the clamping screw 244 is arranged. slightly compressible. During the insertion phase, the insertion part 241 is clamped in the extended position by means of the screw 244.

Below the elongated hole 243 is parallel to this running a longitudinal groove 245 formed. In this longitudinal groove 245, a plunger 250. The plunger 250 has a nose 251 and a front pressure surface 252. By means of the nose 251 pushes the plunger when colliding the insertion part 241, in the here transparent drawn spacer 210, the two retaining element parts 221 and 222 apart while in the end position, the front pressure surface 252 flatly rests on both in the hinge area interlocking retaining element parts 221 and 222. The longitudinal groove 245 has a locking groove 246 arranged in the front region, while the tappet 250 has a bead 253 which, in the position according to FIGS. 27 and 28, that is to say in the insertion position and in the intermediate position of pushing together into the mentioned locking groove 246. The plunger 250 also has at its end a longitudinal slot 254 which extends beyond the region at which the bead 253 is attached. As a result, the end portion of the plunger 250 can be resiliently compressed so that the bead 253 can be pushed out of the locking groove 246 as the insertion portion 241 is pushed into the spacer 210. This inserted position, which corresponds to the installation position of the implant, is shown in FIG. In this position, the plunger 250 is fully inserted in the longitudinal groove 245. This can therefore be seen in FIG. 29, because again the spacer 210 is shown transparent. The bead 253 is now in a rear position on which optionally again a locking groove may be present, which, however, is not mandatory and is not shown in the other figures.

The solution shown in FIGS. 27 to 29 can, if appropriate, also be unilaterally removed for a postoperative procedure. For this purpose, the locking screw fixed in the end position 244 is released again and then by means of a tool which comprises two parallel, interconnected rods, introduced by two mounted from the end side insertion holes 247. While pressing the tool, you pull the same time the insertion part 241 by train at the now exposed rear, second retaining member 230 so that now is pulled out while the insertion part 241, the plunger 250 remains in its rearward position while a pressure through the tool through the upper hole 247 on the upper part of the two-part first retaining element part 221 makes it possible to fold back the two parts 221 and 222 so that finally the position according to FIG. 27 is reached again. In this position, of course, the entire implant 201 can be easily removed.

List of reference numbers:

A vertebral body, vertebrae

B spinous processes C spinal canal

D Interspin ligament

I implant, overall

10 spacers, rolling elements

II interior 12 introduction side surface, plan, front

13 back side

14 wall

15 sidecut

16 longitudinal axis of the rolling element 17 head of the spacer

18 partial summit

18 'crossing incision

18 '' ramps

19 groove-shaped groove 20 first, front retaining element

21 receiving groove

22 inclined face

23 cutting edges

24 part bars 25 rod-shaped part

26 console

30 second, rear retaining element 31 rod-shaped body

32 console attachment

33 through hole

34 guide head 40 tensile and / or pressure element

41 pivot axis

42 torsion spring

43 rod-shaped part

44 thread 45 retaining nut

46 Safety screw

47 separation

50 pliers jaws

51 jaw tips 112 plane partial surface

117 head

118 crossing incision

121 part of the retaining element 20

122 part of the retaining element 20 123 axis

201 implant

210 spacers

211 interior

212 Sidecut 217 Head

220 first, front retaining element

221 long retaining element part 222 short retaining element part

223 axis

230 second, rear retaining element

231 upper retaining element part 232 lower retaining element part

240 tensile and / or pressure element

241 insertion part

242 saddle-like sidecut

243 slot 244 clamping screw

245 longitudinal groove

246 locking groove

247 insertion hole

250 pestle 251 nose

252 printing surface 253 bead

254 longitudinal slot

Claims

claims

1. implant for the treatment of lumbar Spinalkanalstenose with a spacer which is insertable between the spinous processes of two adjacent vertebral bodies, wherein the spacer is designed as a rolling element, on both sides depending on a first and a second retaining element can be brought to the concern, the transversely extending rolling elements Keep abutting the vertebral body processes on both sides, characterized in that the implant is designed unilaterally insertable and in the inserted state, the first retaining element farther from the introduction side by force in a position is pivotable, so that this at the insertion side remote side to the vertebral body extensions Concern comes.

2. Implant according to claim 1, characterized in that the rolling body has a running in the direction of the axis of rotation, the rolling body passing through interior, which has a non-round cross-section, and that in the direction of insertion front of the rolling element coming to rest first retaining element through the interior and then in a holding position can be brought, and that on the first retaining element, a tension and / or pressure element is held, on which the Introductory side remote end, the second retaining element is attachable, wherein both retaining elements are held against rotation relative to the rolling elements.

3. Implant according to claim 1, characterized in that the spacer has a running in the direction of the longitudinal axis, the spacer passing through the interior, which is penetrated by a tensile and / or pressure element, and that in the direction of insertion front of the spacer coming first Retaining element is integrated in the spacer in the insertion position and then at least partially from the spacer into a holding position can be brought, and that the first retaining element, the tensile and / or pressure element is attached, and that on the insertion side remote end of the second retaining element is attachable, wherein both retaining elements are held rotationally secured relative to the spacer.

4. Implant according to claim 1, characterized in that between the first retaining element located in the holding position and the spacer and between the second retaining element and the spacer each a non-rotating positive connection exists.

5. Implant according to claim 1, characterized in that the rolling body has a waisted peripheral surface which causes a self-centering of the spacer between the spinous processes.

6. Implant according to claim 1, characterized in that the spacer has a flat bearing surface at its insertion end.

7. Implant according to claim 1, characterized in that the spacer at its insertion end has an introduction facilitating, forming a partial tip forming.

8. Implant according to claim 1, characterized in that the spacer has a planar bearing surface on the side opposite the insertion side.

9. Implant according to claim 6 or 8, characterized in that in the plane bearing surface a transverse groove-shaped recess is arranged, in which engage the respective retaining elements with partial areas positively.

10. Implant according to claim 1, characterized in that the interior of the spacer has a rectangular or square cross-sectional area.

11. Implant according to claim 1, characterized in that the spacer has a circular or elliptical shape in cross section.

12. Implant according to claim 2, characterized in that the first retaining element consists of one piece and is pivotally articulated on the tension or pressure element.

13. Implant according to claim 9 and 11, characterized in that the first retaining element is designed formally so that it finds in the inserted end position of the implant form-fitting in the insertion direction of the front side of the spacer transversely in a groove-shaped recess recording.

14. The implant according to claim 12, characterized in that the first retaining element has the shape of a flat bar, and at least one of the two narrow sides has a one-sided sharpening, which causes a direction deviating from the feedthrough piercing direction and the retaining element in a pivoting movement.

15. Implant according to claim 12, characterized in that the retaining element has a double-curved design, which causes a pivoting movement of the retaining element during application in the patient.

16. The implant according to claim 12, characterized in that the first retaining element has a raised on the side facing the spacer side an elevated console in which the tension or pressure element pivotally supports and lie under train in the empty space and this form-fitting covering comes.

17. Implant according to claim 12, characterized in that acts between the tension or pressure element and the first retaining element, a spring which is able to put the first retaining element in the application in the patient in a pivoting movement to this from the feedthrough position to the retaining position move.

18. Implant according to claim 17, characterized in that the spring is a torsion spring.

19. Implant according to claim 1, characterized in that the first retaining element is designed in two parts, and held together the two parts in an insertion position and in the inserted state the two parts of the retaining element are pivotable in a retaining position transverse to the front of the spacer.

20. Implant according to claim 19, characterized in that the two parts of the retaining element. can be pivoted about a common axis and the tensile and / or pressure element articulates on this axis.

21. The implant according to claim 19, characterized in that the spacer on the insertion side has a gable shape and has a central gable-shaped recess in which the two parts of the two-part first retaining element at least approximately complementing the shape of the spacer in the insertion position and in the inserted position the two Parts can be moved by train on the tension and / or pressure element (40) in the end position.

22. An implant according to claim 21, characterized in that the two parts of the first retaining element are mounted on an axis on which a torsion spring and on which engages the tensile and / or pressure element, wherein the axis in the insertion position in the region of the introduction side End of the spacer is.

23. Implant according to claim 1, characterized in that the tension and / or pressure element is designed as a threaded rod.

24. Implant according to claim 1, characterized in that the second retaining element is designed in one piece as a transverse rod-shaped element and can be plugged onto the tension and / or pressure element.

25. Implant according to claim 10, characterized in that the second retaining element has a console, which engages in the retaining position positively and non-rotatably in the space crossing the spacer interior.

26. Implant according to claim 14 and 24, characterized in that the second retaining element is secured by a nut on the tension and / or pressure element.

27. Implant according to claim 1, characterized in that the interior is sealingly closable with a filling compound or a filling element.

28. Implant according to claim 1, characterized in that the spacer is partially longitudinally slotted, wherein in

Longitudinal slot during insertion of the spacer, the first retaining element, which consists of two with each other consists of parts pivotally held about an axis, and further that in the longitudinal slot, the tension and / or pressure element is slidably mounted as an insertion part.

29. Implant according to claim 28, characterized in that the insertion part, the second retaining element is firmly formed.

30. An implant according to claim 28, characterized in that the insertion part comprises a plunger, the at

Insertion into the longitudinal slot presses on the two-part first retaining element and spreads it apart.

31. Implant according to claim 28, characterized in that the axis of the two-part first retaining element displaceably supports in a longitudinal slot.

32. Implant according to claim 30, characterized in that the plunger is slidably mounted in the insertion part in a longitudinal groove, wherein the longitudinal groove has a locking groove in which engages an integrally formed on the plunger bead, and that the plunger is longitudinally slotted in the region of the bead in that the plunger is resiliently compressible in this region, so that the bead can be pressed out of the locking groove and the plunger can be retracted telescopically into the longitudinal groove when the insertion part is pushed into the rolling element.

33. Implant according to claim 28, characterized in that the insertion part has a longitudinal direction extending in the insertion direction and the rolling elements is traversed by a transverse locking screw with which the insertion part in the end position, in which both retaining elements abut the vertebral body, relative to the rolling body non-positively is secure.

34. forceps for application of the spacer of the implant according to claim 1, characterized in that the forceps through the interior of the spacer has feasible jaws, which are able to hold the spacer shape and / or non-positively.

35. Pliers according to claim 34, characterized in that the tips of the jaws form a Perforierspitze to facilitate insertion.