US20110320003A1 - Artificial Spinal Disc - Google Patents

Artificial Spinal Disc Download PDF

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Publication number
US20110320003A1
US20110320003A1 US13/230,303 US201113230303A US2011320003A1 US 20110320003 A1 US20110320003 A1 US 20110320003A1 US 201113230303 A US201113230303 A US 201113230303A US 2011320003 A1 US2011320003 A1 US 2011320003A1
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US
United States
Prior art keywords
nucleus
end plate
bearing surface
vertebral
positioning
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US13/230,303
Inventor
Neil Duggal
Louise Raymond
Daniel R. Baker
Robert Conta
Carly A. Thaler
David T. Stinson
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Synergy Spine Solutions Inc
Original Assignee
Synergy Disc Replacement Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Synergy Disc Replacement Inc filed Critical Synergy Disc Replacement Inc
Priority to US13/230,303 priority Critical patent/US20110320003A1/en
Publication of US20110320003A1 publication Critical patent/US20110320003A1/en
Priority to US13/827,209 priority patent/US20130204369A1/en
Assigned to SYNERGY DISC reassignment SYNERGY DISC ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: DUGGAL, NEIL, BAKER, DANIEL, CONTA, ROBERT, THALER, CARLY A., STINSON, DAVID T.
Assigned to SYNERGY DISC REPLACEMENT, INCORPORATED reassignment SYNERGY DISC REPLACEMENT, INCORPORATED CORRECTIVE ASSIGNMENT TO CORRECT THE APPLICATION NUMBERS 12/230,303 AND 12/827,209 PREVIOUSLY RECORDED ON REEL 030660 FRAME 0367. ASSIGNOR(S) HEREBY CONFIRMS THE ASSIGNMENT OF ASSIGNOR'S INTEREST. Assignors: DUGGAL, NEIL, BAKER, DANIEL R, CONTA, ROBERT, THALER, CARLY A, STINSON, DAVID T
Abandoned legal-status Critical Current

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    • A61F2310/00029Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00179Ceramics or ceramic-like structures
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389The prosthesis being coated or covered with a particular material
    • A61F2310/00395Coating or prosthesis-covering structure made of metals or of alloys
    • A61F2310/00407Coating made of titanium or of Ti-based alloys
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389The prosthesis being coated or covered with a particular material
    • A61F2310/00592Coating or prosthesis-covering structure made of ceramics or of ceramic-like compounds
    • A61F2310/00796Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite

Definitions

  • the present invention relates to methods and devices for the treatment of disc disease and spinal deformities with an artificial disc replacement.
  • Spinal arthroplasty is an emerging field that offers the promise of restoring and/or maintaining normal spinal motion.
  • the goal of spinal arthroplasty is to reduce or eliminate adjacent segment disease (ASD) by maintaining the normal spinal biomechanics at the operative level.
  • ASD adjacent segment disease
  • an artificial cervical prosthesis must duplicate as closely as possible the natural spinal biomechanics, including maintaining the axial height of the disc as well as applying angular adjustment throughout the full range of motion of the natural spine.
  • the spine plays an integral role in neural protection, load bearing and motion.
  • the vertebral column provides a strong, yet mobile central axis for the skeleton and is composed of twenty-four vertebral bodies with seventy-five stable articulations.
  • the intervertebral disc is a fundamental component of the spinal motion segment, providing cushioning and flexibility. Adjacent vertebrae are linked together by three articulations: a) the vertebral bodies and disc, which transmit compressive and shear loads and provide flexibility, and b) by two facet joints, which protect the disc from translational shear stress and limit rotation. This “triple joint complex” allows for flexion, extension, lateral bending and rotation of the spine.
  • the intervertebral disc is composed of an inner gel-like matrix called the nucleus a pulposus and an outer surrounding fibrous band called the annulus fibrosus.
  • nucleus a pulposus When compressive loads are placed on the spine, increased pressure in the nucleus pulposus is transmitted to the annulus, which bulges outwards.
  • the degenerative cascade of the intervertebral disc initially involves desiccation of the nucleus pulposus. With decreased elasticity and dampening from the nucleus, increased loads are transmitted to the annulus and facets. The increased stress on the annulus can lead to fissures and radial tears in its collagen fibers.
  • This degenerative cascade can result in axial pain, by stimulating pain fibers in the annulus, or compression of spinal nerve roots and/or the spinal cord. This can manifest itself in motor weakness, pain and/or numbness in the arms or legs or both.
  • the structure and function of the discs may be altered by a variety of factors including repeated stress, trauma, infection, neoplasm, deformity, segmental instability and inflammatory conditions.
  • Degeneration of the intervertebral disc is the most common etiology of clinical symptoms referable to the spine.
  • Degeneration of the spine is a universal concomitant of human aging. In the cervical spine, neck and arm pain caused by nerve root compression has been estimated to affect 51% of the adult population. Spondylosis of the spine and aging are intimately related, with spondylosis increasing in both prevalence and severity with age. Fortunately, the majority of patients will improve without surgery. In approximately 10-15% of cases, spondylosis is associated with persistent nerve root and spinal cord compression and/or spinal pain, with a small percentage ultimately requiring surgery.
  • ASD adjacent segment disease
  • Retrospective studies have estimated that ASD can occur in the cervical spine at a rate as high as 2.9% per year with a projected survivorship rate of 26% at 10 years (Hilibrand A S, Carlson G D, Palumbo M, Jones P K, Bohlman H H: Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg (Am) 81:519-528, 1999).
  • a spinal cord and/or nerve root The primary indication for surgery in the management of cervical spondylosis is radiculopathy, myelopathy and/or neck pain.
  • an anterior interbody fusion is commonly performed.
  • Autologous bone harvested from the iliac crest or cadaveric bone is most commonly used to fill the space created by the removal of the disc.
  • metallic devices such as fusion cages or other types of spacers, xenografts such as bovine bone, and biological strategies such as the use of growth factors.
  • the graft for the interbody fusion can be shaped to correct underlying deformity of the cervical spine. By contouring the graft one can restore lordosis to a straight or kyphotic spine.
  • a more recent alternative to spinal fusion is replacement of the damaged disc with a motion preservation device, which includes either a nucleus or total disc replacement (TDR).
  • TDR total disc replacement
  • the rationale for the development of the artificial disc is to prevent adjacent segment disease.
  • Artificial disc devices can be broadly divided into two categories, those that replace the nucleus only, leaving the annulus and vertebral body end plates intact and those that involve replacement of the disc and addition of prosthetic end plates. Both strategies are directed at restoration of intervertebral disc function.
  • Prosthetic nuclei are described, for example, in U.S. Pat. Nos. 5,047,055 and 5,192,326. United States patent application US2002/0183848 also discloses a prosthetic spinal disc nucleus that has a hydrogel core surrounded by a constraining jacket.
  • the ProdiscTM and the ChariteTM disc are composites of cobalt chromium end plates with a polyethylene core.
  • the ProdiscTM is described in U.S. Pat. No. 5,314,477 and the ChariteTM disc is described in U.S. Pat. Nos. 5,401,269 and 5,556,431.
  • the PrestigeTM disc is another type of artificial disc that comprises a metal on metal design with a ball and trough articulation.
  • Another type of artificial disc that is gaining popularity in the cervical spine is the Bryan® disc, described in several United States patent applications including 2004/0098131; 2004/00544411; and 2002/0 128715.
  • the Bryan® disc is a composite artificial disc with a low friction, wear resistant, elastic nucleus that articulates with two circular metal plates.
  • Kyphosis of the spine has been implicated in segmental instability and the development of clinically significant degenerative disease.
  • Several clinical studies have described that a change in the sagittal or coronal balance of the spine can result in clinically significant axial spinal pain as well the initiation and/or the acceleration of ASD.
  • Modeling of the sagittal cervical spine as a method to discriminate hypolordosis results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects.
  • Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels.
  • Anterior correction of cervical kyphotic deformity effects on myelopathy, neck pain, and sagittal alignment.
  • the goal is to design an artificial disc that is able to correct deformity (coronal and sagittal), has mechanical stops outside the normal range of motion (semi-constrained), and preferably has variable instantaneous axis of rotation (IAR).
  • the limits on the axes of rotation can fall into two categories. One is to provide correction using a permanent rotation or translation of an axis to support the correction. This is accomplished using the geometries of the core and end plates themselves and is referred to the Geometric Constraint category. The second is to keep free range of motion about all axes but provide the correction using a material support. This type of design provides the correction by the imposition of a deformable material in the plane of correction for normal rotation in that plane. This is the Material Constraint category of designs.
  • Degenerative disc disease is a major source of morbidity in our society. It can lead to serious economic and emotional problems for those afflicted. Thus, there is a need for an artificial disc that can alleviate both symptoms and correct deformity (sagittal or coronal or both) of the spine.
  • a strategy to correct lordosis in the lumbar spine has been utilized by the Link-ChariteTM and ProdiscTM lumbar disc replacement systems by using wedge-shaped end plates.
  • a wedge-shaped end plate has also been used in at least one case with the Bryan® cervical disc system.
  • wedge-shaped end plates are not routinely available at the present time for cervical disc replacement systems.
  • the strategy of using wedge-shaped end plate(s) involves forming a differential thickness across the end plate. The articulation between the ball and socket/trough or the nucleus and end plates is not altered, which is an advantage because the complex geometry of how the prosthesis provides motion is not altered.
  • An alternate method of achieving lordotic correction is by changing the nucleus or inner core.
  • the biggest advantage of this approach is that the nucleus or core can be more easily interchanged or revised.
  • instruments can be used to gage the need for and amount of correction and the appropriate nucleus can be inserted.
  • the surgeon is provided with flexibility and ease of insertion, and the ability for revision at a later date, which the other methods do not provide.
  • the invention includes a novel artificial disc that provides the normal range of motion of the natural intervertebral disc, along with the ability to correct deformity of the spine.
  • the proposed disc allows for semi-constrained range of motion of the functional spinal unit. It will reproduce the kinematics of the pre-operative normal spine. It will possess maximum durability and biocompatibility, and a means for integrating itself into the spine bony structure for long-term stability. Its insertion will be safe, simple, and ideally not add significantly to surgical time compared with the current procedures. In contrast to the existing disc replacement systems, it will allow the surgeon to correct deformity while maintaining natural kinematics of the spine.
  • nucleus may be easily revisable. For instance, in most cases where the Bryan® disc needs revision, the entire disc, including the end plates, must be removed. In cases where the alignment of the spine changes with time, especially in children and young adults, this new disc replacement system will allow revision of the nucleus, if needed.
  • the present invention addresses the problems associated with the artificial discs of the prior art by providing an artificial disc that provides for correction of spinal alignment deformity.
  • the artificial disc of the present invention is useful for the treatment of degenerative disc disease including correcting spinal deformities such as kyphosis, lordosis, and scoliosis.
  • the artificial disc incorporates an artificial nucleus having an asymmetrical maximum vertical axis.
  • the present invention includes a non-spherical nucleus with a maximum point of load-bearing and height in a non-central location (a differential in the anterior/posterior height of the nucleus).
  • the nucleus is adapted to provide lordodic correction to a damaged spinal segment.
  • the axis of greatest height is positioned in the anterior part of the nucleus.
  • the nucleus is adapted to provide kyphotic adjustment.
  • the maximum height axis is positioned in the posterior part of the nucleus.
  • the asymmetrical nucleus can be used for the treatment of scoliosis.
  • the axis of maximum height is lateral (parasagittal) to the middle of the disc.
  • an artificial nucleus or core, is provided for use in an artificial disc.
  • the nucleus comprises a body of biocompatible material, having the greatest vertical height either at the central vertical axis or at a vertical axis other than the central vertical axis.
  • the body is spherical or ovoid (egg-shaped), having convex upper and lower surfaces and a non-central maximum height vertical axis.
  • the nucleus is in the form of a truncated cylinder where the top is cut at a plane that is not parallel to the base.
  • the disc is essentially circular.
  • nucleus body with a completely rounded surface (not necessarily spherical) have issues with reliably maintaining correction when exposed to the variable forces of the head and neck.
  • a segment or section that is flat or which has a contour different from the adjacent surface can be formed in the central region of the nucleus body.
  • This section will be referred to as a flattened section, which is meant to refer to any contour that is not the same as the adjacent surface(s) of the nucleus.
  • Such a flattened surface can be planar or it can have other shapes such as a slight convex or concave shape with a radius of curvature different from the adjacent surface.
  • Such a flattened surface could also be in the shape of a compound curve or other complex shape.
  • the flattened segment can be angled relative to the superior end plate of the inferior vertebral body with the height of the anterior part being greater than the height of the posterior part.
  • the overall shape of the nucleus body is still asymmetric, but the flattened segment is incorporated to provide a reliable correction of the deformity.
  • This flat segment provides stabilization of the correction by resisting misalignment moments acting through the nucleus. If the flattened segment is not of adequate size, there may be a tendency for the correction to disappear in the presence of an anterior load or for a hyper-lordotic over correction in the presence of a posterior load (during lordotic correction).
  • An additional advantage of incorporating a flat segment in the nucleus is to provide surface contact over that area during small motions about the resting, neutral position of the device. This should help reduce wear on the device.
  • the nucleus or core could be hemispherical in shape with a flattened inferior surface that fits in an opening or trough formed in the lower end plate.
  • the nucleus is asymmetric in that it has a greater vertical dimension or thickness on the anterior aspect than on the posterior aspect in order to provide a lordotic correction.
  • the superior surface of the nucleus can have a flattened portion.
  • the flattened portion may incorporate a concave segment, but can have the other configurations as mentioned above.
  • the shape of the trough can be such that it defines the outer limits of rotational or translational movement of the nucleus relative to the lower end plate.
  • This design allows for greater ease of insertion of the nucleus without undue distraction of adjacent vertebrae because the trough could be open at one end to allow for the nucleus to be inserted, and then a stop could be inserted in the trough to maintain the nucleus in the trough.
  • an elongated or “sausage type” shape can be used, which has spherical or ovoid end sections and a flattened or cylindrical center section.
  • a nucleus of this shape mates with a cylindrical bearing surface on the upper end plate, both surface and line contact are provided during lateral bending as well as in flexion and extension.
  • a corresponding end plate trough in the lower end plate can be provided that allows for axial rotation with stops beyond the limits of normal motion. This trough can have the shape of a “bow tie,” “dog bone” or the like.
  • the trough can be slightly oversized compared with the nucleus to allow limited anterior/posterior and medial/lateral translation. Additionally, the bearing surface of the end plate trough can be curved upwardly at the outer limits of movement of the nucleus. This feature forces the nucleus to rise upwardly when it rotates and cause an axial distraction of the device that forces the adjacent vertebral bodies apart and loads the tissues between them, resulting in a gradual stop to the motion. The translation of the core within the trough attempts to preserve the mobile instantaneous axis of rotation of the natural disc.
  • an elongated or “sausage type” shape nucleus is shaped so that the superior surface of the nucleus possesses a depression or valley formed in the flattened section, which extends along the sagittal plane. This can be accomplished, for example, by removing material from the central region of the flattened segment of the nucleus, creating a valley between the side portions.
  • the side portions are contiguous with the remaining elements of the nucleus, and do not protrude in the vertical plane.
  • the side portions are preferably symmetrical about the sagittal plane.
  • the trough can be open at the anterior end to allow for insertion of the nucleus without excessive distraction of the adjacent end plates.
  • a locking mechanism can be provided to prevent the nucleus from being expelled from the trough after insertion of the nucleus.
  • a novel type of end plate is provided. Unlike other end plates, which require extensive preparation of the vertebral body surface, the present end plates have an essentially flat outer or vertebral-contacting surface that allows them to be easily inserted.
  • the surface is a semi-round plate having at least one unidirectional keel for anchoring the plate in position.
  • the outer surface of the end plate may be treated in a way that promotes bony ingrowth to enhance stability of the end plate in situ.
  • the outer (vertebral-contacting) surface and the inner (nucleus-contacting) surface are essentially parallel to each other.
  • the outer surface and the inner surface are non-parallel thereby giving the end plate an essentially wedge-like configuration. The orientation of the wide and narrow edges of the wedge can be adjusted to provide various types and degrees of spinal correction.
  • the prosthesis comprises an artificial nucleus and at least one end plate.
  • the prosthesis comprises a superior end plate for attachment to an upper vertebral member, an inferior end plate for attachment to a lower vertebral member and a nucleus adapted to fit between the two end plates.
  • the end plate of the invention has a generally flat surface on the bone contacting side and the appropriate geometric receptacle on the other side for articulating with the nucleus.
  • a central keel can be formed in the center of the inner surface of the end plate to anchor the nucleus in position.
  • the end plate can include a stop member to prevent the prosthesis from moving toward the spinal canal.
  • the nucleus may also have a maximum vertical axis that is not at the geometric center.
  • the nucleus has an upper surface with an upper receptacle and a lower surface with a lower receptacle.
  • the superior end plate has a downwardly projecting protrusion or anchor that engages the upper receptacle and the inferior end plate has an upwardly extending protrusion or anchor that engages the lower receptacle.
  • the prosthesis maintains an appropriate spatial relationship between adjoining vertebrae and also permits normal range of motion of the spine.
  • This embodiment can also include a receptacle that comprises a groove open at one end.
  • the anchor on the end plate can include a central keel, which slides into position in the groove to secure the nucleus.
  • Another embodiment of the invention operates like a universal joint and incorporates three anatomical axes of rotation, two of which provide for flexion/extension and lateral bending motion, while the other one provides for axial rotation. These axes of rotation are accomplished by the use of a pair of two cylinders that can rotate relative to each about a central post.
  • one of the plates has a central post that engages the other plate, and an annular core positioned around the central post that is formed of a resilient material.
  • the core can be asymmetrical and engage both plates to provide necessary deformity correction.
  • the core can engage the end plates to provide the desired angle between the plates for deformity correction, with the central post engaging the other plate when the load exceeds a predetermined limit.
  • the post can engage the other plate with the core engaging the other plate to maintain the plates at the desired angle relative to each other when applied forces tend to change the relative angle of the plates.
  • the core could be replaced by two or more discrete spacers for performing the same function.
  • the nucleus can utilize material deformation to accomplish the desired ranges of motion.
  • the shape of the material can be used to provide a restoring force for deformity correction.
  • material can be removed from various parts of the core to change the modulus of elasticity of the core at selected locations, or material having variable elastic moduli could be used. In this way, different forces and motions can be provided though the design of the core.
  • the end plates can be provided with features that act as stops outside of the desired range of motion, which allow for anatomically-derived gradual stopping. This result can be achieved by forming one or more camming surfaces in or on one of the end plates and providing a co-operating member on the other end plate for engaging the camming surface.
  • the camming surface has a gradual curve on its inner surface.
  • the cooperating member can be provided so that distraction will occur when one end plate rotates relative to the other one.
  • FIG. 1A illustrates an spherical artificial disc nucleus with the maximum central axis in the geometric midline of the nucleus
  • FIG. 1B illustrates the nucleus of FIG. 1A , with an offset maximum vertical axis that provides 3° of correction;
  • FIG. 1C illustrates the nucleus of FIG. 1A , with an offset maximum vertical axis that provides 6° of correction;
  • FIG. 2A illustrates an asymmetrical artificial disc nucleus with the maximum central axis in the geometric midline of the nucleus
  • FIG. 2B illustrates the nucleus of FIG. 2A with an offset maximum vertical axis that provides 3° of correction
  • FIG. 2C illustrates the nucleus of FIG. 2A with an offset maximum vertical axis that provides 6° of correction
  • FIG. 3 is a top view of the embodiment of the artificial disc nucleus shown in FIG. 1A ;
  • FIG. 4 is a perspective view of the embodiment of the artificial nucleus shown in FIG. 1A ;
  • FIG. 5 is a perspective view of the embodiment of the artificial nucleus shown in FIG. 2A ;
  • FIG. 6 is a perspective view of an outer surface of an end plate
  • FIG. 7 is a perspective view of an inner surface of an end plate
  • FIG. 8 is a front view of an end plate
  • FIG. 9 is a front view of a spinal disc device with the nucleus shown in FIG. 1A ;
  • FIG. 10 is a side view of the spinal disc device of FIG. 8 ;
  • FIG. 11 is a front view of a spinal disc device with the nucleus shown in FIG. 2A ;
  • FIG. 12 is a side view of the spinal disc device of FIG. 8 ;
  • FIGS. 13A and 13B illustrate an embodiment of an artificial spinal disc prosthesis where the end plates may be adapted for lordotic correction
  • FIGS. 14A , 14 B, and 14 C illustrate other embodiments where the end plates can be adapted for lordotic correction
  • FIG. 15 is a side view of another embodiment which provides for all directions of movement
  • FIGS. 16A and 16B illustrate the two sections of the nucleus of the embodiment of FIG. 15 ;
  • FIGS. 17 and 18 illustrate another embodiment of the invention in which the nucleus is formed of upper and lower sections with an intermediate section;
  • FIG. 19 illustrates another embodiment of the invention in which the nucleus is cut in half and has a flat lower inferior surface
  • FIG. 20 is a schematic view of the nucleus of FIG. 19 ;
  • FIG. 21 illustrates a modification of the embodiment of FIG. 19 ;
  • FIG. 22 is a an underside view of the nucleus of FIG. 21 ;
  • FIG. 23 is a schematic view of the nucleus of FIG. 21 ;
  • FIG. 24 illustrates a modification of embodiment of FIG. 19 ;
  • FIGS. 25-31 illustrate another embodiment of the invention in which the nucleus is elongated with a flattened section in the center;
  • FIGS. 32 and 33 illustrate another embodiment of the invention which utilizes a universal joint
  • FIGS. 34-36 illustrate another embodiment of the invention in which a resilient ring and a post provide for relative motion between the end plates;
  • FIG. 37 illustrates a modification of the embodiment of FIG. 34 ;
  • FIGS. 38 and 39 illustrate another embodiment of the invention in which the nucleus is shaped to provide medial/lateral correction
  • FIGS. 40-43 illustrate another embodiment of the invention in which the end plates are provided with stops outside the normal range of motion.
  • the present invention relates to systems and methods for partially or wholly replacing diseased or injured joints with artificial joint prostheses.
  • Those of skill in the art will recognize that the following description is merely illustrative of the principles of the invention, which may be applied in various ways to provide many different alternative embodiments. This description is made for the purpose of illustrating the general principles of this invention and is not meant to limit the inventive concepts in the appended claims.
  • the spine follows natural curves, which promote proper sagittal and coronal balance (flexibility) and allow for balanced load sharing between the vertebrae.
  • curves include the cervical, thoracic, lumbar and sacral regions of the spine.
  • the cervical and lumbar regions are naturally lordotic, or curved convexly in the anterior direction.
  • the intradiscal space and vertebral body height may be different for different people.
  • Each intradiscal space has anterior and posterior regions.
  • An artificial disc in the cervical, thoracic and lumbar regions that maintain the same height from the anterior to the posterior may promote an abnormal alignment, resulting in additional stress at the anterior or posterior portions of an adjacent disc. It may also result in an uneven load distribution across the device and cause an excessive amount of relative motion, wear debris and early failure.
  • nucleus and core are used interchangeably to refer to an artificial intervertebral device that replaces a damaged natural spinal disc.
  • the artificial core may be provided alone or in combination with a superior end plate for attachment to an upper vertebra or an inferior end plate for attachment to a lower vertebra or both.
  • upper and lower are used herein to refer to the vertebrae on either side of the disc to be replaced, or a surface on a part in the position shown in the referenced drawing.
  • a “superior” plate is affixed to an upper vertebra and an “inferior” plate is affixed to a lower vertebra of a functional spinal unit.
  • anterior refers to the region towards the front and the term “posterior” refers to the region towards the back.
  • sagittal refers to regions on either side of the central midline axis of a standing human being.
  • asymmetrical is used herein to refer to an axis of maximum height that is not placed centrally or to a nucleus or total disc replacement (TDR) not having its maximum vertical axis placed centrally.
  • the maximum height is not situated or pivoted at a center line of symmetry so that the TDR comprises regions that are not exactly the same in shape or size as other regions on the other side of a line of symmetry.
  • the location of maximal load bearing is located in a non-central location.
  • an artificial disc comprises a nucleus that is not geometrically symmetrical.
  • the disc may have a maximum vertical axis that is not located at the geometric center of the disc.
  • the maximum vertical axis may be located toward the front of the disc, the rear of the disc or on one side of the disc.
  • the positioning of the maximum vertical height and load bearing capability is chosen depending on the type of deformity that needs to be corrected.
  • the present invention also provides methods for the treatment of disc/vertebral body disease, lordosis, kyphosis and scoliosis using an asymmetric artificial disc.
  • nucleus or core may be interchanged and revised intra-operatively and post-operatively. Instruments can be used to gauge the need for and amount of correction and the appropriate implant can then be inserted. By introducing correction into the nucleus, the surgeon benefits from flexibility, ease of insertion and revisability that present systems do not provide.
  • Artificial discs of the present invention can be provided with various degrees of deformity correction.
  • the surgeon can choose a disc having the appropriate correction for the patient.
  • a method of treating a spinal deformity comprises preparing a spinal segment for implantation of an artificial disc, determining the desired angle of the intervertebral space, selecting an artificial nucleus having the desired dimensions, affixing a superior end plate to the upper vertebra, affixing an inferior end plate to the lower vertebra and inserting the selected nucleus between the superior and inferior end plates.
  • the assembled unit of end plate-nucleus-end plate may be inserted in unison.
  • the configuration of the nucleus in this pre-assembled construct can be determined by the intra-operative measurement tools, or with pre-operative calculations. Pre-operative planning techniques and instruments may also be able to determine the size and orientation of this device for insertion.
  • a major advantage of the present system is that the artificial disc can be more easily and rapidly inserted and the nucleus can be changed or revised in accordance with the magnitude of the deformity being corrected. This is especially useful in children and young adults where the alignment of the spine changes over time.
  • an asymmetric nucleus adapted for lordotic correction of the cervical spine is provided.
  • the surgeon can restore lordosis to the cervical spine while maintaining motion.
  • the nucleus may be composed of a low friction elastomer such as polyurethane, polycarbonate-polyurethane, a polymer such as polyethylene (particularly ultra-high molecular weight polyethylene), a suitable ceramic, metals or metal alloys such as titanium or a titanium alloy, chrome-cobalt-molybdenum (CoCrMo), cobalt 28 chromium molybdenum, cobalt chrome, stainless steel, or other suitable materials.
  • a low friction elastomer such as polyurethane, polycarbonate-polyurethane, a polymer such as polyethylene (particularly ultra-high molecular weight polyethylene), a suitable ceramic, metals or metal alloys such as titanium or a titanium alloy, chrome-cobalt-molybdenum (CoCrMo), cobalt 28
  • the nucleus has a generally circular geometric design, with varying degrees of lordosis incorporated into it by utilizing an axis of maximum height anterior to the geometric center of the nucleus.
  • the anterior height of the nucleus varies, depending on the extent of lordotic correction needed.
  • the nucleus is available in various lordotic angles, e.g. 0, 3° and 6°, as well as differing heights (e.g., 4, 6 and 8 mm).
  • a set of instruments or other means can be used to gauge the need for lordotic correction.
  • the nucleus slides between a superior end plate and an inferior end plate.
  • the nucleus can be maintained in position using various types of connectors.
  • the convex surface of the nucleus has a midline groove to allow the nucleus to slide into place between the positioned end plates.
  • a central keel on the concave surface of the end plate is received in the groove of the nucleus.
  • other types of connections can be used to maintain the nucleus in position. For example, a tooth and lock system or a pop-in system could be used.
  • an artificial nucleus which has the shape of a truncated cylinder or which is generally spherical or ovoid in shape, wherein the two halves on the arc on either side of a central axis are not symmetrical.
  • the curvature is not geometrically parallel or symmetric.
  • the implant consists of three pieces.
  • the end plates will be made in differing sizes to accommodate differences in anatomy. These may be fabricated of titanium or a titanium alloy, chrome-cobalt-molybdenum (CoCrMo), cobalt 28 chromium molybdenum, cobalt chrome, stainless steel or other materials suitable for spinal prosthetic inserts.
  • the end plates can have two distinct surfaces.
  • the flat surface of each end plate, which contacts the vertebral body end plate, is capable of accommodating bony ingrowth and incorporates a suitable coating, such as porous titanium, a calcium phosphate, or includes other types of known surfaces that promote bony ingrowth for long-term stability.
  • the end plates can also have one or more parasagittal keels that provide immediate fixation.
  • a pair of parallel keels can be formed on the outer surface of one of the end plates, and a single, centrally-located keel can be formed on the outer surface of the other end plate.
  • the other (inner) surface of the end plates can have a contour that corresponds with the geometric shape of the nucleus to form a bearing surface that allows for optimal articulation and wear characteristics with respect to the nucleus.
  • This bearing surface there can be a single, central keel, which provides a constraint for the nucleus against excessive translation and range of motion.
  • the nucleus can have a circular geometric design, with a midline groove to allow the nucleus to slide into place between the positioned end plates. A central keel on the concave surface of the end plate would fit into the groove of the nucleus.
  • a set of instruments could be inserted to confirm the lordotic correction, but these may also be used as confirmation for other types of pre-surgical planning techniques and instrumentation.
  • intra-operative instruments may be used as confirmation for other types of pre-surgical planning techniques and instrumentation.
  • FIGS. 1A to 1C illustrate various examples of artificial disc nuclei where the nucleus is symmetrical, with a maximum central axis in the geometric center 20 of a nucleus 10 .
  • the reference letters A and P illustrate the anterior and posterior orientation, respectively, of the nuclei 10 , 14 and 18 .
  • the nucleus 10 is generally spherical in shape and is truncated with a flattened portion 22 A on the upper side of the nucleus 10 and another flattened surface 22 B on the lower side.
  • the nucleus also has upper and lower curved surfaces 24 A and 24 B, respectively, and a circumferential wall 26 .
  • the flattened surfaces can be advantageous because when the nucleus has a completely rounded surface, it cannot reliably maintain correction when exposed to the variable forces of the head and neck.
  • a flattened surface incorporated into the central region of the nucleus can be used to solve this problem.
  • the flattened surfaces have a contour different from the adjacent surface, and are formed in the nucleus body.
  • the terms “flattened section” or “flattened surface” are used interchangeably and are meant to refer to any contour that is not the same as the adjacent surface(s) of the nucleus.
  • Such a flattened surface can be planar or it be slightly convex or concave and have a radius of curvature different from the adjacent surface.
  • Such a flattened surface could also be in the shape of a compound curve or other complex shape.
  • This flattened surface can be angled relative to the superior end plate of the inferior vertebral body (or vice versa, or both), with the height of the anterior end being greater than the height of the posterior end when lordotic correction is sought.
  • the overall shape of the core can still be asymmetric, but the flattened surface can be incorporated to provide a reliable correction of the deformity.
  • This flattened segment provides stabilization to resist the moments acting through the nucleus, i.e., if the flat is not of adequate size, there may be a tendency for the correction to disappear in the presence of an anterior load or for a hyper-lordotic over correction in the presence of a posterior load (during lordotic correction).
  • Another advantage of the flattened segment is to provide surface contact over that area during small movements about the, neutral position of the device, which could help reduce wear on the device.
  • FIG. 1A illustrates a nucleus 10 that has not been adapted for lordotic correction because the upper and lower surfaces 22 A and 22 B are parallel to each other. In this nucleus, the axis 20 of greatest height falls in the center of the disc.
  • FIG. 1B a nucleus 14 that provides 3° of correction is illustrated. This nucleus provides for lordotic correction.
  • FIG. 1C illustrates another artificial disc nucleus 18 having a greater degree of deformity correction. When deformity correction is provided as shown in FIGS. 1B and 1C , the geometric center of the nucleus may shift to a location that is offset from the axis 20 .
  • the anterior/posterior directions are reversed, it provides a kyphotic correction. If the nucleus is rotated 90 degrees, a scoliotic correction is provided. In the illustration in FIG. 1C , the maximum vertical axis 20 is positioned to provide a correction of 6°. It is apparent that the nucleus can be adjusted to provide various degrees of correction and, in certain cases, if no degree of correction is needed. Alternatively, only one of the halves of the nucleus 10 may have a flattened portion, with the other half having an outer surface that is curved.
  • FIGS. 2A through 2C asymmetrical ovoid embodiments of an artificial nucleus are shown.
  • the nucleus comprises upper and lower surfaces 22 A and 22 B, which are “flattened” by virtue of the ovoid shape of the nucleus, upper and lower curved surfaces 24 A and 24 B, and a circumferential center portion 26 .
  • the maximum height axis 16 is asymmetrical with the geometric center 12 of the disc.
  • the maximum vertical height is at the central vertical axis 12 .
  • the maximum vertical axis 16 is positioned to provide an angle of correction of 3°.
  • the maximum vertical axis 16 is positioned to provide an angle of correction of 6°.
  • FIG. 3 is a top view of one example of a nucleus.
  • This nucleus 40 comprises a central convex or flattened region 42 , which includes a groove or slot 44 .
  • This groove or slot 44 enables the nucleus to slide onto the central keel or anchor of an end plate (not shown). While the nucleus 40 is shown as essentially circular, it is clearly apparent that it may take on other shapes such as an ovoid or ellipsoid shape. It is also clearly apparent that other types of anchor receiving means can be used.
  • the shape of the groove may vary or a snap-in or bayonet or dog-bone type of receptacle can be provided to anchor the nucleus in position.
  • Those practiced in the art can provide additional locking methods including the addition of one or more parts to the core that provide an anchor.
  • the nucleus may take the form of a truncated curved body as shown in FIG. 4 .
  • the nucleus 50 has an upper surface 52 that terminates in essentially flattened planar top 54 .
  • a slot 56 or a groove or opening of another appropriate shape, can be formed in upper surface 52 for receiving an anchor formed in the end plate.
  • the lower surface 58 is typically an inverse of the upper surface.
  • the bottom surface could be asymmetrically spherical or ovoid in shape.
  • the nucleus may be circular, ovoid or egg-shaped having a non-central maximum vertical axis as shown in FIG. 5 .
  • the nucleus could be essentially circular or asymmetrically spherical.
  • FIG. 5 illustrates an artificial nucleus 60 where the upper surface 62 is an asymmetric convex surface. Again, either the top or the bottom or both surfaces may be asymmetric.
  • nuclei in the figures have been shown adapted for lordotic correction. It is clearly apparent that the nucleus can have an asymmetric maximum height at the front (anterior), the rear (posterior) or the side (lateral).
  • the asymmetrical nucleus of the present invention can be used to correct for various types of spinal misalignment including sagittal and coronal deformity.
  • novel corrective nucleus of the present invention may be provided alone or it may be provided in combination with an upper end plate, a lower end plate or both an upper and a lower end plate.
  • FIGS. 6 through 8 illustrate an exemplary artificial end plate 70 that can be used in conjunction with the nucleus to provide a novel artificial disc unit.
  • An artificial end plate according to the present invention comprises an inner surface with a concave bearing surface for receiving the convex surface of an artificial disc.
  • the outer, or bone contacting, surface is essentially flat.
  • FIG. 6 shows an end plate 70 with a flat outer surface 72 that enables the end plate to slide on the surface of the vertebra.
  • One or more unidirectional keels 76 are formed on the outer surface 72 to provide for immediate fixation.
  • the keels may be placed centrally or parasagittally.
  • Fixation can be enhanced by incorporating onto the outer surface 72 a suitable coating 74 , such as porous titanium, a calcium phosphate or the like, to promote bony ingrowth for long term stability.
  • a stop member 78 can be provided at the anterior edge 80 of the end plate.
  • the stop member prevents the prosthesis from migrating posteriorly and possibly impinging on the spinal cord.
  • An essentially semi-circular wall 82 joins the outer surface of the end plate to the inner surface. The thickness of 82 may vary with increased thickness anteriorly, posteriorly or parasagittally, as discussed further below.
  • the inner surface 84 is shown in greater detail in FIG. 7 .
  • the inner surface 84 of the end plate articulates with the nucleus.
  • this inner surface has a concave region 86 , which receives the nucleus.
  • An anchor 88 is provided in the center of the concave region 86 for positioning the nucleus and preventing it from migrating.
  • the anchor 88 can be generally rectangular in shape with rounded edges, as shown, avoiding premature wear and cutting into the nucleus.
  • FIG. 8 illustrates a front view of the end plate showing the outer surface 72 having two parasagittal keels 76 and the inner surface 84 having a concave region 86 and a central anchor 88 .
  • FIGS. 9-12 illustrate a nucleus and end plates described above assembled into a TDR implant.
  • FIGS. 9 and 10 show the use of a nucleus 96 with a truncated cylinder shape and a flattened portion 97 on the superior side of the nucleus as described above, in conjunction with FIGS. 1A-1C
  • FIGS. 11-12 show the same design with a nucleus 96 having an ovoid shape as shown in FIGS. 2A-2C .
  • a complete spinal disc prosthesis 90 comprising a superior end plate 92 , an inferior end plate 94 and an artificial disc nucleus 96 is provided.
  • the end plates and nucleus can be provided in different sizes to accommodate differences in anatomy.
  • the end plates and various nuclei can be provided in a kit to the surgeon so that the appropriate sized components can be selected and used when the final size is determined.
  • the end plates may be fabricated of titanium or titanium alloy, chrome-cobalt-molybdenum (CoCrMo), cobalt 28 chromium molybdenum, cobalt chrome, ceramics or other material suitable for spinal prosthetic implants.
  • the end plates have two distinct surfaces.
  • the outer surface 98 is the surface that contacts the vertebral end plate.
  • the outer surface is essentially flat enabling it to easily contact the surface of the natural vertebral end plate.
  • the flat surface can be porous and incorporate a suitable treatment, such as porous titanium, a calcium phosphate or other types of known treatments such as coatings, plasma sprays, and structural changes to the surface, that promote bony ingrowth or ongrowth for long-term stability.
  • At least one parasagittal keel 100 is formed on the outer surface of each end plate to provide immediate fixation.
  • FIGS. 9-12 three parasagittal keels 100 are aligned with each other and located along both sides of the outer surface of the end plates.
  • FIG. 9A a similar end plate design with an upper end plate 92 and a lower end plate 94 have an offset keel configuration with a pair of aligned parasagittal keels 100 A formed on the outer surface of the upper end plate and a centrally-located row of aligned keels 100 B formed on the outer surface of the lower end plate 94 .
  • This latter arrangement is believed to be advantageous because, with the upper and lower keels being offset from each other, the end plates should have greater stability and result in less stress on a vertebra where multiple implants are used.
  • each of the end plates has a concave region 103 or bearing surface that articulates with the nucleus.
  • An anchoring protrusion 104 projects outwardly from the concave region, which provides an anchor for the nucleus and restricts posterior translation.
  • Both the superior and the inferior end plates have flanges 106 for preventing the end plates from migrating into the spinal canal.
  • the end plates can have holes 107 for allowing the end plates to be connected to the adjacent vertebrae through either metallic or bioabsorbable screws (not shown) that can be inserted through holes 107 .
  • FIGS. 9 and 11 illustrate front views of the prosthesis and FIGS. 10 and 12 illustrate side views.
  • spinal deformity can be addressed by providing an artificial spinal disc prosthesis where correction is provided in the end plates.
  • Corrective end plates may be provided alone, in combination with a symmetrical artificial nucleus that has flattened surfaces as described above on both the top and bottom of the nucleus, as shown in FIGS. 13A-13B , or in combination with an asymmetrical nucleus that has flattened surfaces as described above on both the top and bottom of the nucleus, as shown in FIGS. 14A-14C .
  • FIGS. 13A-13B and 14 A- 14 C are shown in FIGS. 13A-13B and 14 A- 14 C.
  • the degree of correction can be achieved by altering the inner (nucleus-contacting) side of the end plate or the outer (vertebral-contacting) side of the end plate.
  • the end plate 110 comprises an outer (bone-contacting) surface 112 , an inner surface 114 , and a perimeter wall 116 connecting the outer and inner surfaces.
  • the height of the perimeter wall 116 may vary according to the degree and type of correction required.
  • FIG. 13B illustrates an end plate adapted for a greater degree of correction than the end plate of FIG. 13A .
  • variable height can be adjusted to treat different conditions such as lordosis, kyphosis or scoliosis.
  • the inner surface may be shaped to receive the nucleus, and the height of the end plate can be adjusted according to the degree of correction required.
  • the outer surface 120 and the inner surface 122 may be essentially planar and the height is adjusted as the outer and inner surfaces become increasingly non-parallel as a result of variation in the height of the perimeter wall 124 .
  • FIGS. 14A through 14C illustrate increasing degrees of correction, respectively.
  • FIGS. 15 , 16 A and 16 B illustrate another embodiment of the invention, which provides for all directions of movement, flexion/extension, lateral bending, and rotation about the symmetrical axis.
  • the nucleus 130 is formed in two sections 130 A and 130 B.
  • a post 132 is formed on the inner surface of one section 130 A, and fits in an opening 134 that is formed on the inner surface of the other section 130 B to provide for relative rotational movement between the two sections 130 A and 130 B.
  • the post 132 and opening 134 can be formed on either section of the nucleus 130 .
  • the post and opening can be of any suitable size, and can be perpendicular to the opposing surfaces of the nucleus sections 130 A and 130 B, or be tilted at an angle off horizontal to orient the axis of axial rotation with the anatomically correct axis and provide a deformity correction.
  • the contact surfaces between the nucleus 130 and end plates 136 and 138 are designed to have the same corresponding asymmetrical contours at the preferred angle between them, as shown in FIG. 15 . Because there is only relative movement between the nucleus and the end plates in the anterior/posterior and medial/lateral directions, greater surface contact between the nucleus and the respective end plates is possible in order to transmit rotations of the end plates to the nucleus so that the two halves 130 A and 130 B, of the nucleus 130 will rotate with respect to each other, rather than having the end plates 136 and 138 , rotate on the outer surface of the nucleus 130 .
  • FIGS. 17 and 18 show another embodiment of the invention where instead of forming the nucleus 130 of a single piece of material, it can be formed of upper and lower sections 130 A and 130 B, with an intermediate section 140 , that is either flat or wedge-shaped as shown in FIG. 17 , fixed to the upper and upper and lower sections.
  • the intermediate section 140 can provide the nucleus with the appropriate degree of correction as shown in FIG. 18 , instead of providing wedge-shaped end plates as discussed above.
  • the nucleus 130 is essentially cut in half and has a flat inferior surface. This can be applied to the embodiment seen in FIGS. 17 and 18 , where the section 130 B is removed, leaving the inferior surface of intermediate section 140 articulating with the inferior end plate.
  • deformity correction can be achieved.
  • FIGS. 19 and 20 show another embodiment of the invention where the nucleus 130 is essentially cut in half and has a flat lower inferior surface.
  • This shape can be used to resist expulsion of a nucleus with an ovoid/asymmetric shape, which could occur when the ovoid shape of the nucleus causes the end plates to tilt relative to each other to provide correction.
  • the bottom surface of the nucleus 130 is flat and is formed with a circular opening 134 that is shaped and positioned to receive a post 136 formed on the opposing surface of the lower end plate 138 for allowing relative rotational movement between the nucleus 130 and the end plate 138 .
  • the nucleus could have the flat surface and opening 134 on its upper or superior surface, instead of being on the lower surface as shown.
  • the nucleus is preferably asymmetrical as shown in FIG. 19 .
  • FIGS. 21 through 24 A modification of the configuration in FIGS. 19 and 20 , is shown in FIGS. 21 through 24 , where the nucleus 130 is positioned in a slot or trough 142 formed in the upper surface of the lower end plate 138 .
  • the undersurface of the upper end plate 136 is contoured to match the nucleus.
  • the undersurface of the end plate 136 can be flat and engage a flattened upper surface 146 of the nucleus 130 .
  • the trough can be larger than the nucleus in both the anterior/posterior and medial/lateral directions to allow for a desired amount of translation in those directions as shown by the arrows A and B in FIG. 22 .
  • the trough can be open on the posterior or anterior end to allow the nucleus to be inserted simply by sliding it into the trough, as shown by the arrow A in FIG. 21 . In this way, the nucleus can be inserted without undue distraction of adjacent vertebrae.
  • the nucleus can be prevented from moving out of the trough by providing a stop 144 of any suitable size and shape.
  • FIG. 23 is a schematic view of the nucleus 130 that is inserted in the trough in FIG. 21 .
  • FIGS. 25-31 Another embodiment of the invention is shown in FIGS. 25-31 , where the nucleus 130 is elongated, with a flattened section 150 that is a partial cylinder with curved sections 152 and 154 on both sides of the flattened section. It is believed that this design, when mated with a cylindrical surface 156 on the interior of the upper end plate 136 , shown in FIG. 29 , will provide better wear characteristics because it will have surface contact during medial/lateral bending and line contact during flexion/extension.
  • the end plate can include a stop member to prevent the prosthesis from moving toward the spinal canal.
  • the elongated shape of the nucleus 130 is illustrated in FIGS. 25 and 26 , which show that the nucleus has a round cross section with constant medial-lateral radius from anterior to posterior (A-P), with the flat section 150 in the middle being oriented to provide a correction angle as described above, for the flatted portions on the other embodiments of the nucleus.
  • the nucleus 130 is asymmetrical, with the flattened surface 150 oriented at an angle and having a greater height at the anterior end than at the posterior end.
  • the nucleus 130 has an asymmetrical shape aligned with the sagittal plane, and across or crossing the coronal plane, of the vertebral bodies.
  • the interior surface 156 of the upper end plate 136 has a cylindrical shape with the same constant radius in the anterior/posterior direction as the nucleus.
  • the cylindrical surface 156 mates with the flattened section 150 of the nucleus 130 , and sits at an angle that provides a deformity correction as shown in FIG. 31 .
  • this position there is surface contact between the end plate 136 and the nucleus 130 .
  • medial/lateral bending there is also surface contact between the end plate and nucleus.
  • flexion/extension with or without lateral bending, there is line contact between the end plate and nucleus. This configuration of core and end plate will always have line or surface contact, thus reducing the wear potential from point contact in some of the previous designs.
  • the elongated shape of the nucleus 130 allows for the end plate 138 to have a trough 157 in the shape of a “bow tie” as shown in FIGS. 27 and 28 .
  • This shape allows for axial rotation with stops beyond the limits of normal motion.
  • the shape is oversized relative to the nucleus 130 by an appropriate amount to allow limited anterior/posterior and medial/lateral translation.
  • the bottom surface of the trough 157 can be rounded upwardly at the medial/lateral sides in FIG. 30 (not shown), so that as the nucleus 130 rotates it is “cammed” up causing a distraction of the device that forces the vertebral bodies apart and loads the tissues between them resulting in a gradual stop to the motion.
  • Translation of the nucleus 130 within the trough 157 will tend to preserve the mobile instantaneous axis of rotation of the natural disc.
  • FIGS. 32 and 33 show another embodiment of the invention, which utilizes a universal joint formed of a pair of cylinders 160 and 162 that rotate relative to each about a central post 164 that projects from one of the cylinders 162 and engages an opening 166 in the other cylinder 160 .
  • the cylinders 160 and 162 are oriented perpendicular to each other and engage cylindrical surfaces 168 and 170 , respectively, in the adjacent end plates 136 and 138 .
  • This design provides for three anatomical axes of rotation. Because of the independence of each axis of rotation, any correction provided by the shape of the nucleus that is formed of the two cylinders will result in rotation to compensate for the correction and a return to the uncorrected neutral position.
  • the cylinders 160 and 162 may be shaped similarly to the elongated nucleus 130 shown in FIGS. 25-27 , or another suitable shape with a flat inferior surface.
  • FIGS. 34-36 Another embodiment of the invention is shown in FIGS. 34-36 , where a resilient ring 172 and a post 174 that has a rounded top portion 176 provide for relative motion between the end plates and for the desired angle of correction.
  • the ring 172 is shown in detail in FIG. 35 .
  • the ring 172 can be wedge shaped as shown in order to provide the desired amount of correction, or it can be flat (not shown) if no correction is desired.
  • a projection 180 can be formed on the upper surface of the lower end plate 138 to mate with an opening 182 in the ring 172 in order to prevent the ring 172 from moving relative to the lower end plate once the ring is in its desired position.
  • the upper end plate 136 has a cavity 178 that can be contoured to match the shape of the rounded top portion 176 .
  • the ring 172 is shaped so that the end plate 136 will ride on the ring 172 during “normal” ranges of motion, or through regular activities. However, when the normal ranges of motion are exceeded, then the ring 172 will compress and the upper end plate 136 will engage the post 174 causing the adjacent vertebrae to distract and thereby provide a gradual stopping motion or “anatomically-derived gradual stopping.”
  • the post 174 could be designed to serve as the primary load carrying part of the articulation by riding in the cavity 178 . In this design, the deformity correction force is only provided by compressing the ring 172 . This design would have the advantage of reducing material stresses in the elastomer ring and creep.
  • the same result could be achieved by providing two or more stops 184 A and 184 B, formed of a resilient material, between the two end plates.
  • the stops 184 A and 184 B can be mounted on the upper surface of the lower end plate 138 .
  • One of the stops 184 A can project upwardly a greater distance than the other stop 184 B in order to provide the desired correction.
  • FIGS. 38 and 39 Another embodiment of the invention is shown in FIGS. 38 and 39 , where a nucleus 186 is provided that is formed of a resilient material that is shaped so that the nucleus provides medial/lateral rotation, but requires deformation of the material during flexion and extension. This is accomplished by proving a central portion 188 that is spherical or ovoid in shape and “flattened” adjacent end portions 190 A and 190 B that are cylindrical, which extend the flattened end portions around the circumference of the nucleus at both ends.
  • the upper end plate has a cavity (not shown) that has a contour that is similar in shape to the nucleus 186 .
  • a trough (not shown) similar to the one in FIGS. 27 and 28 can be formed in the lower end plate 138 .
  • the upper and lower end plates will rotate relative to each other through rotational movement of the upper end plate on the nucleus 186 .
  • flexion/extension in the direction of arrows B-B will occur only through deformation of the nucleus 186 .
  • the nucleus 186 can be rotated 90 ° on the lower end plate 138 so that so that the end plate 136 will rotate on the nucleus during flexion/extension and the nucleus will deform during medial/lateral movement.
  • the end portion 190 A has a larger diameter than the end portion 190 B to provide for the desired amount of correction.
  • the nucleus has been shaped so the resilience of the nucleus varies over its length.
  • the nucleus could be formed of materials having varying degrees of resiliency along its length to achieve the same results.
  • FIGS. 40-43 illustrate another embodiment of the invention where the end plates 136 and 138 are provided with stops outside of the normal range of motion, which also utilize the concept of “anatomically-derived gradual stopping” discussed above in conjunction with Figures 34 and 35 .
  • This type of stop can be added to any design that employs the use of end plates.
  • This aspect of the invention is based on duplicating how the human body moves and then designing the cooperating surfaces to mimic those motions as closely as possible.
  • the end plate 136 has a post 200 on its lower surface that engages pocket 202 formed in the upper surface of the lower end plate and 138 .
  • a pair of posts and pockets are provided on opposite sides of the nucleus 130 .
  • the pocket 202 has a slot 204 in it with a curved surface 206 that is engaged by the lower end 208 of the post 200 .
  • the lower end 208 of the post rides along the curved surface 206 .
  • the post reaches the outer limits of travel the lower end 208 will begin riding up the gradually curved section of the surface 208 , which causes distraction between adjacent vertebrae as illustrated by the arrow A in FIG. 43 and loads the tissues between them, resulting in a gradual stop to the motion.

Abstract

An artificial disc prosthesis is provided. The prosthesis of the present invention enables spinal segment alignment by having a variable height across its surface. The variable height is achieved by an asymmetric artificial nucleus or by at least one variable height end plate.

Description

    CROSS-REFERENCE TO RELATED APPLICATIONS
  • This application is a continuation of:
  • pending prior U.S. patent application Ser. No. 12/241,326, filed Sep. 30, 2008 and entitled ARTIFICIAL SPINAL DISC (Attorney's Docket No. HO-P03202US0 CON 1), which is a continuation of:
  • pending prior U.S. patent application Ser. No. 10/590,139, filed Feb. 11, 2008 and entitled ARTIFICIAL SPINAL DISC (Attorney's Docket No. HO-P03203US0), filed as a U.S. national stage filing of:
  • PCT Application No. PCT/US05/023134, filed Jun. 30, 2005 and entitled ARTIFICIAL SPINAL DISC (Attorney's Docket No. HO-P03203WO0), which claims the benefit of:
  • prior U.S. Provisional Patent Application Ser. No. 60/658,161, filed Mar. 4, 2005 and entitled ARTIFICIAL SPINAL DISC (Attorney's Docket No. H310916US), and
  • prior U.S. Provisional Patent Application Ser. No. 60/584,240, filed Jun. 30, 2004 and entitled ARTIFICIAL DISK FOR DEFORMITY CORRECTION (Attorney's Docket No. 55485-1).
  • The above-identified documents are hereby incorporated by reference in their entirety.
  • TECHNICAL FIELD
  • The present invention relates to methods and devices for the treatment of disc disease and spinal deformities with an artificial disc replacement.
  • BACKGROUND OF THE INVENTION
  • Spinal arthroplasty is an emerging field that offers the promise of restoring and/or maintaining normal spinal motion. The goal of spinal arthroplasty is to reduce or eliminate adjacent segment disease (ASD) by maintaining the normal spinal biomechanics at the operative level. To accomplish this, an artificial cervical prosthesis must duplicate as closely as possible the natural spinal biomechanics, including maintaining the axial height of the disc as well as applying angular adjustment throughout the full range of motion of the natural spine.
  • The spine plays an integral role in neural protection, load bearing and motion. The vertebral column provides a strong, yet mobile central axis for the skeleton and is composed of twenty-four vertebral bodies with seventy-five stable articulations. The intervertebral disc is a fundamental component of the spinal motion segment, providing cushioning and flexibility. Adjacent vertebrae are linked together by three articulations: a) the vertebral bodies and disc, which transmit compressive and shear loads and provide flexibility, and b) by two facet joints, which protect the disc from translational shear stress and limit rotation. This “triple joint complex” allows for flexion, extension, lateral bending and rotation of the spine.
  • The intervertebral disc is composed of an inner gel-like matrix called the nucleus a pulposus and an outer surrounding fibrous band called the annulus fibrosus. When compressive loads are placed on the spine, increased pressure in the nucleus pulposus is transmitted to the annulus, which bulges outwards. The degenerative cascade of the intervertebral disc initially involves desiccation of the nucleus pulposus. With decreased elasticity and dampening from the nucleus, increased loads are transmitted to the annulus and facets. The increased stress on the annulus can lead to fissures and radial tears in its collagen fibers. With further degeneration, this can lead to circumferential bulging of the disc, contained and uncontained disc herniations, and complete desiccation of the disc. This degenerative cascade can result in axial pain, by stimulating pain fibers in the annulus, or compression of spinal nerve roots and/or the spinal cord. This can manifest itself in motor weakness, pain and/or numbness in the arms or legs or both.
  • The structure and function of the discs may be altered by a variety of factors including repeated stress, trauma, infection, neoplasm, deformity, segmental instability and inflammatory conditions. Degeneration of the intervertebral disc is the most common etiology of clinical symptoms referable to the spine. Degeneration of the spine is a universal concomitant of human aging. In the cervical spine, neck and arm pain caused by nerve root compression has been estimated to affect 51% of the adult population. Spondylosis of the spine and aging are intimately related, with spondylosis increasing in both prevalence and severity with age. Fortunately, the majority of patients will improve without surgery. In approximately 10-15% of cases, spondylosis is associated with persistent nerve root and spinal cord compression and/or spinal pain, with a small percentage ultimately requiring surgery.
  • The most common type of surgery used in the United States for the treatment of degenerative disorders of the spine (spondylosis) is spinal fusion. In an interbody fusion, the diseased disc is removed and either a wedge of bone from the patient's hip, allograft or a metallic spacer is placed between the vertebrae where the disc was removed. This immobilizes the functional spinal unit. While this surgery has been successful in eliminating motion, there are disadvantages associated with it. By converting a mobile, functional spinal unit into a fixed, nonfunctional one, fusion results in increased strain patterns at levels adjacent to the fused segment. When a segment of the spine is fused, there is elimination of motion at the level of surgery. Therefore, the stresses that would normally be absorbed by the disc at the site of surgery are now transferred to adjacent segments. This can cause adjacent segment disease (ASD) to one or several spinal units adjacent to the affected level. ASD can be defined as a clinical syndrome of symptomatic degenerative changes occurring adjacent to a previously fused motion segment. Retrospective studies have estimated that ASD can occur in the cervical spine at a rate as high as 2.9% per year with a projected survivorship rate of 26% at 10 years (Hilibrand A S, Carlson G D, Palumbo M, Jones P K, Bohlman H H: Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg (Am) 81:519-528, 1999).
  • In the cervical spine, thousands of North Americans undergo surgery for cervical spondylosis each year. The majority of these procedures involve an anterior discectomy with decompression of the spinal cord and/or nerve root. The primary indication for surgery in the management of cervical spondylosis is radiculopathy, myelopathy and/or neck pain. Following the discectomy, an anterior interbody fusion is commonly performed. Autologous bone harvested from the iliac crest or cadaveric bone is most commonly used to fill the space created by the removal of the disc. A number of other solutions have been suggested, including metallic devices such as fusion cages or other types of spacers, xenografts such as bovine bone, and biological strategies such as the use of growth factors. The graft for the interbody fusion can be shaped to correct underlying deformity of the cervical spine. By contouring the graft one can restore lordosis to a straight or kyphotic spine.
  • A more recent alternative to spinal fusion is replacement of the damaged disc with a motion preservation device, which includes either a nucleus or total disc replacement (TDR). The rationale for the development of the artificial disc is to prevent adjacent segment disease. Artificial disc devices can be broadly divided into two categories, those that replace the nucleus only, leaving the annulus and vertebral body end plates intact and those that involve replacement of the disc and addition of prosthetic end plates. Both strategies are directed at restoration of intervertebral disc function. Prosthetic nuclei are described, for example, in U.S. Pat. Nos. 5,047,055 and 5,192,326. United States patent application US2002/0183848 also discloses a prosthetic spinal disc nucleus that has a hydrogel core surrounded by a constraining jacket.
  • There are several different types of prosthetic devices for use in the cervical or lumbar segments of the spine designed for TDR. For example, the Prodisc™ and the Charite™ disc are composites of cobalt chromium end plates with a polyethylene core. The Prodisc™ is described in U.S. Pat. No. 5,314,477 and the Charite™ disc is described in U.S. Pat. Nos. 5,401,269 and 5,556,431. The Prestige™ disc is another type of artificial disc that comprises a metal on metal design with a ball and trough articulation. Another type of artificial disc that is gaining popularity in the cervical spine is the Bryan® disc, described in several United States patent applications including 2004/0098131; 2004/00544411; and 2002/0 128715. The Bryan® disc is a composite artificial disc with a low friction, wear resistant, elastic nucleus that articulates with two circular metal plates.
  • Presently, there are at least four artificial cervical disc replacement systems undergoing clinical trials worldwide. These include unconstrained devices, such as the PCM cervical disc. These unconstrained devices do not have mechanical stops to limit their range of motion. The Bryan® Cervical disc, the Prodisc™ C and the Prestige™ LP cervical disc systems limit range of motion to varying degrees. These systems can be considered semi-constrained, in that there are mechanical stops outside the normal range of motion. Thus far, only the Charite™ disc has been approved for use in the United States.
  • Artificial spinal discs have been implanted for the management of degenerative disc disease producing radiculopathy, myelopathy and/or axial spinal pain. More recently, artificial discs have been adopted for the treatment of trauma. The aim of TDR is to reproduce the biomechanics of the natural disc. Early clinical and biomechanical studies with single and multi-level disc replacement have reported favorable clinical outcomes and preserved range of motion at the level of surgery. Preservation of range of motion, however, while an important feature of an artificial disc, is only a single measure of spinal biomechanics. The effect of the disc on angulation at the operative level, the average disc space height, and overall spinal alignment (sagittal and coronal balance) also needs to be considered.
  • While the introduction of artificial discs has led to many successful surgeries, there are still problems associated with the current discs. For example, all of the current artificial cervical discs have a fixed height across the entire disc. The artificial discs presently available can have issues with focal kyphosis or kyphosis at adjacent segments of the spine after the patient post-operatively reassumes an upright position, supporting the weight of the head and body. For instance, with the Bryan® disc, the end plates are allowed to move freely about all axes of rotation, allowing the end plate to assume a position resulting from the forces exerted on the implant by the head and neck. At times, this position may be significantly different from the positioning of the disc intra-operatively. Several published studies with the Bryan® cervical disc replacement system have reported a tendency for the end plates of the prosthesis and the alignment of the cervical spine to develop kyphosis following surgery. [Pickett G E, Mitsis D K, Sekhon L H et al. Effects of a cervical disc prosthesis on segmental and cervical spine alignment. Neurosurg Focus 2004;17(E5):30-35; Johnson J P, Lauryssen C, Cambron H O, et al. Sagittal alignment and the Bryan® cervical disc. Neurosurg Focus 2004;17(E14):1-4; Sekhon L H S. Cervical arthroplasty in the management of spondylotic myelopathy: 18 month results. Neurosurg Focus 2004; 17(E8):55-61.] This kyphotic angulation of the prosthesis has been attributed to the passive (unconstrained motion with a mobile nucleus and variable instantaneous axis of rotation) design of the implant. None of the current TDR systems addresses this major complication.
  • A significant number of patients with spinal disc disease have a loss of sagittal alignment of the spine as a result of the degenerative process. In addition, varying degrees of coronal imbalance can also occur. None of the available artificial disc replacement systems are designed to restore normal alignment to a spine that is straight, which have focal/global kyphosis or coronal deformity. Existing artificial disc replacement systems that are inserted into either a straight, kyphotic or angulated segment are likely to take on the angle and local biomechanics determined by the facets, ligaments and muscle forces. As such, patients with a pre-operative straight spine may develop post-operative kyphosis, and patients with a pre-operative kyphosis may have a worsening of the deformity post-operatively. Kyphosis of the spine has been implicated in segmental instability and the development of clinically significant degenerative disease. Several clinical studies have described that a change in the sagittal or coronal balance of the spine can result in clinically significant axial spinal pain as well the initiation and/or the acceleration of ASD. [Kawakami M, Tamaki T, Yoshida M, et al. Axial symptoms and cervical alignment after anterior spinal fusion for patients with cervical myelopathy. J Spinal Disord 1999;12:50-60; Harrison D D, Harrison D E, Janik T J, et al. Modeling of the sagittal cervical spine as a method to discriminate hypolordosis: results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine 2004;29:2485-2492; Katsuura A, Hukuda S, Saruhashi Y, et al. Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J 2001;10:320-324; Ferch R D, Shad A, Cadoux-Hudson T A, Teddy P J. Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment. J Neurosurg 2004; 100:S13-S19; Katsuura A, Hukuda S, Imanaka T, Miyamoto K, Kanemoto M. Anterior cervical plate used in degenerative disease can maintain cervical lordosis. J Spinal Disord 1996; 9:470-476.]
  • Attempting to provide a deformity correction by simply altering the end plate or the nucleus of an artificial disc, while still maintaining free movement about all axes of rotation, may not be sustainable as the forces exerted by the head and body on the artificial disc could counteract the desired correction. To provide a sustainable correction, some limitation on the axes of rotation is required. From a design perspective, the goal is to design an artificial disc that is able to correct deformity (coronal and sagittal), has mechanical stops outside the normal range of motion (semi-constrained), and preferably has variable instantaneous axis of rotation (IAR).
  • The limits on the axes of rotation can fall into two categories. One is to provide correction using a permanent rotation or translation of an axis to support the correction. This is accomplished using the geometries of the core and end plates themselves and is referred to the Geometric Constraint category. The second is to keep free range of motion about all axes but provide the correction using a material support. This type of design provides the correction by the imposition of a deformable material in the plane of correction for normal rotation in that plane. This is the Material Constraint category of designs.
  • Degenerative disc disease is a major source of morbidity in our society. It can lead to serious economic and emotional problems for those afflicted. Thus, there is a need for an artificial disc that can alleviate both symptoms and correct deformity (sagittal or coronal or both) of the spine.
  • BRIEF SUMMARY OF THE INVENTION
  • There are a number of different strategies that can be used with disc replacements to address the need for alignment/deformity correction in the spine. With most of the available discs, the angle of disc insertion can significantly alter the orientation of the prosthesis. This is related to bone removal and end-plate preparation for the prosthesis. By changing the angle of insertion, the disc can be placed either in parallel or at an angle to the disc space. Unfortunately, by changing only the angle of insertion, one cannot correct an underlying deformity of the spine. Simply changing the angle of insertion is not adequate to compensate for a device that does not have sufficient off-center load bearing support or structure to maintain the correction of the deformity.
  • A strategy to correct lordosis in the lumbar spine has been utilized by the Link-Charite™ and Prodisc™ lumbar disc replacement systems by using wedge-shaped end plates. A wedge-shaped end plate has also been used in at least one case with the Bryan® cervical disc system. However, wedge-shaped end plates are not routinely available at the present time for cervical disc replacement systems. The strategy of using wedge-shaped end plate(s) involves forming a differential thickness across the end plate. The articulation between the ball and socket/trough or the nucleus and end plates is not altered, which is an advantage because the complex geometry of how the prosthesis provides motion is not altered. The disadvantage, however, is that this strategy is not forgiving if an error is made with either an overly corrected end plate or an end plate that is not corrected enough. The revision of the end plate can be difficult at the time of surgery and may even preclude the disc space from receiving a disc replacement. As most systems have a coating on the end plates that promote bony ingrowth, revision at a later date may be extremely difficult or even impossible. As there are two surfaces to the end plate, an outer surface that contacts the bone and an inner surface that articulates with the nucleus or core, it is conceivable that by changing the location or geometry of the inner surface, one could alter the center of rotation. This would be most applicable to prostheses that function as a “ball and socket” articulation. By changing the location of the “socket” or trough, this could alter how the prosthesis impacts alignment at the level of the disc.
  • An alternate method of achieving lordotic correction is by changing the nucleus or inner core. The biggest advantage of this approach is that the nucleus or core can be more easily interchanged or revised. Intra-operatively, instruments can be used to gage the need for and amount of correction and the appropriate nucleus can be inserted. By designing the correction into the nucleus, the surgeon is provided with flexibility and ease of insertion, and the ability for revision at a later date, which the other methods do not provide.
  • The invention includes a novel artificial disc that provides the normal range of motion of the natural intervertebral disc, along with the ability to correct deformity of the spine. The proposed disc allows for semi-constrained range of motion of the functional spinal unit. It will reproduce the kinematics of the pre-operative normal spine. It will possess maximum durability and biocompatibility, and a means for integrating itself into the spine bony structure for long-term stability. Its insertion will be safe, simple, and ideally not add significantly to surgical time compared with the current procedures. In contrast to the existing disc replacement systems, it will allow the surgeon to correct deformity while maintaining natural kinematics of the spine.
  • A major advantage of this system will be that the nucleus may be easily revisable. For instance, in most cases where the Bryan® disc needs revision, the entire disc, including the end plates, must be removed. In cases where the alignment of the spine changes with time, especially in children and young adults, this new disc replacement system will allow revision of the nucleus, if needed.
  • The present invention addresses the problems associated with the artificial discs of the prior art by providing an artificial disc that provides for correction of spinal alignment deformity.
  • The artificial disc of the present invention is useful for the treatment of degenerative disc disease including correcting spinal deformities such as kyphosis, lordosis, and scoliosis.
  • It is an object of one aspect of the invention to provide an improved artificial disc replacement that maintains motion at the operative level and reduces the incidence of adjacent segment disease.
  • In one aspect of the invention, the artificial disc incorporates an artificial nucleus having an asymmetrical maximum vertical axis. The present invention includes a non-spherical nucleus with a maximum point of load-bearing and height in a non-central location (a differential in the anterior/posterior height of the nucleus).
  • In one embodiment, the nucleus is adapted to provide lordodic correction to a damaged spinal segment. In this case, the axis of greatest height is positioned in the anterior part of the nucleus.
  • In another embodiment, the nucleus is adapted to provide kyphotic adjustment. In this case, the maximum height axis is positioned in the posterior part of the nucleus.
  • In yet another embodiment, the asymmetrical nucleus can be used for the treatment of scoliosis. To achieve this, the axis of maximum height is lateral (parasagittal) to the middle of the disc.
  • According to another aspect of the present invention, an artificial nucleus, or core, is provided for use in an artificial disc. The nucleus comprises a body of biocompatible material, having the greatest vertical height either at the central vertical axis or at a vertical axis other than the central vertical axis.
  • In another embodiment, the body is spherical or ovoid (egg-shaped), having convex upper and lower surfaces and a non-central maximum height vertical axis. In an alternative embodiment, the nucleus is in the form of a truncated cylinder where the top is cut at a plane that is not parallel to the base. In another preferred embodiment, the disc is essentially circular.
  • It has been found that nucleus body with a completely rounded surface (not necessarily spherical) have issues with reliably maintaining correction when exposed to the variable forces of the head and neck. To address this issue, a segment or section that is flat or which has a contour different from the adjacent surface, can be formed in the central region of the nucleus body. This section will be referred to as a flattened section, which is meant to refer to any contour that is not the same as the adjacent surface(s) of the nucleus. Such a flattened surface can be planar or it can have other shapes such as a slight convex or concave shape with a radius of curvature different from the adjacent surface. Such a flattened surface could also be in the shape of a compound curve or other complex shape. In the example of providing a lordotic correction, the flattened segment can be angled relative to the superior end plate of the inferior vertebral body with the height of the anterior part being greater than the height of the posterior part. The overall shape of the nucleus body is still asymmetric, but the flattened segment is incorporated to provide a reliable correction of the deformity. This flat segment provides stabilization of the correction by resisting misalignment moments acting through the nucleus. If the flattened segment is not of adequate size, there may be a tendency for the correction to disappear in the presence of an anterior load or for a hyper-lordotic over correction in the presence of a posterior load (during lordotic correction). An additional advantage of incorporating a flat segment in the nucleus is to provide surface contact over that area during small motions about the resting, neutral position of the device. This should help reduce wear on the device.
  • In another embodiment, the nucleus or core could be hemispherical in shape with a flattened inferior surface that fits in an opening or trough formed in the lower end plate. Alternatively, the nucleus is asymmetric in that it has a greater vertical dimension or thickness on the anterior aspect than on the posterior aspect in order to provide a lordotic correction. The superior surface of the nucleus can have a flattened portion. The flattened portion may incorporate a concave segment, but can have the other configurations as mentioned above. The shape of the trough can be such that it defines the outer limits of rotational or translational movement of the nucleus relative to the lower end plate. This design allows for greater ease of insertion of the nucleus without undue distraction of adjacent vertebrae because the trough could be open at one end to allow for the nucleus to be inserted, and then a stop could be inserted in the trough to maintain the nucleus in the trough.
  • In another embodiment, instead of ovoid shaped nucleus, an elongated or “sausage type” shape can be used, which has spherical or ovoid end sections and a flattened or cylindrical center section. When a nucleus of this shape mates with a cylindrical bearing surface on the upper end plate, both surface and line contact are provided during lateral bending as well as in flexion and extension. When this type of elongated nucleus is used, a corresponding end plate trough in the lower end plate can be provided that allows for axial rotation with stops beyond the limits of normal motion. This trough can have the shape of a “bow tie,” “dog bone” or the like. The trough can be slightly oversized compared with the nucleus to allow limited anterior/posterior and medial/lateral translation. Additionally, the bearing surface of the end plate trough can be curved upwardly at the outer limits of movement of the nucleus. This feature forces the nucleus to rise upwardly when it rotates and cause an axial distraction of the device that forces the adjacent vertebral bodies apart and loads the tissues between them, resulting in a gradual stop to the motion. The translation of the core within the trough attempts to preserve the mobile instantaneous axis of rotation of the natural disc.
  • In another embodiment, an elongated or “sausage type” shape nucleus is shaped so that the superior surface of the nucleus possesses a depression or valley formed in the flattened section, which extends along the sagittal plane. This can be accomplished, for example, by removing material from the central region of the flattened segment of the nucleus, creating a valley between the side portions. The side portions are contiguous with the remaining elements of the nucleus, and do not protrude in the vertical plane. The side portions are preferably symmetrical about the sagittal plane.
  • Additionally, the trough can be open at the anterior end to allow for insertion of the nucleus without excessive distraction of the adjacent end plates. A locking mechanism can be provided to prevent the nucleus from being expelled from the trough after insertion of the nucleus.
  • In another aspect of the invention, a novel type of end plate is provided. Unlike other end plates, which require extensive preparation of the vertebral body surface, the present end plates have an essentially flat outer or vertebral-contacting surface that allows them to be easily inserted. In a preferred embodiment, the surface is a semi-round plate having at least one unidirectional keel for anchoring the plate in position. The outer surface of the end plate may be treated in a way that promotes bony ingrowth to enhance stability of the end plate in situ. In one embodiment, the outer (vertebral-contacting) surface and the inner (nucleus-contacting) surface are essentially parallel to each other. In another embodiment, the outer surface and the inner surface are non-parallel thereby giving the end plate an essentially wedge-like configuration. The orientation of the wide and narrow edges of the wedge can be adjusted to provide various types and degrees of spinal correction.
  • In another aspect of the invention the prosthesis comprises an artificial nucleus and at least one end plate. In this embodiment, the prosthesis comprises a superior end plate for attachment to an upper vertebral member, an inferior end plate for attachment to a lower vertebral member and a nucleus adapted to fit between the two end plates. The end plate of the invention has a generally flat surface on the bone contacting side and the appropriate geometric receptacle on the other side for articulating with the nucleus. A central keel can be formed in the center of the inner surface of the end plate to anchor the nucleus in position. The end plate can include a stop member to prevent the prosthesis from moving toward the spinal canal. The nucleus may also have a maximum vertical axis that is not at the geometric center.
  • In another embodiment, the nucleus has an upper surface with an upper receptacle and a lower surface with a lower receptacle. The superior end plate has a downwardly projecting protrusion or anchor that engages the upper receptacle and the inferior end plate has an upwardly extending protrusion or anchor that engages the lower receptacle. The prosthesis maintains an appropriate spatial relationship between adjoining vertebrae and also permits normal range of motion of the spine. This embodiment can also include a receptacle that comprises a groove open at one end. The anchor on the end plate can include a central keel, which slides into position in the groove to secure the nucleus.
  • Another embodiment of the invention operates like a universal joint and incorporates three anatomical axes of rotation, two of which provide for flexion/extension and lateral bending motion, while the other one provides for axial rotation. These axes of rotation are accomplished by the use of a pair of two cylinders that can rotate relative to each about a central post.
  • In another embodiment, one of the plates has a central post that engages the other plate, and an annular core positioned around the central post that is formed of a resilient material. The core can be asymmetrical and engage both plates to provide necessary deformity correction. The core can engage the end plates to provide the desired angle between the plates for deformity correction, with the central post engaging the other plate when the load exceeds a predetermined limit. Or, the post can engage the other plate with the core engaging the other plate to maintain the plates at the desired angle relative to each other when applied forces tend to change the relative angle of the plates. Alternatively, the core could be replaced by two or more discrete spacers for performing the same function.
  • In another aspect of the invention, the nucleus can utilize material deformation to accomplish the desired ranges of motion. The shape of the material can be used to provide a restoring force for deformity correction. In order to achieve these results, material can be removed from various parts of the core to change the modulus of elasticity of the core at selected locations, or material having variable elastic moduli could be used. In this way, different forces and motions can be provided though the design of the core.
  • The end plates can be provided with features that act as stops outside of the desired range of motion, which allow for anatomically-derived gradual stopping. This result can be achieved by forming one or more camming surfaces in or on one of the end plates and providing a co-operating member on the other end plate for engaging the camming surface. The camming surface has a gradual curve on its inner surface. During relative movement between the end plates, the camming surface is engaged by the cooperating member, which results in an axial distraction of the end plates and provides a soft tissue assist to prevent a hard stop. Alternatively for rotational movement, cooperating camming surfaces can be provided so that distraction will occur when one end plate rotates relative to the other one.
  • The foregoing has outlined rather broadly the features and technical advantages of the present invention in order that the detailed description of the invention that follows may be better understood. Additional features and advantages of the invention will be described hereinafter which form the subject of the claims of the invention. It should be appreciated by those skilled in the art that the conception and specific embodiment disclosed may be readily utilized as a basis for modifying or designing other structures for carrying out the same purposes of the present invention. It should also be realized by those skilled in the art that such equivalent constructions do not depart from the spirit and scope of the invention as set fourth in the appended claims. The novel features which are believed to be characteristic of the invention, both as to its organization and method of operation, together with further objects and advantages will be better understood from the following description when considered in connection with the accompanying figures. It is to be expressly understood, however, that each of the figures is provided for the purpose of illustration and description only and is not intended as a definition of the limits of the present invention.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • These and other features of the invention will become more apparent from the following description in which reference is made to the appended drawings wherein:
  • FIG. 1A illustrates an spherical artificial disc nucleus with the maximum central axis in the geometric midline of the nucleus;
  • FIG. 1B illustrates the nucleus of FIG. 1A, with an offset maximum vertical axis that provides 3° of correction;
  • FIG. 1C illustrates the nucleus of FIG. 1A, with an offset maximum vertical axis that provides 6° of correction;
  • FIG. 2A illustrates an asymmetrical artificial disc nucleus with the maximum central axis in the geometric midline of the nucleus;
  • FIG. 2B illustrates the nucleus of FIG. 2A with an offset maximum vertical axis that provides 3° of correction;
  • FIG. 2C illustrates the nucleus of FIG. 2A with an offset maximum vertical axis that provides 6° of correction;
  • FIG. 3 is a top view of the embodiment of the artificial disc nucleus shown in FIG. 1A;
  • FIG. 4 is a perspective view of the embodiment of the artificial nucleus shown in FIG. 1A;
  • FIG. 5 is a perspective view of the embodiment of the artificial nucleus shown in FIG. 2A;
  • FIG. 6 is a perspective view of an outer surface of an end plate;
  • FIG. 7 is a perspective view of an inner surface of an end plate;
  • FIG. 8 is a front view of an end plate;
  • FIG. 9 is a front view of a spinal disc device with the nucleus shown in FIG. 1A;
  • FIG. 10 is a side view of the spinal disc device of FIG. 8;
  • FIG. 11 is a front view of a spinal disc device with the nucleus shown in FIG. 2A;
  • FIG. 12 is a side view of the spinal disc device of FIG. 8;
  • FIGS. 13A and 13B illustrate an embodiment of an artificial spinal disc prosthesis where the end plates may be adapted for lordotic correction;
  • FIGS. 14A, 14B, and 14C illustrate other embodiments where the end plates can be adapted for lordotic correction;
  • FIG. 15 is a side view of another embodiment which provides for all directions of movement;
  • FIGS. 16A and 16B illustrate the two sections of the nucleus of the embodiment of FIG. 15;
  • FIGS. 17 and 18 illustrate another embodiment of the invention in which the nucleus is formed of upper and lower sections with an intermediate section;
  • FIG. 19 illustrates another embodiment of the invention in which the nucleus is cut in half and has a flat lower inferior surface;
  • FIG. 20 is a schematic view of the nucleus of FIG. 19;
  • FIG. 21 illustrates a modification of the embodiment of FIG. 19;
  • FIG. 22 is a an underside view of the nucleus of FIG. 21;
  • FIG. 23 is a schematic view of the nucleus of FIG. 21;
  • FIG. 24 illustrates a modification of embodiment of FIG. 19;
  • FIGS. 25-31 illustrate another embodiment of the invention in which the nucleus is elongated with a flattened section in the center;
  • FIGS. 32 and 33 illustrate another embodiment of the invention which utilizes a universal joint;
  • FIGS. 34-36 illustrate another embodiment of the invention in which a resilient ring and a post provide for relative motion between the end plates;
  • FIG. 37 illustrates a modification of the embodiment of FIG. 34;
  • FIGS. 38 and 39 illustrate another embodiment of the invention in which the nucleus is shaped to provide medial/lateral correction; and
  • FIGS. 40-43 illustrate another embodiment of the invention in which the end plates are provided with stops outside the normal range of motion.
  • DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
  • The present invention relates to systems and methods for partially or wholly replacing diseased or injured joints with artificial joint prostheses. Those of skill in the art will recognize that the following description is merely illustrative of the principles of the invention, which may be applied in various ways to provide many different alternative embodiments. This description is made for the purpose of illustrating the general principles of this invention and is not meant to limit the inventive concepts in the appended claims.
  • In its proper, healthy alignment, the spine follows natural curves, which promote proper sagittal and coronal balance (flexibility) and allow for balanced load sharing between the vertebrae. These curves include the cervical, thoracic, lumbar and sacral regions of the spine. Naturally, in order to accommodate a curve, there must be some variation in the angle of articulation between the functional spinal units and the height of an intradiscal space. The cervical and lumbar regions are naturally lordotic, or curved convexly in the anterior direction. At different segments along the spine, there are typically different heights for the vertebral bodies and the intradiscal space. In addition, the intradiscal space and vertebral body height may be different for different people.
  • Each intradiscal space has anterior and posterior regions. An artificial disc in the cervical, thoracic and lumbar regions that maintain the same height from the anterior to the posterior may promote an abnormal alignment, resulting in additional stress at the anterior or posterior portions of an adjacent disc. It may also result in an uneven load distribution across the device and cause an excessive amount of relative motion, wear debris and early failure.
  • As used herein, the terms, nucleus and core are used interchangeably to refer to an artificial intervertebral device that replaces a damaged natural spinal disc. The artificial core may be provided alone or in combination with a superior end plate for attachment to an upper vertebra or an inferior end plate for attachment to a lower vertebra or both.
  • The terms “upper” and “lower” are used herein to refer to the vertebrae on either side of the disc to be replaced, or a surface on a part in the position shown in the referenced drawing. A “superior” plate is affixed to an upper vertebra and an “inferior” plate is affixed to a lower vertebra of a functional spinal unit.
  • The terms vertical and horizontal are used herein relative to a standing human being in the anatomical position. The term “anterior” refers to the region towards the front and the term “posterior” refers to the region towards the back. The term “sagittal” refers to regions on either side of the central midline axis of a standing human being.
  • The term “asymmetrical” is used herein to refer to an axis of maximum height that is not placed centrally or to a nucleus or total disc replacement (TDR) not having its maximum vertical axis placed centrally. In other words, the maximum height is not situated or pivoted at a center line of symmetry so that the TDR comprises regions that are not exactly the same in shape or size as other regions on the other side of a line of symmetry. The location of maximal load bearing is located in a non-central location.
  • In one embodiment of the present invention, an artificial disc comprises a nucleus that is not geometrically symmetrical. The disc may have a maximum vertical axis that is not located at the geometric center of the disc. The maximum vertical axis may be located toward the front of the disc, the rear of the disc or on one side of the disc. The positioning of the maximum vertical height and load bearing capability is chosen depending on the type of deformity that needs to be corrected. The present invention also provides methods for the treatment of disc/vertebral body disease, lordosis, kyphosis and scoliosis using an asymmetric artificial disc.
  • One advantage of the present invention is that the “nucleus” or core may be interchanged and revised intra-operatively and post-operatively. Instruments can be used to gauge the need for and amount of correction and the appropriate implant can then be inserted. By introducing correction into the nucleus, the surgeon benefits from flexibility, ease of insertion and revisability that present systems do not provide.
  • Artificial discs of the present invention can be provided with various degrees of deformity correction. For this aspect of the invention, the surgeon can choose a disc having the appropriate correction for the patient. Thus, a method of treating a spinal deformity is provided. This method comprises preparing a spinal segment for implantation of an artificial disc, determining the desired angle of the intervertebral space, selecting an artificial nucleus having the desired dimensions, affixing a superior end plate to the upper vertebra, affixing an inferior end plate to the lower vertebra and inserting the selected nucleus between the superior and inferior end plates. Alternatively, and the assembled unit of end plate-nucleus-end plate may be inserted in unison. The configuration of the nucleus in this pre-assembled construct can be determined by the intra-operative measurement tools, or with pre-operative calculations. Pre-operative planning techniques and instruments may also be able to determine the size and orientation of this device for insertion.
  • A major advantage of the present system is that the artificial disc can be more easily and rapidly inserted and the nucleus can be changed or revised in accordance with the magnitude of the deformity being corrected. This is especially useful in children and young adults where the alignment of the spine changes over time.
  • In one embodiment, an asymmetric nucleus adapted for lordotic correction of the cervical spine is provided. The surgeon can restore lordosis to the cervical spine while maintaining motion. The nucleus may be composed of a low friction elastomer such as polyurethane, polycarbonate-polyurethane, a polymer such as polyethylene (particularly ultra-high molecular weight polyethylene), a suitable ceramic, metals or metal alloys such as titanium or a titanium alloy, chrome-cobalt-molybdenum (CoCrMo), cobalt 28 chromium molybdenum, cobalt chrome, stainless steel, or other suitable materials. It has a generally circular geometric design, with varying degrees of lordosis incorporated into it by utilizing an axis of maximum height anterior to the geometric center of the nucleus. The anterior height of the nucleus varies, depending on the extent of lordotic correction needed. The nucleus is available in various lordotic angles, e.g. 0, 3° and 6°, as well as differing heights (e.g., 4, 6 and 8 mm). Before deciding on the final nucleus size, a set of instruments or other means can be used to gauge the need for lordotic correction.
  • The nucleus slides between a superior end plate and an inferior end plate. The nucleus can be maintained in position using various types of connectors. For example, in one embodiment, the convex surface of the nucleus has a midline groove to allow the nucleus to slide into place between the positioned end plates. A central keel on the concave surface of the end plate is received in the groove of the nucleus. It is apparent that other types of connections can be used to maintain the nucleus in position. For example, a tooth and lock system or a pop-in system could be used.
  • A number of embodiments of the nucleus and artificial disc of the present invention are illustrated in the appended drawings. In one aspect of the invention, correction of spinal segment alignment is provided by an artificial nucleus which has the shape of a truncated cylinder or which is generally spherical or ovoid in shape, wherein the two halves on the arc on either side of a central axis are not symmetrical. In other words, the curvature is not geometrically parallel or symmetric.
  • In one embodiment, the implant consists of three pieces. The end plates will be made in differing sizes to accommodate differences in anatomy. These may be fabricated of titanium or a titanium alloy, chrome-cobalt-molybdenum (CoCrMo), cobalt 28 chromium molybdenum, cobalt chrome, stainless steel or other materials suitable for spinal prosthetic inserts.
  • The end plates can have two distinct surfaces. The flat surface of each end plate, which contacts the vertebral body end plate, is capable of accommodating bony ingrowth and incorporates a suitable coating, such as porous titanium, a calcium phosphate, or includes other types of known surfaces that promote bony ingrowth for long-term stability. The end plates can also have one or more parasagittal keels that provide immediate fixation. In one embodiment of the invention, a pair of parallel keels can be formed on the outer surface of one of the end plates, and a single, centrally-located keel can be formed on the outer surface of the other end plate. The other (inner) surface of the end plates can have a contour that corresponds with the geometric shape of the nucleus to form a bearing surface that allows for optimal articulation and wear characteristics with respect to the nucleus. In the middle of this bearing surface, there can be a single, central keel, which provides a constraint for the nucleus against excessive translation and range of motion. The nucleus can have a circular geometric design, with a midline groove to allow the nucleus to slide into place between the positioned end plates. A central keel on the concave surface of the end plate would fit into the groove of the nucleus. Before deciding on the final nucleus size, a set of instruments could be inserted to confirm the lordotic correction, but these may also be used as confirmation for other types of pre-surgical planning techniques and instrumentation. Alternatively, intra-operative instruments may be used as confirmation for other types of pre-surgical planning techniques and instrumentation.
  • FIGS. 1A to 1C illustrate various examples of artificial disc nuclei where the nucleus is symmetrical, with a maximum central axis in the geometric center 20 of a nucleus 10.
  • The reference letters A and P illustrate the anterior and posterior orientation, respectively, of the nuclei 10, 14 and 18. The nucleus 10 is generally spherical in shape and is truncated with a flattened portion 22A on the upper side of the nucleus 10 and another flattened surface 22B on the lower side. The nucleus also has upper and lower curved surfaces 24A and 24B, respectively, and a circumferential wall 26.
  • The flattened surfaces, as described above, can be advantageous because when the nucleus has a completely rounded surface, it cannot reliably maintain correction when exposed to the variable forces of the head and neck. A flattened surface incorporated into the central region of the nucleus can be used to solve this problem. The flattened surfaces have a contour different from the adjacent surface, and are formed in the nucleus body. The terms “flattened section” or “flattened surface” are used interchangeably and are meant to refer to any contour that is not the same as the adjacent surface(s) of the nucleus. Such a flattened surface can be planar or it be slightly convex or concave and have a radius of curvature different from the adjacent surface. Such a flattened surface could also be in the shape of a compound curve or other complex shape.
  • This flattened surface can be angled relative to the superior end plate of the inferior vertebral body (or vice versa, or both), with the height of the anterior end being greater than the height of the posterior end when lordotic correction is sought. The overall shape of the core can still be asymmetric, but the flattened surface can be incorporated to provide a reliable correction of the deformity. This flattened segment provides stabilization to resist the moments acting through the nucleus, i.e., if the flat is not of adequate size, there may be a tendency for the correction to disappear in the presence of an anterior load or for a hyper-lordotic over correction in the presence of a posterior load (during lordotic correction). Another advantage of the flattened segment is to provide surface contact over that area during small movements about the, neutral position of the device, which could help reduce wear on the device.
  • FIG. 1A illustrates a nucleus 10 that has not been adapted for lordotic correction because the upper and lower surfaces 22A and 22B are parallel to each other. In this nucleus, the axis 20 of greatest height falls in the center of the disc. In FIG. 1B, a nucleus 14 that provides 3° of correction is illustrated. This nucleus provides for lordotic correction. FIG. 1C illustrates another artificial disc nucleus 18 having a greater degree of deformity correction. When deformity correction is provided as shown in FIGS. 1B and 1C, the geometric center of the nucleus may shift to a location that is offset from the axis 20.
  • If the anterior/posterior directions are reversed, it provides a kyphotic correction. If the nucleus is rotated 90 degrees, a scoliotic correction is provided. In the illustration in FIG. 1C, the maximum vertical axis 20 is positioned to provide a correction of 6°. It is apparent that the nucleus can be adjusted to provide various degrees of correction and, in certain cases, if no degree of correction is needed. Alternatively, only one of the halves of the nucleus 10 may have a flattened portion, with the other half having an outer surface that is curved.
  • In FIGS. 2A through 2C, asymmetrical ovoid embodiments of an artificial nucleus are shown. The nucleus comprises upper and lower surfaces 22A and 22B, which are “flattened” by virtue of the ovoid shape of the nucleus, upper and lower curved surfaces 24A and 24B, and a circumferential center portion 26. In the embodiments shown in FIGS. 2B and 2C, the maximum height axis 16 is asymmetrical with the geometric center 12 of the disc. In the nucleus shown in FIG. 2A, where there is no correction, the maximum vertical height is at the central vertical axis 12. In the nucleus shown in FIG. 2B, the maximum vertical axis 16 is positioned to provide an angle of correction of 3°. In the nucleus shown in FIG. 2C, the maximum vertical axis 16 is positioned to provide an angle of correction of 6°.
  • FIG. 3 is a top view of one example of a nucleus. This nucleus 40 comprises a central convex or flattened region 42, which includes a groove or slot 44. This groove or slot 44 enables the nucleus to slide onto the central keel or anchor of an end plate (not shown). While the nucleus 40 is shown as essentially circular, it is clearly apparent that it may take on other shapes such as an ovoid or ellipsoid shape. It is also clearly apparent that other types of anchor receiving means can be used. For example, the shape of the groove may vary or a snap-in or bayonet or dog-bone type of receptacle can be provided to anchor the nucleus in position. Those practiced in the art can provide additional locking methods including the addition of one or more parts to the core that provide an anchor.
  • For deformity correction, the nucleus may take the form of a truncated curved body as shown in FIG. 4. For this embodiment, the nucleus 50 has an upper surface 52 that terminates in essentially flattened planar top 54. A slot 56 or a groove or opening of another appropriate shape, can be formed in upper surface 52 for receiving an anchor formed in the end plate. The lower surface 58 is typically an inverse of the upper surface. However, instead of being truncated with a flat surface as shown in FIG. 4, the bottom surface could be asymmetrically spherical or ovoid in shape.
  • Alternatively, the nucleus may be circular, ovoid or egg-shaped having a non-central maximum vertical axis as shown in FIG. 5. In another embodiment, the nucleus could be essentially circular or asymmetrically spherical.
  • FIG. 5 illustrates an artificial nucleus 60 where the upper surface 62 is an asymmetric convex surface. Again, either the top or the bottom or both surfaces may be asymmetric.
  • For illustrative purposes, the nuclei in the figures have been shown adapted for lordotic correction. It is clearly apparent that the nucleus can have an asymmetric maximum height at the front (anterior), the rear (posterior) or the side (lateral). The asymmetrical nucleus of the present invention can be used to correct for various types of spinal misalignment including sagittal and coronal deformity.
  • The novel corrective nucleus of the present invention may be provided alone or it may be provided in combination with an upper end plate, a lower end plate or both an upper and a lower end plate.
  • FIGS. 6 through 8 illustrate an exemplary artificial end plate 70 that can be used in conjunction with the nucleus to provide a novel artificial disc unit. An artificial end plate according to the present invention comprises an inner surface with a concave bearing surface for receiving the convex surface of an artificial disc. The outer, or bone contacting, surface is essentially flat.
  • To accommodate some previously known end plates, it was necessary to spend a significant amount of surgical time to prepare the vertebrae to the appropriate shape to accommodate the artificial end plate. FIG. 6 shows an end plate 70 with a flat outer surface 72 that enables the end plate to slide on the surface of the vertebra. One or more unidirectional keels 76 are formed on the outer surface 72 to provide for immediate fixation. The keels may be placed centrally or parasagittally. Fixation can be enhanced by incorporating onto the outer surface 72 a suitable coating 74, such as porous titanium, a calcium phosphate or the like, to promote bony ingrowth for long term stability.
  • A stop member 78 can be provided at the anterior edge 80 of the end plate. The stop member prevents the prosthesis from migrating posteriorly and possibly impinging on the spinal cord. An essentially semi-circular wall 82 joins the outer surface of the end plate to the inner surface. The thickness of 82 may vary with increased thickness anteriorly, posteriorly or parasagittally, as discussed further below. The inner surface 84 is shown in greater detail in FIG. 7.
  • The inner surface 84 of the end plate articulates with the nucleus. In the embodiment shown in FIG. 7, this inner surface has a concave region 86, which receives the nucleus. An anchor 88 is provided in the center of the concave region 86 for positioning the nucleus and preventing it from migrating. The anchor 88 can be generally rectangular in shape with rounded edges, as shown, avoiding premature wear and cutting into the nucleus. FIG. 8 illustrates a front view of the end plate showing the outer surface 72 having two parasagittal keels 76 and the inner surface 84 having a concave region 86 and a central anchor 88.
  • FIGS. 9-12 illustrate a nucleus and end plates described above assembled into a TDR implant. FIGS. 9 and 10 show the use of a nucleus 96 with a truncated cylinder shape and a flattened portion 97 on the superior side of the nucleus as described above, in conjunction with FIGS. 1A-1C, and FIGS. 11-12 show the same design with a nucleus 96 having an ovoid shape as shown in FIGS. 2A-2C. In these figures, a complete spinal disc prosthesis 90 comprising a superior end plate 92, an inferior end plate 94 and an artificial disc nucleus 96 is provided. The end plates and nucleus can be provided in different sizes to accommodate differences in anatomy. The end plates and various nuclei can be provided in a kit to the surgeon so that the appropriate sized components can be selected and used when the final size is determined. The end plates may be fabricated of titanium or titanium alloy, chrome-cobalt-molybdenum (CoCrMo), cobalt 28 chromium molybdenum, cobalt chrome, ceramics or other material suitable for spinal prosthetic implants.
  • The end plates have two distinct surfaces. The outer surface 98 is the surface that contacts the vertebral end plate. The outer surface is essentially flat enabling it to easily contact the surface of the natural vertebral end plate. The flat surface can be porous and incorporate a suitable treatment, such as porous titanium, a calcium phosphate or other types of known treatments such as coatings, plasma sprays, and structural changes to the surface, that promote bony ingrowth or ongrowth for long-term stability. At least one parasagittal keel 100 is formed on the outer surface of each end plate to provide immediate fixation.
  • As shown in FIGS. 9-12, three parasagittal keels 100 are aligned with each other and located along both sides of the outer surface of the end plates. Alternatively, as shown FIG. 9A a similar end plate design with an upper end plate 92 and a lower end plate 94 have an offset keel configuration with a pair of aligned parasagittal keels 100A formed on the outer surface of the upper end plate and a centrally-located row of aligned keels 100B formed on the outer surface of the lower end plate 94. This latter arrangement is believed to be advantageous because, with the upper and lower keels being offset from each other, the end plates should have greater stability and result in less stress on a vertebra where multiple implants are used.
  • Referring back to FIGS. 9-12, the inner surface 102 of each of the end plates has a concave region 103 or bearing surface that articulates with the nucleus. An anchoring protrusion 104 projects outwardly from the concave region, which provides an anchor for the nucleus and restricts posterior translation. Both the superior and the inferior end plates have flanges 106 for preventing the end plates from migrating into the spinal canal. The end plates can have holes 107 for allowing the end plates to be connected to the adjacent vertebrae through either metallic or bioabsorbable screws (not shown) that can be inserted through holes 107. FIGS. 9 and 11 illustrate front views of the prosthesis and FIGS. 10 and 12 illustrate side views.
  • In another aspect of the invention, shown in FIGS. 13A-13B and 14A-14C, spinal deformity can be addressed by providing an artificial spinal disc prosthesis where correction is provided in the end plates. Corrective end plates may be provided alone, in combination with a symmetrical artificial nucleus that has flattened surfaces as described above on both the top and bottom of the nucleus, as shown in FIGS. 13A-13B, or in combination with an asymmetrical nucleus that has flattened surfaces as described above on both the top and bottom of the nucleus, as shown in FIGS. 14A-14C.
  • Correctional end plates are shown in FIGS. 13A-13B and 14A-14C. The degree of correction can be achieved by altering the inner (nucleus-contacting) side of the end plate or the outer (vertebral-contacting) side of the end plate. As shown in FIGS. 13A-13B, the end plate 110 comprises an outer (bone-contacting) surface 112, an inner surface 114, and a perimeter wall 116 connecting the outer and inner surfaces. The height of the perimeter wall 116 may vary according to the degree and type of correction required. For example, FIG. 13B illustrates an end plate adapted for a greater degree of correction than the end plate of FIG. 13A. The positioning of the variable height can be adjusted to treat different conditions such as lordosis, kyphosis or scoliosis. The inner surface may be shaped to receive the nucleus, and the height of the end plate can be adjusted according to the degree of correction required.
  • Alternatively, as shown in FIGS. 14A-14C, the outer surface 120 and the inner surface 122 may be essentially planar and the height is adjusted as the outer and inner surfaces become increasingly non-parallel as a result of variation in the height of the perimeter wall 124. FIGS. 14A through 14C illustrate increasing degrees of correction, respectively. An advantage of having an essentially planar outer, or vertebral-contacting, surface is that the device is easier to insert and requires less operating time to prepare the vertebral surface as compared to traditional artificial disc devices.
  • FIGS. 15,16A and 16B illustrate another embodiment of the invention, which provides for all directions of movement, flexion/extension, lateral bending, and rotation about the symmetrical axis. In this design, the nucleus 130 is formed in two sections 130A and 130B. A post 132 is formed on the inner surface of one section 130A, and fits in an opening 134 that is formed on the inner surface of the other section 130B to provide for relative rotational movement between the two sections 130A and 130B. The post 132 and opening 134 can be formed on either section of the nucleus 130. The post and opening can be of any suitable size, and can be perpendicular to the opposing surfaces of the nucleus sections 130A and 130B, or be tilted at an angle off horizontal to orient the axis of axial rotation with the anatomically correct axis and provide a deformity correction.
  • In this configuration, the contact surfaces between the nucleus 130 and end plates 136 and 138, are designed to have the same corresponding asymmetrical contours at the preferred angle between them, as shown in FIG. 15. Because there is only relative movement between the nucleus and the end plates in the anterior/posterior and medial/lateral directions, greater surface contact between the nucleus and the respective end plates is possible in order to transmit rotations of the end plates to the nucleus so that the two halves 130A and 130B, of the nucleus 130 will rotate with respect to each other, rather than having the end plates 136 and 138, rotate on the outer surface of the nucleus 130.
  • FIGS. 17 and 18 show another embodiment of the invention where instead of forming the nucleus 130 of a single piece of material, it can be formed of upper and lower sections 130A and 130B, with an intermediate section 140, that is either flat or wedge-shaped as shown in FIG. 17, fixed to the upper and upper and lower sections. The intermediate section 140 can provide the nucleus with the appropriate degree of correction as shown in FIG. 18, instead of providing wedge-shaped end plates as discussed above. In a related embodiment of the invention, the nucleus 130 is essentially cut in half and has a flat inferior surface. This can be applied to the embodiment seen in FIGS. 17 and 18, where the section 130B is removed, leaving the inferior surface of intermediate section 140 articulating with the inferior end plate. By varying the configuration of the intermediate section 140, deformity correction can be achieved.
  • FIGS. 19 and 20 show another embodiment of the invention where the nucleus 130 is essentially cut in half and has a flat lower inferior surface. This shape can be used to resist expulsion of a nucleus with an ovoid/asymmetric shape, which could occur when the ovoid shape of the nucleus causes the end plates to tilt relative to each other to provide correction. As shown, the bottom surface of the nucleus 130 is flat and is formed with a circular opening 134 that is shaped and positioned to receive a post 136 formed on the opposing surface of the lower end plate 138 for allowing relative rotational movement between the nucleus 130 and the end plate 138. Alternatively, the nucleus could have the flat surface and opening 134 on its upper or superior surface, instead of being on the lower surface as shown. In this embodiment, the nucleus is preferably asymmetrical as shown in FIG. 19.
  • A modification of the configuration in FIGS. 19 and 20, is shown in FIGS. 21 through 24, where the nucleus 130 is positioned in a slot or trough 142 formed in the upper surface of the lower end plate 138. As shown in FIG. 21, the undersurface of the upper end plate 136 is contoured to match the nucleus. Alternatively, as shown in FIG. 24, the undersurface of the end plate 136 can be flat and engage a flattened upper surface 146 of the nucleus 130.
  • The trough can be larger than the nucleus in both the anterior/posterior and medial/lateral directions to allow for a desired amount of translation in those directions as shown by the arrows A and B in FIG. 22. The trough can be open on the posterior or anterior end to allow the nucleus to be inserted simply by sliding it into the trough, as shown by the arrow A in FIG. 21. In this way, the nucleus can be inserted without undue distraction of adjacent vertebrae. The nucleus can be prevented from moving out of the trough by providing a stop 144 of any suitable size and shape. FIG. 23 is a schematic view of the nucleus 130 that is inserted in the trough in FIG. 21.
  • Another embodiment of the invention is shown in FIGS. 25-31, where the nucleus 130 is elongated, with a flattened section 150 that is a partial cylinder with curved sections 152 and 154 on both sides of the flattened section. It is believed that this design, when mated with a cylindrical surface 156 on the interior of the upper end plate 136, shown in FIG. 29, will provide better wear characteristics because it will have surface contact during medial/lateral bending and line contact during flexion/extension. The end plate can include a stop member to prevent the prosthesis from moving toward the spinal canal.
  • The elongated shape of the nucleus 130 is illustrated in FIGS. 25 and 26, which show that the nucleus has a round cross section with constant medial-lateral radius from anterior to posterior (A-P), with the flat section 150 in the middle being oriented to provide a correction angle as described above, for the flatted portions on the other embodiments of the nucleus. The nucleus 130 is asymmetrical, with the flattened surface 150 oriented at an angle and having a greater height at the anterior end than at the posterior end. Thus when implanted between two vertebral bodies in the A-P orientation indicated in FIGS. 25 and 26, the nucleus 130 has an asymmetrical shape aligned with the sagittal plane, and across or crossing the coronal plane, of the vertebral bodies. The interior surface 156 of the upper end plate 136 has a cylindrical shape with the same constant radius in the anterior/posterior direction as the nucleus.
  • In the neutral position, the cylindrical surface 156 mates with the flattened section 150 of the nucleus 130, and sits at an angle that provides a deformity correction as shown in FIG. 31. In this position, there is surface contact between the end plate 136 and the nucleus 130. During medial/lateral bending, there is also surface contact between the end plate and nucleus. During flexion/extension, with or without lateral bending, there is line contact between the end plate and nucleus. This configuration of core and end plate will always have line or surface contact, thus reducing the wear potential from point contact in some of the previous designs.
  • The elongated shape of the nucleus 130 allows for the end plate 138 to have a trough 157 in the shape of a “bow tie” as shown in FIGS. 27 and 28. This shape allows for axial rotation with stops beyond the limits of normal motion. The shape is oversized relative to the nucleus 130 by an appropriate amount to allow limited anterior/posterior and medial/lateral translation. Additionally, the bottom surface of the trough 157 can be rounded upwardly at the medial/lateral sides in FIG. 30 (not shown), so that as the nucleus 130 rotates it is “cammed” up causing a distraction of the device that forces the vertebral bodies apart and loads the tissues between them resulting in a gradual stop to the motion. Translation of the nucleus 130 within the trough 157 will tend to preserve the mobile instantaneous axis of rotation of the natural disc.
  • FIGS. 32 and 33 show another embodiment of the invention, which utilizes a universal joint formed of a pair of cylinders 160 and 162 that rotate relative to each about a central post 164 that projects from one of the cylinders 162 and engages an opening 166 in the other cylinder 160. The cylinders 160 and 162 are oriented perpendicular to each other and engage cylindrical surfaces 168 and 170, respectively, in the adjacent end plates 136 and 138. This design provides for three anatomical axes of rotation. Because of the independence of each axis of rotation, any correction provided by the shape of the nucleus that is formed of the two cylinders will result in rotation to compensate for the correction and a return to the uncorrected neutral position. Alternatively, the cylinders 160 and 162 may be shaped similarly to the elongated nucleus 130 shown in FIGS. 25-27, or another suitable shape with a flat inferior surface.
  • Another embodiment of the invention is shown in FIGS. 34-36, where a resilient ring 172 and a post 174 that has a rounded top portion 176 provide for relative motion between the end plates and for the desired angle of correction. The ring 172 is shown in detail in FIG. 35. The ring 172 can be wedge shaped as shown in order to provide the desired amount of correction, or it can be flat (not shown) if no correction is desired. A projection 180 can be formed on the upper surface of the lower end plate 138 to mate with an opening 182 in the ring 172 in order to prevent the ring 172 from moving relative to the lower end plate once the ring is in its desired position.
  • The upper end plate 136 has a cavity 178 that can be contoured to match the shape of the rounded top portion 176. The ring 172 is shaped so that the end plate 136 will ride on the ring 172 during “normal” ranges of motion, or through regular activities. However, when the normal ranges of motion are exceeded, then the ring 172 will compress and the upper end plate 136 will engage the post 174 causing the adjacent vertebrae to distract and thereby provide a gradual stopping motion or “anatomically-derived gradual stopping.” Alternatively, the post 174 could be designed to serve as the primary load carrying part of the articulation by riding in the cavity 178. In this design, the deformity correction force is only provided by compressing the ring 172. This design would have the advantage of reducing material stresses in the elastomer ring and creep.
  • As shown in FIG. 37, instead providing the ring 176, the same result could be achieved by providing two or more stops 184A and 184B, formed of a resilient material, between the two end plates. The stops 184A and 184B can be mounted on the upper surface of the lower end plate 138. One of the stops 184A can project upwardly a greater distance than the other stop 184B in order to provide the desired correction.
  • Another embodiment of the invention is shown in FIGS. 38 and 39, where a nucleus 186 is provided that is formed of a resilient material that is shaped so that the nucleus provides medial/lateral rotation, but requires deformation of the material during flexion and extension. This is accomplished by proving a central portion 188 that is spherical or ovoid in shape and “flattened” adjacent end portions 190A and 190B that are cylindrical, which extend the flattened end portions around the circumference of the nucleus at both ends. The upper end plate has a cavity (not shown) that has a contour that is similar in shape to the nucleus 186. A trough (not shown) similar to the one in FIGS. 27 and 28 can be formed in the lower end plate 138.
  • For medial/lateral movement in the direction of the arrows A-A, the upper and lower end plates will rotate relative to each other through rotational movement of the upper end plate on the nucleus 186. However, flexion/extension in the direction of arrows B-B will occur only through deformation of the nucleus 186. Alternatively, the nucleus 186 can be rotated 90° on the lower end plate 138 so that so that the end plate 136 will rotate on the nucleus during flexion/extension and the nucleus will deform during medial/lateral movement. The end portion 190A has a larger diameter than the end portion 190B to provide for the desired amount of correction. As shown, the nucleus has been shaped so the resilience of the nucleus varies over its length. However, the nucleus could be formed of materials having varying degrees of resiliency along its length to achieve the same results.
  • FIGS. 40-43 illustrate another embodiment of the invention where the end plates 136 and 138 are provided with stops outside of the normal range of motion, which also utilize the concept of “anatomically-derived gradual stopping” discussed above in conjunction with Figures 34 and 35. This type of stop can be added to any design that employs the use of end plates. This aspect of the invention is based on duplicating how the human body moves and then designing the cooperating surfaces to mimic those motions as closely as possible. As shown in FIG. 40, the end plate 136 has a post 200 on its lower surface that engages pocket 202 formed in the upper surface of the lower end plate and 138. Preferably, a pair of posts and pockets are provided on opposite sides of the nucleus 130.
  • As shown in FIGS. 40-43, the pocket 202 has a slot 204 in it with a curved surface 206 that is engaged by the lower end 208 of the post 200. As the end plates 136 and 138 move in the anterior/posterior direction relative to each other during extension/flexion, the lower end 208 of the post rides along the curved surface 206. As the post reaches the outer limits of travel the lower end 208 will begin riding up the gradually curved section of the surface 208, which causes distraction between adjacent vertebrae as illustrated by the arrow A in FIG. 43 and loads the tissues between them, resulting in a gradual stop to the motion.
  • Although the present invention and its advantages have been described in detail, it should be understood that various changes, substitutions and alterations can be made herein without departing from the spirit and scope of the invention as defined by the appended claims. Moreover, the scope of the present application is not intended to be limited to the particular embodiments of the process, machine, manufacture, composition of matter, means, methods and steps described in the specification. As one of ordinary skill in the art will readily appreciate from the disclosure of the present invention, processes, machines, manufacture, compositions of matter, means, methods, or steps, presently existing or later to be developed that perform substantially the same function or achieve substantially the same result as the corresponding embodiments described herein may be utilized according to the present invention. Accordingly, the appended claims are intended to include within their scope such processes, machines, manufacture, compositions of matter, means, methods, or steps.

Claims (15)

1. A method for implanting an intervertebral disc prosthesis in a portion of a spine, the method comprising:
securing a first vertebral contacting surface to a first vertebral body, the first vertebral contacting surface comprising at least one bone engagement feature;
securing a second vertebral contacting surface to a second vertebral body, the second vertebral contacting surface comprising at least one bone engagement feature;
positioning first, second, third and fourth bearing surfaces between the first and second vertebral contacting surfaces, at least one of the first and second bearing surfaces comprising a section inclined at a constant slope to provide a correction angle when the prosthesis is in a neutral position, each of the third and fourth bearing surfaces comprising a planar portion;
positioning the planar portions of the third and fourth bearing surfaces into surface contact with one another; and
positioning the inclined section to cross the coronal plane of the first and second vertebral bodies to urge the first and second vertebral contacting surfaces toward a relative anterior/posterior orientation that provides a preferred lordotic angle between the first and second vertebral bodies.
2. The method of claim 1, wherein an anterior portion of the inclined section is higher than a posterior portion of the inclined section to correct lordosis, wherein the preferred lordotic angle is greater than zero.
3. The method of claim 1, wherein the preferred lordotic angle is selected from the group consisting of 3 and 6 degrees.
4. The method of claim 1, further comprising:
securing a first end plate to the first vertebral body, wherein the first end plate comprises the first vertebral contacting surface, the first end plate further comprising the first bearing surface; and
positioning the first bearing surface to cooperate with the second bearing surface to urge the first and second vertebral contacting surfaces toward the anterior/posterior orientation.
5. The method of claim 4, further comprising:
securing a second end plate to the second vertebral body, wherein the second end plate comprises the second vertebral contacting surface, the second end plate further comprising the second bearing surface; and
positioning the second bearing surface to cooperate with the first bearing surface to urge the first and second vertebral contacting surfaces toward the anterior/posterior orientation.
6. The method of claim 2, further comprising positioning a nucleus between the first and second vertebral contacting surfaces, the nucleus formed separately from the first and second vertebral contacting surfaces, wherein the nucleus comprises the first and third bearing surfaces.
7. The method of claim 6, further comprising:
securing a first end plate to the first vertebral body, the first end plate comprising the first vertebral contacting surface, securing a second end plate to the second vertebral body, the second end plate comprising the second vertebral contacting surface, wherein the first end plate comprises the second bearing surface and the second end plate comprises the fourth bearing surface;
positioning the second bearing surface to articulate with the first bearing surface of the nucleus, and
positioning the fourth bearing surface to articulate with the third bearing surface of the nucleus.
8. The method of claim 6, wherein an anterior portion of the nucleus has a greater thickness than a posterior portion of the nucleus to correct lordosis, wherein the preferred lordotic angle is greater than zero.
9. A method for implanting an intervertebral disc prosthesis in a portion of a spine, the method comprising:
securing a first essentially flat vertebral contacting surface to a first vertebral body;
securing a second essentially flat vertebral contacting surface to a second vertebral body;
positioning a nucleus between the first and second vertebral contacting surfaces, a first bearing surface formed on the nucleus, a planar third surface formed on the nucleus opposite the first bearing surface; a first straight section formed on the first bearing surface, the first straight section having a constant non-zero slope oriented with respect to the planar third surface to provide a corrective angle;
positioning the first straight section to cross the coronal plane of the first and second vertebral bodies; and
positioning a second bearing surface to articulate with the first bearing surface such that the second bearing surface mates with the constantly sloped first straight section to urge the first and second vertebral contacting surfaces toward an orientation of the first vertebral contacting surface relative to the second vertebral contacting surface that provides a deformity correction across at least one axis.
10. The method of claim 9, wherein the second bearing surface comprises a second straight section formed on the second bearing surface.
11. A method for implanting an intervertebral disc prosthesis in a portion of a spine, the method comprising:
securing a first end plate to a first vertebral body, the first end plate comprising a plurality of bone engagement features shaped to penetrate bone and a first bearing surface;
securing a second end plate to a second vertebral body, the second end plate comprising a plurality of bone engagement features shaped to penetrate bone and a planar second bearing surface; and
positioning a nucleus between the first and second end plates, the nucleus comprising a third bearing surface and a planar fourth bearing surface, the nucleus comprising an asymmetrical shape across a coronal plane of the first and second vertebral bodies;
positioning the third bearing surface to articulate with the first bearing surface, the asymmetrical shape urging the first and second endplates to remain in a relative orientation that provides a preferred lordotic angle between the first and second vertebral bodies, providing line contact between the first and third bearing surfaces when the first bearing surface is articulated relative to the third bearing surface in the anterior/posterior direction; and
positioning the fourth bearing surface to articulate with the second bearing surface to permit at least one of medial-lateral and anterior-posterior translation between the nucleus and the second end plate.
12. The method of claim 11, wherein the fourth bearing surface comprises a second straight section.
13. The method of claim 11, wherein an anterior portion of the nucleus has a greater thickness than a posterior portion of the nucleus to provide the preferred lordotic angle.
14. The method of claim 11, further comprising positioning at least one stop member formed on one of the first and second end plates to abut the respective vertebral body to prevent the prosthesis from migrating from its intended position between the first and second vertebral bodies.
15. The method of claim 11, wherein the second bearing surface comprises a trough larger than the fourth bearing surface in at least one of the anterior-posterior and medial-lateral dimensions to permit translation between the nucleus and the second end plate, wherein positioning the nucleus further comprises sliding the nucleus into the trough along an anterior-posterior direction.
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US65816105P 2005-03-04 2005-03-04
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US59013908A 2008-02-11 2008-02-11
US12/241,326 US8038716B2 (en) 2004-06-30 2008-09-30 Artificial spinal disc
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US12/241,344 Active 2028-06-16 US9125754B2 (en) 2004-06-30 2008-09-30 Artificial spinal disc
US12/946,581 Active US8231677B2 (en) 2004-06-30 2010-11-15 Artificial spinal disc
US13/230,303 Abandoned US20110320003A1 (en) 2004-06-30 2011-09-12 Artificial Spinal Disc
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Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100217395A1 (en) * 2006-07-24 2010-08-26 Rudolf Bertagnoli Intervertebral implant with keel
US20120172988A1 (en) * 2011-01-04 2012-07-05 Synthes Usa, Llc Intervertebral implant with multiple radii
US8882839B2 (en) 1999-07-02 2014-11-11 DePuy Synthes Products, LLC Intervertebral implant
US10064739B2 (en) 2004-06-30 2018-09-04 Synergy Disc Replacement, Inc. Systems and methods for vertebral disc replacement
US10687958B2 (en) * 2011-02-23 2020-06-23 Globus Medical, Inc. Six degree spine stabilization devices and methods
US11452618B2 (en) 2019-09-23 2022-09-27 Dimicron, Inc Spinal artificial disc removal tool

Families Citing this family (205)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
AR038680A1 (en) 2002-02-19 2005-01-26 Synthes Ag INTERVERTEBRAL IMPLANT
US8696749B2 (en) * 2002-04-25 2014-04-15 Blackstone Medical, Inc. Artificial intervertebral disc
JP4429909B2 (en) 2002-09-19 2010-03-10 ビリアーズ, マラン デ Intervertebral prosthesis
EP2457541A1 (en) 2003-02-06 2012-05-30 Synthes GmbH Implant between vertebrae
CN1774220A (en) 2003-02-14 2006-05-17 德普伊斯派尔公司 In-situ formed intervertebral fusion device and method
US7819903B2 (en) 2003-03-31 2010-10-26 Depuy Spine, Inc. Spinal fixation plate
US20040267367A1 (en) 2003-06-30 2004-12-30 Depuy Acromed, Inc Intervertebral implant with conformable endplate
FR2858546B1 (en) * 2003-08-04 2006-04-28 Spine Next Sa INTERVERTEBRAL DISC PROSTHESIS
US7785351B2 (en) 2003-08-05 2010-08-31 Flexuspine, Inc. Artificial functional spinal implant unit system and method for use
US7753958B2 (en) 2003-08-05 2010-07-13 Gordon Charles R Expandable intervertebral implant
US8636802B2 (en) 2004-03-06 2014-01-28 DePuy Synthes Products, LLC Dynamized interspinal implant
US9237958B2 (en) * 2004-06-30 2016-01-19 Synergy Disc Replacement Inc. Joint prostheses
BRPI0512736B1 (en) * 2004-06-30 2022-04-12 Synergy Disc Replacement, Inc Core for an artificial disc to replace the natural disc of a human spine
US8414648B2 (en) 2004-08-09 2013-04-09 Si-Bone Inc. Apparatus, systems, and methods for achieving trans-iliac lumbar fusion
US8444693B2 (en) 2004-08-09 2013-05-21 Si-Bone Inc. Apparatus, systems, and methods for achieving lumbar facet fusion
US8425570B2 (en) 2004-08-09 2013-04-23 Si-Bone Inc. Apparatus, systems, and methods for achieving anterior lumbar interbody fusion
US8388667B2 (en) 2004-08-09 2013-03-05 Si-Bone, Inc. Systems and methods for the fixation or fusion of bone using compressive implants
US9949843B2 (en) 2004-08-09 2018-04-24 Si-Bone Inc. Apparatus, systems, and methods for the fixation or fusion of bone
US20070156241A1 (en) 2004-08-09 2007-07-05 Reiley Mark A Systems and methods for the fixation or fusion of bone
US20180228621A1 (en) 2004-08-09 2018-08-16 Mark A. Reiley Apparatus, systems, and methods for the fixation or fusion of bone
US8470004B2 (en) 2004-08-09 2013-06-25 Si-Bone Inc. Apparatus, systems, and methods for stabilizing a spondylolisthesis
US20060036251A1 (en) 2004-08-09 2006-02-16 Reiley Mark A Systems and methods for the fixation or fusion of bone
US9662158B2 (en) * 2004-08-09 2017-05-30 Si-Bone Inc. Systems and methods for the fixation or fusion of bone at or near a sacroiliac joint
WO2006042486A1 (en) * 2004-10-18 2006-04-27 Buettner-Janz Karin Intervertebral disk endoprosthesis having a motion-adapted edge for the lumbar and cervical spine
WO2006042485A1 (en) * 2004-10-18 2006-04-27 Buettner-Janz Karin Intervertebral disk endoprosthesis for lumbar and cervical spine, which corresponds to the physiology of movement
ATE524121T1 (en) 2004-11-24 2011-09-15 Abdou Samy DEVICES FOR PLACING AN ORTHOPEDIC INTERVERTEBRAL IMPLANT
WO2007003438A2 (en) * 2005-07-06 2007-01-11 Copf Franz Jun Intervertebral disc prosthesis
US8366718B2 (en) 2005-07-06 2013-02-05 Copf Jr Franz Preparation device for preparing an intervertebral disc compartment
HK1121665A1 (en) 2005-07-06 2009-04-30 Franz Jun Copf Intervertebral disc prosthesis
FR2891135B1 (en) 2005-09-23 2008-09-12 Ldr Medical Sarl INTERVERTEBRAL DISC PROSTHESIS
US8435295B2 (en) * 2005-09-26 2013-05-07 Infinity Orthopaedics Company System and method for intervertebral implant delivery and removal
FR2893248A1 (en) * 2005-11-16 2007-05-18 Vincent Pointillart INTERVERTEBRAL DISC PROSTHESIS
JP5224528B2 (en) * 2006-02-01 2013-07-03 シンテス ゲーエムベーハー Whole disc substitute device
US8252058B2 (en) * 2006-02-16 2012-08-28 Amedica Corporation Spinal implant with elliptical articulatory interface
US20070198093A1 (en) * 2006-02-17 2007-08-23 Amedica Corporation Spinal implant with offset keels
EP1988855A2 (en) 2006-02-27 2008-11-12 Synthes GmbH Intervertebral implant with fixation geometry
US8118869B2 (en) * 2006-03-08 2012-02-21 Flexuspine, Inc. Dynamic interbody device
US8366776B2 (en) * 2006-04-13 2013-02-05 Warsaw Orthopedic, Inc. Vertebral implants having predetermined angular correction and method of use
US8043379B2 (en) * 2006-04-21 2011-10-25 Depuy Spine, Inc. Disc prosthesis having remote flexion/extension center of rotation
US8303660B1 (en) * 2006-04-22 2012-11-06 Samy Abdou Inter-vertebral disc prosthesis with variable rotational stop and methods of use
DE102006030124A1 (en) * 2006-06-28 2008-01-03 Ulrich Gmbh & Co. Kg Implant for insertion between two vertebral bodies of the spine
US20080051901A1 (en) * 2006-07-28 2008-02-28 Spinalmotion, Inc. Spinal Prosthesis with Multiple Pillar Anchors
US9278006B2 (en) * 2006-10-26 2016-03-08 European Foot Platform Sc Ankle prosthesis with neutral position adjustment
US8105382B2 (en) 2006-12-07 2012-01-31 Interventional Spine, Inc. Intervertebral implant
US8597358B2 (en) 2007-01-19 2013-12-03 Flexuspine, Inc. Dynamic interbody devices
US8308801B2 (en) * 2007-02-12 2012-11-13 Brigham Young University Spinal implant
US9237954B2 (en) * 2007-03-29 2016-01-19 Life Spine, Inc. Height adjustable spinal prostheses
US8900307B2 (en) 2007-06-26 2014-12-02 DePuy Synthes Products, LLC Highly lordosed fusion cage
US8052754B2 (en) 2007-09-28 2011-11-08 Zimmer Gmbh Intervertebral endoprosthesis
US8187330B2 (en) 2007-10-22 2012-05-29 Flexuspine, Inc. Dampener system for a posterior stabilization system with a variable length elongated member
US8267965B2 (en) 2007-10-22 2012-09-18 Flexuspine, Inc. Spinal stabilization systems with dynamic interbody devices
US8157844B2 (en) 2007-10-22 2012-04-17 Flexuspine, Inc. Dampener system for a posterior stabilization system with a variable length elongated member
US8523912B2 (en) 2007-10-22 2013-09-03 Flexuspine, Inc. Posterior stabilization systems with shared, dual dampener systems
US8182514B2 (en) 2007-10-22 2012-05-22 Flexuspine, Inc. Dampener system for a posterior stabilization system with a fixed length elongated member
US8162994B2 (en) 2007-10-22 2012-04-24 Flexuspine, Inc. Posterior stabilization system with isolated, dual dampener systems
EP2217179A1 (en) 2007-11-16 2010-08-18 Synthes GmbH Low profile intervertebral implant
FR2924923B1 (en) * 2007-12-12 2010-02-05 Medicrea International PROSTHESIS OF VERTEBRAL DISC, IN PARTICULAR FOR CERVICAL VERTEBRATES
EP2471493A1 (en) 2008-01-17 2012-07-04 Synthes GmbH An expandable intervertebral implant and associated method of manufacturing the same
FR2929105B1 (en) * 2008-03-25 2010-04-02 Medicrea International PROSTHESIS OF VERTEBRAL DISC, IN PARTICULAR FOR CERVICAL VERTEBRATES
CA2720580A1 (en) 2008-04-05 2009-10-08 Synthes Usa, Llc Expandable intervertebral implant
CA2726642A1 (en) * 2008-06-05 2009-12-10 Synthes Usa, Llc Articulating disc implant
DE102008032691A1 (en) * 2008-07-03 2010-01-07 Aesculap Ag Intervertebral disc prosthesis system
US8709083B2 (en) 2009-06-04 2014-04-29 William E. Duffield Intervertebral fusion implant
US8328872B2 (en) 2008-09-02 2012-12-11 Globus Medical, Inc. Intervertebral fusion implant
US8545566B2 (en) * 2008-10-13 2013-10-01 Globus Medical, Inc. Articulating spacer
BRPI0921486A2 (en) 2008-11-07 2019-09-10 Synthes Gmbh vertebral intercorporeal unit of spacer and coupled plate
WO2010060423A2 (en) * 2008-11-30 2010-06-03 Privelop-Spine Ag Intervertebral implant
US8287572B2 (en) 2009-02-11 2012-10-16 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US9526620B2 (en) 2009-03-30 2016-12-27 DePuy Synthes Products, Inc. Zero profile spinal fusion cage
US9066809B2 (en) * 2009-05-15 2015-06-30 Globus Medical Inc. Method for inserting and positioning an artificial disc
KR20120025493A (en) * 2009-05-19 2012-03-15 신세스 게엠바하 Dynamic trial implants
US9173748B2 (en) * 2009-08-07 2015-11-03 Ebi, Llc Toroid-shaped spinal disc
WO2011019699A2 (en) 2009-08-10 2011-02-17 Howmedica Osteonics Corp Intervertebral implant with integrated fixation
US9033993B2 (en) 2009-11-03 2015-05-19 Howmedica Osteonics Corp. Intervertebral implant with integrated fixation
US8764806B2 (en) 2009-12-07 2014-07-01 Samy Abdou Devices and methods for minimally invasive spinal stabilization and instrumentation
US9393129B2 (en) 2009-12-10 2016-07-19 DePuy Synthes Products, Inc. Bellows-like expandable interbody fusion cage
US9480511B2 (en) 2009-12-17 2016-11-01 Engage Medical Holdings, Llc Blade fixation for ankle fusion and arthroplasty
US9155631B2 (en) 2010-04-08 2015-10-13 Globus Medical Inc. Intervertbral implant
US9301850B2 (en) 2010-04-12 2016-04-05 Globus Medical, Inc. Expandable vertebral implant
US9579211B2 (en) 2010-04-12 2017-02-28 Globus Medical, Inc. Expandable vertebral implant
US11426287B2 (en) 2010-04-12 2022-08-30 Globus Medical Inc. Expandable vertebral implant
US8870880B2 (en) 2010-04-12 2014-10-28 Globus Medical, Inc. Angling inserter tool for expandable vertebral implant
US8282683B2 (en) 2010-04-12 2012-10-09 Globus Medical, Inc. Expandable vertebral implant
US8591585B2 (en) 2010-04-12 2013-11-26 Globus Medical, Inc. Expandable vertebral implant
US9592063B2 (en) 2010-06-24 2017-03-14 DePuy Synthes Products, Inc. Universal trial for lateral cages
US8979860B2 (en) 2010-06-24 2015-03-17 DePuy Synthes Products. LLC Enhanced cage insertion device
TW201215379A (en) 2010-06-29 2012-04-16 Synthes Gmbh Distractible intervertebral implant
US9474625B2 (en) * 2010-09-03 2016-10-25 Globus Medical, Inc Expandable fusion device and method of installation thereof
US9402732B2 (en) 2010-10-11 2016-08-02 DePuy Synthes Products, Inc. Expandable interspinous process spacer implant
US9925051B2 (en) 2010-12-16 2018-03-27 Engage Medical Holdings, Llc Arthroplasty systems and methods
EP2654626B1 (en) 2010-12-21 2016-02-24 Synthes GmbH Intervertebral implants and systems
US9241809B2 (en) 2010-12-21 2016-01-26 DePuy Synthes Products, Inc. Intervertebral implants, systems, and methods of use
CN103561689B (en) * 2011-03-11 2016-01-20 Fbc设备有限公司 Spinal implant
US8388687B2 (en) 2011-03-25 2013-03-05 Flexuspine, Inc. Interbody device insertion systems and methods
US8425606B2 (en) * 2011-06-21 2013-04-23 John A. Cowan Method and implant device for grafting adjacent vertebral bodies
US8685096B2 (en) 2011-08-23 2014-04-01 Amendia, Inc. Lumbar fusion device
US9681959B2 (en) 2011-09-16 2017-06-20 Globus Medical, Inc. Low profile plate
US10245155B2 (en) 2011-09-16 2019-04-02 Globus Medical, Inc. Low profile plate
US9237957B2 (en) 2011-09-16 2016-01-19 Globus Medical, Inc. Low profile plate
US10881526B2 (en) 2011-09-16 2021-01-05 Globus Medical, Inc. Low profile plate
US9539109B2 (en) 2011-09-16 2017-01-10 Globus Medical, Inc. Low profile plate
US9149365B2 (en) 2013-03-05 2015-10-06 Globus Medical, Inc. Low profile plate
US9848994B2 (en) 2011-09-16 2017-12-26 Globus Medical, Inc. Low profile plate
US8845728B1 (en) 2011-09-23 2014-09-30 Samy Abdou Spinal fixation devices and methods of use
US9078772B2 (en) * 2011-09-28 2015-07-14 Depuy (Ireland) Rotatable patella drill guide
US9615856B2 (en) 2011-11-01 2017-04-11 Imds Llc Sacroiliac fusion cage
US9254130B2 (en) 2011-11-01 2016-02-09 Hyun Bae Blade anchor systems for bone fusion
US9526627B2 (en) 2011-11-17 2016-12-27 Exactech, Inc. Expandable interbody device system and method
US20130226240A1 (en) 2012-02-22 2013-08-29 Samy Abdou Spinous process fixation devices and methods of use
ES2606182T3 (en) 2012-03-09 2017-03-23 Koc Universitesi Disc prosthesis
IN2014DN06946A (en) 2012-03-09 2015-04-10 Si Bone Inc
US10363140B2 (en) 2012-03-09 2019-07-30 Si-Bone Inc. Systems, device, and methods for joint fusion
WO2013134682A1 (en) * 2012-03-09 2013-09-12 Si-Bone Inc. Artificial si joint
US10238382B2 (en) 2012-03-26 2019-03-26 Engage Medical Holdings, Llc Blade anchor for foot and ankle
ES2828357T3 (en) 2012-05-04 2021-05-26 Si Bone Inc Fenestrated implant
US20130325071A1 (en) 2012-05-30 2013-12-05 Marcin Niemiec Aligning Vertebral Bodies
CN102727329B (en) * 2012-06-28 2015-01-07 深圳清华大学研究院 Artificial cervical intervertebral disc
US9326861B2 (en) 2012-08-03 2016-05-03 Globus Medical, Inc. Stabilizing joints
US9198767B2 (en) 2012-08-28 2015-12-01 Samy Abdou Devices and methods for spinal stabilization and instrumentation
US9320617B2 (en) 2012-10-22 2016-04-26 Cogent Spine, LLC Devices and methods for spinal stabilization and instrumentation
US9585765B2 (en) 2013-02-14 2017-03-07 Globus Medical, Inc Devices and methods for correcting vertebral misalignment
US10105239B2 (en) 2013-02-14 2018-10-23 Globus Medical, Inc. Devices and methods for correcting vertebral misalignment
US9492288B2 (en) 2013-02-20 2016-11-15 Flexuspine, Inc. Expandable fusion device for positioning between adjacent vertebral bodies
US10117754B2 (en) 2013-02-25 2018-11-06 Globus Medical, Inc. Expandable intervertebral implant
US9522070B2 (en) 2013-03-07 2016-12-20 Interventional Spine, Inc. Intervertebral implant
US9456906B2 (en) 2013-03-15 2016-10-04 Globus Medical, Inc. Expandable intervertebral implant
US9572677B2 (en) 2013-03-15 2017-02-21 Globus Medical, Inc. Expandable intervertebral implant
US9149367B2 (en) 2013-03-15 2015-10-06 Globus Medical Inc Expandable intervertebral implant
US9539103B2 (en) 2013-03-15 2017-01-10 Globus Medical, Inc. Expandable intervertebral implant
US9034045B2 (en) 2013-03-15 2015-05-19 Globus Medical, Inc Expandable intervertebral implant
US9233009B2 (en) 2013-03-15 2016-01-12 Globus Medical, Inc. Expandable intervertebral implant
US9936983B2 (en) 2013-03-15 2018-04-10 Si-Bone Inc. Implants for spinal fixation or fusion
US9474622B2 (en) 2013-03-15 2016-10-25 Globus Medical, Inc Expandable intervertebral implant
US9186258B2 (en) 2013-03-15 2015-11-17 Globus Medical, Inc. Expandable intervertebral implant
DE102013005398B3 (en) * 2013-03-28 2014-06-18 Spontech Spine Intelligence Group Ag Motion preserving spinal disk prosthesis implanted into intervertebral space between vertebral bodies of human spinal column, has foam core with pores, whose pore size from center of core is decreased continuously toward edges of core
FR3010628B1 (en) 2013-09-18 2015-10-16 Medicrea International METHOD FOR REALIZING THE IDEAL CURVATURE OF A ROD OF A VERTEBRAL OSTEOSYNTHESIS EQUIPMENT FOR STRENGTHENING THE VERTEBRAL COLUMN OF A PATIENT
WO2015057866A1 (en) 2013-10-15 2015-04-23 Si-Bone Inc. Implant placement
US11147688B2 (en) 2013-10-15 2021-10-19 Si-Bone Inc. Implant placement
FR3012030B1 (en) 2013-10-18 2015-12-25 Medicrea International METHOD FOR REALIZING THE IDEAL CURVATURE OF A ROD OF A VERTEBRAL OSTEOSYNTHESIS EQUIPMENT FOR STRENGTHENING THE VERTEBRAL COLUMN OF A PATIENT
KR101397192B1 (en) * 2013-12-18 2014-05-19 윤홍원 Intervertebral tentional artificial disc replacement
US10398565B2 (en) 2014-04-24 2019-09-03 Choice Spine, Llc Limited profile intervertebral implant with incorporated fastening and locking mechanism
US9517144B2 (en) 2014-04-24 2016-12-13 Exactech, Inc. Limited profile intervertebral implant with incorporated fastening mechanism
US9968461B2 (en) 2014-05-15 2018-05-15 Globus Medical, Inc. Standalone interbody implants
US9545320B2 (en) 2014-05-15 2017-01-17 Globus Medical, Inc. Standalone interbody implants
US9486327B2 (en) 2014-05-15 2016-11-08 Globus Medical, Inc. Standalone interbody implants
US11160666B2 (en) 2014-05-15 2021-11-02 Globus Medical, Inc. Laterally insertable intervertebral spinal implant
US9675465B2 (en) 2014-05-15 2017-06-13 Globus Medical, Inc. Standalone interbody implants
WO2016025612A1 (en) * 2014-08-12 2016-02-18 Kraemer Paul E Spinal fusion apparatus
WO2016044731A1 (en) 2014-09-18 2016-03-24 Si-Bone Inc. Implants for bone fixation or fusion
US9662157B2 (en) 2014-09-18 2017-05-30 Si-Bone Inc. Matrix implant
GB201416867D0 (en) * 2014-09-24 2014-11-05 Fitzbionics Ltd A prosthetic intervertebral disc joint assembly
US9867718B2 (en) 2014-10-22 2018-01-16 DePuy Synthes Products, Inc. Intervertebral implants, systems, and methods of use
AU2016200179B2 (en) 2015-01-14 2020-09-17 Stryker European Operations Holdings Llc Spinal implant with porous and solid surfaces
AU2016200195B2 (en) 2015-01-14 2020-07-02 Stryker European Operations Holdings Llc Spinal implant with fluid delivery capabilities
US11426290B2 (en) 2015-03-06 2022-08-30 DePuy Synthes Products, Inc. Expandable intervertebral implant, system, kit and method
US20160270928A1 (en) * 2015-03-18 2016-09-22 Baui Biotech Co., Ltd. Spinal spacer
US10376206B2 (en) 2015-04-01 2019-08-13 Si-Bone Inc. Neuromonitoring systems and methods for bone fixation or fusion procedures
CA2930123A1 (en) 2015-05-18 2016-11-18 Stryker European Holdings I, Llc Partially resorbable implants and methods
CN105030388A (en) * 2015-08-19 2015-11-11 深圳清华大学研究院 Lumbar intervertebral disc prosthesis, implanting instrument, device composed of waist prosthesis and implanting instrument and method for inserting lumbar vertebra implantation material
US10034768B2 (en) 2015-09-02 2018-07-31 Globus Medical, Inc. Implantable systems, devices and related methods
US10857003B1 (en) 2015-10-14 2020-12-08 Samy Abdou Devices and methods for vertebral stabilization
CN109688981A (en) 2016-06-28 2019-04-26 Eit 新兴移植技术股份有限公司 Distensible, adjustable angle intervertebral cage
JP7023877B2 (en) 2016-06-28 2022-02-22 イーアイティー・エマージング・インプラント・テクノロジーズ・ゲーエムベーハー Expandable and angle-adjustable range-of-motion intervertebral cage
US10390955B2 (en) 2016-09-22 2019-08-27 Engage Medical Holdings, Llc Bone implants
US10231849B2 (en) 2016-10-13 2019-03-19 Warsaw Orthopedic, Inc. Surgical instrument system and method
US10973648B1 (en) 2016-10-25 2021-04-13 Samy Abdou Devices and methods for vertebral bone realignment
US10744000B1 (en) 2016-10-25 2020-08-18 Samy Abdou Devices and methods for vertebral bone realignment
WO2018109556A1 (en) 2016-12-12 2018-06-21 Medicrea International Systems and methods for patient-specific spinal implants
US10888433B2 (en) 2016-12-14 2021-01-12 DePuy Synthes Products, Inc. Intervertebral implant inserter and related methods
CN106901876B (en) * 2017-02-22 2019-03-01 无锡宝莱福医疗器械有限公司 A kind of biomimetic type artificial intervertebral disk and its forming method
CN106618811B (en) * 2017-02-22 2019-01-29 无锡宝莱福医疗器械有限公司 A kind of function bionics type cervical artificial disc
CN106726022B (en) * 2017-02-22 2019-06-18 无锡宝莱福医疗器械有限公司 A kind of artificial intervertebral disk and its forming method of no interface friction
US10456272B2 (en) 2017-03-03 2019-10-29 Engage Uni Llc Unicompartmental knee arthroplasty
US11540928B2 (en) 2017-03-03 2023-01-03 Engage Uni Llc Unicompartmental knee arthroplasty
US11452608B2 (en) 2017-04-05 2022-09-27 Globus Medical, Inc. Decoupled spacer and plate and method of installing the same
US10376385B2 (en) 2017-04-05 2019-08-13 Globus Medical, Inc. Decoupled spacer and plate and method of installing the same
WO2018193316A2 (en) 2017-04-21 2018-10-25 Medicrea International A system for developing one or more patient-specific spinal implants
US10398563B2 (en) 2017-05-08 2019-09-03 Medos International Sarl Expandable cage
US11344424B2 (en) 2017-06-14 2022-05-31 Medos International Sarl Expandable intervertebral implant and related methods
US10940016B2 (en) 2017-07-05 2021-03-09 Medos International Sarl Expandable intervertebral fusion cage
US10881523B2 (en) * 2017-07-05 2021-01-05 Keith L Doty Motion preserving spinal total disc replacement apparatus, method and related systems
EP3459502A1 (en) 2017-09-20 2019-03-27 Stryker European Holdings I, LLC Spinal implants
EP3687422A4 (en) 2017-09-26 2021-09-22 SI-Bone, Inc. Systems and methods for decorticating the sacroiliac joint
US10918422B2 (en) 2017-12-01 2021-02-16 Medicrea International Method and apparatus for inhibiting proximal junctional failure
US10426628B2 (en) 2017-12-14 2019-10-01 Simplify Medical Pty Ltd Intervertebral prosthesis
CN108836579B (en) * 2018-07-06 2023-07-28 北京爱康宜诚医疗器材有限公司 Artificial intervertebral disc prosthesis
CN108969162A (en) * 2018-07-27 2018-12-11 深圳清华大学研究院 A kind of intervertebral motion retaining device
US11179248B2 (en) 2018-10-02 2021-11-23 Samy Abdou Devices and methods for spinal implantation
US11446156B2 (en) 2018-10-25 2022-09-20 Medos International Sarl Expandable intervertebral implant, inserter instrument, and related methods
AU2020223180A1 (en) 2019-02-14 2021-07-22 Si-Bone Inc. Implants for spinal fixation and or fusion
US11369419B2 (en) 2019-02-14 2022-06-28 Si-Bone Inc. Implants for spinal fixation and or fusion
WO2020201353A1 (en) 2019-04-02 2020-10-08 Medicrea International Systems, methods, and devices for developing patient-specific spinal implants, treatments, operations, and/or procedures
US11925417B2 (en) 2019-04-02 2024-03-12 Medicrea International Systems, methods, and devices for developing patient-specific spinal implants, treatments, operations, and/or procedures
EP4065015A4 (en) 2019-11-27 2024-01-03 Si Bone Inc Bone stabilizing implants and methods of placement across si joints
US11197765B2 (en) 2019-12-04 2021-12-14 Robert S. Bray, Jr. Artificial disc replacement device
US11769251B2 (en) 2019-12-26 2023-09-26 Medicrea International Systems and methods for medical image analysis
US11839554B2 (en) 2020-01-23 2023-12-12 Robert S. Bray, Jr. Method of implanting an artificial disc replacement device
US11426286B2 (en) 2020-03-06 2022-08-30 Eit Emerging Implant Technologies Gmbh Expandable intervertebral implant
US20220110762A1 (en) * 2020-10-12 2022-04-14 Musgrave Solutions LLC Spinal Prothesis
EP4259015A1 (en) 2020-12-09 2023-10-18 SI-Bone, Inc. Sacro-iliac joint stabilizing implants and methods of implantation
US11850160B2 (en) 2021-03-26 2023-12-26 Medos International Sarl Expandable lordotic intervertebral fusion cage
US11752009B2 (en) 2021-04-06 2023-09-12 Medos International Sarl Expandable intervertebral fusion cage
KR102573983B1 (en) 2021-05-13 2023-09-04 주식회사 에이스메디코프 Disc implant assembly
TWI789143B (en) 2021-12-03 2023-01-01 財團法人工業技術研究院 Aritificial intervertebral disk
KR20230172726A (en) * 2022-06-16 2023-12-26 주식회사 허브바이오텍 Lumbar artificial disk

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030176923A1 (en) * 2002-03-12 2003-09-18 Waldemar Link Gmbh & Co. Intervertebral prosthesis
US20040225365A1 (en) * 2003-02-12 2004-11-11 Sdgi Holdings, Inc. Articular disc prosthesis for transforaminal insertion
US8231677B2 (en) * 2004-06-30 2012-07-31 Synergy Disc Replacement, Inc. Artificial spinal disc

Family Cites Families (171)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CA992255A (en) * 1971-01-25 1976-07-06 Cutter Laboratories Prosthesis for spinal repair
US3875595A (en) * 1974-04-15 1975-04-08 Edward C Froning Intervertebral disc prosthesis and instruments for locating same
CA1146301A (en) 1980-06-13 1983-05-17 J. David Kuntz Intervertebral disc prosthesis
US4309777A (en) * 1980-11-13 1982-01-12 Patil Arun A Artificial intervertebral disc
GB8620937D0 (en) * 1986-08-29 1986-10-08 Shepperd J A N Spinal implant
CA1283501C (en) 1987-02-12 1991-04-30 Thomas P. Hedman Artificial spinal disc
US4714469A (en) 1987-02-26 1987-12-22 Pfizer Hospital Products Group, Inc. Spinal implant
US4863477A (en) * 1987-05-12 1989-09-05 Monson Gary L Synthetic intervertebral disc prosthesis
JPH01136655A (en) * 1987-11-24 1989-05-29 Asahi Optical Co Ltd Movable type pyramid spacer
US4874389A (en) 1987-12-07 1989-10-17 Downey Ernest L Replacement disc
DE3809793A1 (en) * 1988-03-23 1989-10-05 Link Waldemar Gmbh Co SURGICAL INSTRUMENT SET
DE8807485U1 (en) * 1988-06-06 1989-08-10 Mecron Medizinische Produkte Gmbh, 1000 Berlin, De
US4911718A (en) * 1988-06-10 1990-03-27 University Of Medicine & Dentistry Of N.J. Functional and biocompatible intervertebral disc spacer
CA1333209C (en) * 1988-06-28 1994-11-29 Gary Karlin Michelson Artificial spinal fusion implants
US5609635A (en) 1988-06-28 1997-03-11 Michelson; Gary K. Lordotic interbody spinal fusion implants
CA1318469C (en) 1989-02-15 1993-06-01 Acromed Corporation Artificial disc
DE8912648U1 (en) * 1989-10-23 1990-11-22 Mecron Medizinische Produkte Gmbh, 1000 Berlin, De
FR2659226B1 (en) 1990-03-07 1992-05-29 Jbs Sa PROSTHESIS FOR INTERVERTEBRAL DISCS AND ITS IMPLEMENTATION INSTRUMENTS.
DE69115688T2 (en) * 1990-04-17 1996-08-14 Ecole Polytech PHOTOVOLTAIC CELLS
US5192326A (en) 1990-12-21 1993-03-09 Pfizer Hospital Products Group, Inc. Hydrogel bead intervertebral disc nucleus
US5047055A (en) * 1990-12-21 1991-09-10 Pfizer Hospital Products Group, Inc. Hydrogel intervertebral disc nucleus
US5123926A (en) * 1991-02-22 1992-06-23 Madhavan Pisharodi Artificial spinal prosthesis
US5320644A (en) * 1991-08-30 1994-06-14 Sulzer Brothers Limited Intervertebral disk prosthesis
GB9125798D0 (en) * 1991-12-04 1992-02-05 Customflex Limited Improvements in or relating to spinal vertebrae implants
US5425773A (en) 1992-01-06 1995-06-20 Danek Medical, Inc. Intervertebral disk arthroplasty device
US5258031A (en) * 1992-01-06 1993-11-02 Danek Medical Intervertebral disk arthroplasty
DE4208116C2 (en) 1992-03-13 1995-08-03 Link Waldemar Gmbh Co Intervertebral disc prosthesis
DE4208115A1 (en) 1992-03-13 1993-09-16 Link Waldemar Gmbh Co DISC ENDOPROTHESIS
DE59206917D1 (en) 1992-04-21 1996-09-19 Sulzer Medizinaltechnik Ag Artificial intervertebral disc body
JPH06178787A (en) * 1992-12-14 1994-06-28 Shima Yumiko Centrum spacer with joint, intervertebral cavity measuring device and centrum spacer pattern
US5676701A (en) 1993-01-14 1997-10-14 Smith & Nephew, Inc. Low wear artificial spinal disc
DE69428143T2 (en) * 1993-02-09 2002-05-29 Depuy Acromed Inc disc
AU683243B2 (en) * 1993-02-10 1997-11-06 Zimmer Spine, Inc. Spinal stabilization surgical tool set
FR2707480B1 (en) 1993-06-28 1995-10-20 Bisserie Michel Intervertebral disc prosthesis.
RU2080841C1 (en) 1993-06-28 1997-06-10 Частное предприятие "Алекс" Intervertebral disk endoprosthesis
DE4423826B4 (en) * 1993-07-07 2007-01-04 Pentax Corp. Ceramic vertebral prosthesis
FR2709949B1 (en) 1993-09-14 1995-10-13 Commissariat Energie Atomique Intervertebral disc prosthesis.
US5458642A (en) 1994-01-18 1995-10-17 Beer; John C. Synthetic intervertebral disc
US5674296A (en) 1994-11-14 1997-10-07 Spinal Dynamics Corporation Human spinal disc prosthesis
DE69534978T2 (en) 1994-12-09 2007-01-04 SDGI Holdings, Inc., Wilmington Adjustable vertebral body replacement
FR2728159B1 (en) 1994-12-16 1997-06-27 Tornier Sa ELASTIC DISC PROSTHESIS
US6051751A (en) * 1995-01-20 2000-04-18 Spire Corporation Arthroplasty process for securely anchoring prostheses to bone, and arthroplasty products therefor
FR2730159B1 (en) * 1995-02-06 1997-04-25 Teule Jean Germain PROSTHESIS FOR INTERVERTEBRAL DISC
US5782830A (en) * 1995-10-16 1998-07-21 Sdgi Holdings, Inc. Implant insertion device
DE59510855D1 (en) * 1995-11-08 2004-03-18 Ct Pulse Orthopedics Ltd Intervertebral prosthesis
US5683465A (en) 1996-03-18 1997-11-04 Shinn; Gary Lee Artificial intervertebral disk prosthesis
US5755796A (en) * 1996-06-06 1998-05-26 Ibo; Ivo Prosthesis of the cervical intervertebralis disk
US5895428A (en) * 1996-11-01 1999-04-20 Berry; Don Load bearing spinal joint implant
US5898428A (en) * 1996-11-19 1999-04-27 Micron Display Technology Inc. High impedance transmission line tap circuit
US5827328A (en) 1996-11-22 1998-10-27 Buttermann; Glenn R. Intervertebral prosthetic device
US5893889A (en) * 1997-06-20 1999-04-13 Harrington; Michael Artificial disc
CA2298652A1 (en) * 1997-08-04 1999-02-11 Dennis P. Gordon Multiple axis intervertebral prosthesis
US6146421A (en) * 1997-08-04 2000-11-14 Gordon, Maya, Roberts And Thomas, Number 1, Llc Multiple axis intervertebral prosthesis
US5824094A (en) 1997-10-17 1998-10-20 Acromed Corporation Spinal disc
US5888226A (en) * 1997-11-12 1999-03-30 Rogozinski; Chaim Intervertebral prosthetic disc
US5899941A (en) * 1997-12-09 1999-05-04 Chubu Bearing Kabushiki Kaisha Artificial intervertebral disk
US6162252A (en) 1997-12-12 2000-12-19 Depuy Acromed, Inc. Artificial spinal disc
US5989291A (en) 1998-02-26 1999-11-23 Third Millennium Engineering, Llc Intervertebral spacer device
DE59801514D1 (en) * 1998-03-13 2001-10-25 Link Waldemar Gmbh Co Set of intervertebral disc prostheses
US6179874B1 (en) * 1998-04-23 2001-01-30 Cauthen Research Group, Inc. Articulating spinal implant
US6019792A (en) * 1998-04-23 2000-02-01 Cauthen Research Group, Inc. Articulating spinal implant
US6136031A (en) 1998-06-17 2000-10-24 Surgical Dynamics, Inc. Artificial intervertebral disc
US5928284A (en) * 1998-07-09 1999-07-27 Mehdizadeh; Hamid M. Disc replacement prosthesis
AU748746B2 (en) 1998-07-22 2002-06-13 Spinal Dynamics Corporation Threaded cylindrical multidiscoid single or multiple array disc prosthesis
US6063121A (en) * 1998-07-29 2000-05-16 Xavier; Ravi Vertebral body prosthesis
US6749635B1 (en) * 1998-09-04 2004-06-15 Sdgi Holdings, Inc. Peanut spectacle multi discoid thoraco-lumbar disc prosthesis
US6113637A (en) 1998-10-22 2000-09-05 Sofamor Danek Holdings, Inc. Artificial intervertebral joint permitting translational and rotational motion
US6039763A (en) * 1998-10-27 2000-03-21 Disc Replacement Technologies, Inc. Articulating spinal disc prosthesis
FR2787019B1 (en) * 1998-12-11 2001-03-02 Dimso Sa INTERVERTEBRAL DISC PROSTHESIS WITH IMPROVED MECHANICAL BEHAVIOR
FR2787016B1 (en) * 1998-12-11 2001-03-02 Dimso Sa INTERVERTEBRAL DISK PROSTHESIS
US6146422A (en) 1999-01-25 2000-11-14 Lawson; Kevin Jon Prosthetic nucleus replacement for surgical reconstruction of intervertebral discs and treatment method
US6368350B1 (en) * 1999-03-11 2002-04-09 Sulzer Spine-Tech Inc. Intervertebral disc prosthesis and method
US6602291B1 (en) 1999-04-05 2003-08-05 Raymedica, Inc. Prosthetic spinal disc nucleus having a shape change characteristic
US6964686B2 (en) 1999-05-17 2005-11-15 Vanderbilt University Intervertebral disc replacement prosthesis
US6579321B1 (en) * 1999-05-17 2003-06-17 Vanderbilt University Intervertebral disc replacement prosthesis
ATE235863T1 (en) * 1999-05-21 2003-04-15 Link Waldemar Gmbh Co INTERVERBARY ENDOPROSTHESIS WITH A TOOTHED CONNECTION PLATE
US6520996B1 (en) * 1999-06-04 2003-02-18 Depuy Acromed, Incorporated Orthopedic implant
ES2238290T3 (en) * 1999-06-04 2005-09-01 Sdgi Holdings, Inc. IMPLANT OF ARTIFICIAL DISK.
BR9917397A (en) * 1999-07-02 2002-03-05 Spine Solutions Inc Intervertebral Implant
US7201776B2 (en) * 1999-10-08 2007-04-10 Ferree Bret A Artificial intervertebral disc replacements with endplates
MXPA02002672A (en) 1999-09-14 2003-10-14 Spine Solutions Inc Instrument for inserting intervertebral implants.
US6592624B1 (en) * 1999-11-24 2003-07-15 Depuy Acromed, Inc. Prosthetic implant element
US7115143B1 (en) * 1999-12-08 2006-10-03 Sdgi Holdings, Inc. Orthopedic implant surface configuration
FR2805733B1 (en) * 2000-03-03 2002-06-07 Scient X DISC PROSTHESIS FOR CERVICAL VERTEBRUS
FR2805985B1 (en) * 2000-03-10 2003-02-07 Eurosurgical INTERVERTEBRAL DISK PROSTHESIS
US6478800B1 (en) 2000-05-08 2002-11-12 Depuy Acromed, Inc. Medical installation tool
US6610093B1 (en) * 2000-07-28 2003-08-26 Perumala Corporation Method and apparatus for stabilizing adjacent vertebrae
EP1307153B1 (en) 2000-08-08 2009-09-23 Warsaw Orthopedic, Inc. Apparatus for stereotactic implantation
AU2001281166B2 (en) 2000-08-08 2006-07-20 Warsaw Orthopedic, Inc. Implantable joint prosthesis
US20020035400A1 (en) * 2000-08-08 2002-03-21 Vincent Bryan Implantable joint prosthesis
US7601174B2 (en) 2000-08-08 2009-10-13 Warsaw Orthopedic, Inc. Wear-resistant endoprosthetic devices
US6562045B2 (en) * 2001-02-13 2003-05-13 Sdgi Holdings, Inc. Machining apparatus
US6989032B2 (en) * 2001-07-16 2006-01-24 Spinecore, Inc. Artificial intervertebral disc
US6669730B2 (en) 2001-02-15 2003-12-30 Spinecore, Inc. Intervertebral spacer device utilizing a spirally slotted belleville washer having radially extending grooves
EP1250898A1 (en) * 2001-04-05 2002-10-23 Waldemar Link (GmbH & Co.) Intervertebral disc prosthesis system
FR2824261B1 (en) 2001-05-04 2004-05-28 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS AND IMPLEMENTATION METHOD AND TOOLS
US6607558B2 (en) * 2001-07-03 2003-08-19 Axiomed Spine Corporation Artificial disc
DE10132588C2 (en) * 2001-07-05 2003-05-22 Fehling Instr Gmbh Disc prosthesis
US6478801B1 (en) 2001-07-16 2002-11-12 Third Millennium Engineering, Llc Insertion tool for use with tapered trial intervertebral distraction spacers
US6468310B1 (en) 2001-07-16 2002-10-22 Third Millennium Engineering, Llc Intervertebral spacer device having a wave washer force restoring element
US6375682B1 (en) * 2001-08-06 2002-04-23 Lewis W. Fleischmann Collapsible, rotatable and expandable spinal hydraulic prosthetic device
US6593624B2 (en) * 2001-09-25 2003-07-15 Matrix Semiconductor, Inc. Thin film transistors with vertically offset drain regions
ATE398431T1 (en) 2001-08-24 2008-07-15 Zimmer Gmbh ARTIFICIAL DISC
DE50114037D1 (en) 2001-08-24 2008-07-31 Zimmer Gmbh Artificial disc
US6652533B2 (en) 2001-09-20 2003-11-25 Depuy Acromed, Inc. Medical inserter tool with slaphammer
US6709439B2 (en) * 2001-10-30 2004-03-23 Depuy Spine, Inc. Slaphammer tool
FR2831796B1 (en) * 2001-11-06 2003-12-26 Ldr Medical BONE ANCHORING DEVICE FOR PROSTHESIS
US7025787B2 (en) * 2001-11-26 2006-04-11 Sdgi Holdings, Inc. Implantable joint prosthesis and associated instrumentation
US6740118B2 (en) * 2002-01-09 2004-05-25 Sdgi Holdings, Inc. Intervertebral prosthetic joint
US6761723B2 (en) * 2002-01-14 2004-07-13 Dynamic Spine, Inc. Apparatus and method for performing spinal surgery
EP1344507A1 (en) 2002-03-12 2003-09-17 Waldemar Link (GmbH & Co.) Intervertebral prosthesis for the cervical spine
US6726720B2 (en) * 2002-03-27 2004-04-27 Depuy Spine, Inc. Modular disc prosthesis
US6706068B2 (en) * 2002-04-23 2004-03-16 Bret A. Ferree Artificial disc replacements with natural kinematics
US7156848B2 (en) * 2002-04-24 2007-01-02 Ferree Bret A Check reins for artificial disc replacements
US7179294B2 (en) * 2002-04-25 2007-02-20 Warsaw Orthopedic, Inc. Articular disc prosthesis and method for implanting the same
AU2003228697B2 (en) 2002-04-25 2009-04-02 Blackstone Medical, Inc. Artificial intervertebral disc
US7291171B2 (en) 2002-05-10 2007-11-06 Ferree Bret A Artificial disc replacement (ADR) using elastic tether member
US7001433B2 (en) * 2002-05-23 2006-02-21 Pioneer Laboratories, Inc. Artificial intervertebral disc device
US6770095B2 (en) * 2002-06-18 2004-08-03 Depuy Acroned, Inc. Intervertebral disc
EP1534194A2 (en) * 2002-06-26 2005-06-01 Nuvasive, Inc. Total disc replacement system and related methods
US6793678B2 (en) * 2002-06-27 2004-09-21 Depuy Acromed, Inc. Prosthetic intervertebral motion disc having dampening
US7101400B2 (en) 2002-08-19 2006-09-05 Jeffery Thramann Shaped memory artificial disc and methods of engrafting the same
US6899735B2 (en) * 2002-10-02 2005-05-31 Sdgi Holdings, Inc. Modular intervertebral prosthesis system
US7156876B2 (en) * 2002-10-09 2007-01-02 Depuy Acromed, Inc. Intervertebral motion disc having articulation and shock absorption
EP1555964A1 (en) * 2002-10-28 2005-07-27 Mathys Medizinaltechnik AG Intervertebral disk prosthesis or artificial vertebra
US6966929B2 (en) 2002-10-29 2005-11-22 St. Francis Medical Technologies, Inc. Artificial vertebral disk replacement implant with a spacer
CA2502292C (en) * 2002-10-31 2011-07-26 Spinal Concepts, Inc. Movable disc implant
FR2846550B1 (en) 2002-11-05 2006-01-13 Ldr Medical INTERVERTEBRAL DISC PROSTHESIS
US7204852B2 (en) * 2002-12-13 2007-04-17 Spine Solutions, Inc. Intervertebral implant, insertion tool and method of inserting same
ATE394087T1 (en) 2002-12-17 2008-05-15 Synthes Gmbh INTERVERBARY IMPLANT
US6994727B2 (en) * 2002-12-17 2006-02-07 Amedica Corporation Total disc implant
JP4210653B2 (en) 2002-12-17 2009-01-21 ジンテーズ ゲゼルシャフト ミト ベシュレンクテル ハフツング Intervertebral implant
US7048764B2 (en) * 2003-01-07 2006-05-23 Ferree Bret A Artificial disc replacements with articulating components
GB0301085D0 (en) 2003-01-17 2003-02-19 Krishna Manoj Articulating spinal disc prosthesis
WO2004066884A1 (en) * 2003-01-31 2004-08-12 Spinalmotion, Inc. Intervertebral prosthesis placement instrument
US7235101B2 (en) * 2003-09-15 2007-06-26 Warsaw Orthopedic, Inc. Revisable prosthetic device
US6908484B2 (en) * 2003-03-06 2005-06-21 Spinecore, Inc. Cervical disc replacement
JP2006515194A (en) * 2003-03-24 2006-05-25 マシーズ メディツィナルテヒニク アクチエンゲゼルシャフト Intervertebral disc or intervertebral disc prosthesis
US7108720B2 (en) 2003-03-31 2006-09-19 Depuy Products, Inc. Reduced wear orthopaedic implant apparatus and method
US7060097B2 (en) * 2003-03-31 2006-06-13 Depuy Spine, Inc. Method and apparatus for implant stability
EP1610740A4 (en) 2003-04-04 2009-04-08 Theken Disc Llc Artificial disc prosthesis
JP2006521845A (en) 2003-04-07 2006-09-28 サービテック・インコーポレイテッド Intervertebral joint prosthesis for cervical spine
US8012212B2 (en) 2003-04-07 2011-09-06 Nuvasive, Inc. Cervical intervertebral disk prosthesis
US7105024B2 (en) 2003-05-06 2006-09-12 Aesculap Ii, Inc. Artificial intervertebral disc
US7048766B2 (en) * 2003-06-06 2006-05-23 Ferree Bret A Methods and apparatus for total disc replacements with oblique keels
FR2856587B1 (en) * 2003-06-26 2006-02-24 Scient X DISCRETE PROSTHESIS FOR CERVICAL VERTEBRATES WITH CONTROLLED DEBATMENT
US7695515B2 (en) * 2003-07-15 2010-04-13 Spinal Generations, Llc Spinal disc prosthesis system
US7621956B2 (en) 2003-07-31 2009-11-24 Globus Medical, Inc. Prosthetic spinal disc replacement
US7153325B2 (en) 2003-08-01 2006-12-26 Ultra-Kinetics, Inc. Prosthetic intervertebral disc and methods for using the same
US7188254B2 (en) 2003-08-20 2007-03-06 Microsoft Corporation Peer-to-peer authorization method
DE20313183U1 (en) * 2003-08-22 2003-10-16 Aesculap Ag & Co Kg Intervertebral implant
US7794465B2 (en) 2003-09-10 2010-09-14 Warsaw Orthopedic, Inc. Artificial spinal discs and associated implantation instruments and methods
WO2005039455A1 (en) 2003-09-23 2005-05-06 Vanderbilt University Intervertebral disc replacement prosthesis
US7255714B2 (en) * 2003-09-30 2007-08-14 Michel H. Malek Vertically adjustable intervertebral disc prosthesis
FR2861581B1 (en) 2003-10-29 2006-01-06 Laurent Salle TOTAL PROSTHESIS OF INTERVERTEBRAL DISC
GB0325421D0 (en) 2003-10-30 2003-12-03 Gill Steven S An intervertebral prosthesis
US7520899B2 (en) * 2003-11-05 2009-04-21 Kyphon Sarl Laterally insertable artificial vertebral disk replacement implant with crossbar spacer
US7670377B2 (en) * 2003-11-21 2010-03-02 Kyphon Sarl Laterally insertable artifical vertebral disk replacement implant with curved spacer
WO2005053580A1 (en) 2003-11-28 2005-06-16 Richard Mervyn Walker An intervertebral prosthesis
US7217291B2 (en) * 2003-12-08 2007-05-15 St. Francis Medical Technologies, Inc. System and method for replacing degenerated spinal disks
US7250060B2 (en) * 2004-01-27 2007-07-31 Sdgi Holdings, Inc. Hybrid intervertebral disc system
US7850733B2 (en) * 2004-02-10 2010-12-14 Atlas Spine, Inc. PLIF opposing wedge ramp
ATE387165T1 (en) 2004-03-08 2008-03-15 Impliant Ltd SPINAL PROSTHESIS
US7637955B2 (en) 2004-03-23 2009-12-29 Warsaw Orthopedic, Inc. Constrained artificial spinal disc
US8172904B2 (en) * 2004-06-30 2012-05-08 Synergy Disc Replacement, Inc. Artificial spinal disc
US7763024B2 (en) * 2004-09-23 2010-07-27 Spine Solutions, Inc. Adjustable cutting of cutout in vertebral bone
AU2006243713A1 (en) 2005-05-02 2006-11-09 Kinetic Spine Technologies Inc. Artificial intervertebral disc
FR2893838B1 (en) 2005-11-30 2008-08-08 Ldr Medical Soc Par Actions Si PROSTHESIS OF INTERVERTEBRAL DISC AND INSTRUMENTATION OF INSERTION OF THE PROSTHESIS BETWEEN VERTEBRATES
US20070198093A1 (en) 2006-02-17 2007-08-23 Amedica Corporation Spinal implant with offset keels
US8998990B2 (en) 2006-07-24 2015-04-07 DePuy Synthes Products, LLC Intervertebral implant with keel
US7325260B1 (en) 2007-01-22 2008-02-05 Hoyt Bruce E Bag and apparatus for retrofitting an extendable and retractable showerhead to existing fixed showerhead locations

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030176923A1 (en) * 2002-03-12 2003-09-18 Waldemar Link Gmbh & Co. Intervertebral prosthesis
US20040225365A1 (en) * 2003-02-12 2004-11-11 Sdgi Holdings, Inc. Articular disc prosthesis for transforaminal insertion
US8231677B2 (en) * 2004-06-30 2012-07-31 Synergy Disc Replacement, Inc. Artificial spinal disc

Cited By (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8882839B2 (en) 1999-07-02 2014-11-11 DePuy Synthes Products, LLC Intervertebral implant
US9526624B2 (en) 1999-07-02 2016-12-27 DePuy Synthes Products, Inc. Intervertebral implant
US10786362B2 (en) 2004-06-30 2020-09-29 Synergy Disc Replacement, Inc. Systems and methods for vertebral disc replacement
US10064739B2 (en) 2004-06-30 2018-09-04 Synergy Disc Replacement, Inc. Systems and methods for vertebral disc replacement
US11690728B2 (en) 2006-07-24 2023-07-04 Centinel Spine, Llc Intervertebral implant with keel
US8998990B2 (en) * 2006-07-24 2015-04-07 DePuy Synthes Products, LLC Intervertebral implant with keel
US20100217395A1 (en) * 2006-07-24 2010-08-26 Rudolf Bertagnoli Intervertebral implant with keel
US9387086B2 (en) 2006-07-24 2016-07-12 DePuy Synthes Products, Inc. Intervertebral implant with keel
US9883950B2 (en) 2006-07-24 2018-02-06 Centinel Spine Llc Intervertebral implant with keel
US10583014B2 (en) 2006-07-24 2020-03-10 Centinel Spine, Llc Intervertebral implant with keel
US9101485B2 (en) * 2011-01-04 2015-08-11 DePuy Synthes Products, Inc. Intervertebral implant with multiple radii
US20120172988A1 (en) * 2011-01-04 2012-07-05 Synthes Usa, Llc Intervertebral implant with multiple radii
US10687958B2 (en) * 2011-02-23 2020-06-23 Globus Medical, Inc. Six degree spine stabilization devices and methods
US11357639B2 (en) * 2011-02-23 2022-06-14 Globus Medical, Inc. Six degree spine stabilization devices and methods
US20220273457A1 (en) * 2011-02-23 2022-09-01 Globus Medical, Inc. Six degree spine stabilization devices and methods
US11857433B2 (en) * 2011-02-23 2024-01-02 Globus Medical, Inc. Six degree spine stabilization devices and methods
US11452618B2 (en) 2019-09-23 2022-09-27 Dimicron, Inc Spinal artificial disc removal tool
US11590003B2 (en) 2019-09-23 2023-02-28 Dimicron Inc. Spinal artificial disc removal tool

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