DE4239716C1 - Elastic implant for stabilising degenerated spinal column segments - Google Patents

Elastic implant for stabilising degenerated spinal column segments

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Publication number
DE4239716C1
DE4239716C1 DE19924239716 DE4239716A DE4239716C1 DE 4239716 C1 DE4239716 C1 DE 4239716C1 DE 19924239716 DE19924239716 DE 19924239716 DE 4239716 A DE4239716 A DE 4239716A DE 4239716 C1 DE4239716 C1 DE 4239716C1
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DE
Germany
Prior art keywords
rod
resilient body
elastic implant
rods
implant according
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.)
Expired - Fee Related
Application number
DE19924239716
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German (de)
Inventor
Michael Dr Winter
Bernhard Kneifel
Klaus Mueller
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.)
Forschungszentrum Karlsruhe GmbH
Original Assignee
Kernforschungszentrum Karlsruhe GmbH
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Priority to DE19924239716 priority Critical patent/DE4239716C1/en
Application granted granted Critical
Publication of DE4239716C1 publication Critical patent/DE4239716C1/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7014—Longitudinal elements, e.g. rods with means for adjusting the distance between two screws or hooks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7005—Parts of the longitudinal elements, e.g. their ends, being specially adapted to fit in the screw or hook heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7025—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a sliding joint
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7026—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other with a part that is flexible due to its form
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
    • A61B17/704—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other the longitudinal element passing through a ball-joint in the screw head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8695—Washers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/60—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors
    • A61B2017/606—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like for external osteosynthesis, e.g. distractors, contractors with resilient spring element
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30537—Special structural features of bone or joint prostheses not otherwise provided for adjustable
    • A61F2002/3055—Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting length
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30535—Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30565—Special structural features of bone or joint prostheses not otherwise provided for having spring elements

Abstract

An elastic connecting component is provided between two fixture points and comprises two axially arranged rods (1,5) which via a sprung body (9) elastically accommodating both pressure and tractive loads are joined together. The sprung body (9) is enclosed by a housing, which guides the rods axially.The first rod (1) at its first end carries the internally cylindrically formed housing (11). The second rod (5) at its first end supports the sprung body (9), which encompasses the rod, and is fitted between two movably arranged plates (6,13) on the rod. Both the movably arranged plates and the sprung body are arranged between two plates (4,12) fitted on the second rod (5).

Description

Die Erfindung betrifft ein elastisches Implantat gemäß dem Oberbegriff des ersten Patentanspruchs.The invention relates to an elastic implant according to the Preamble of the first claim.

Ein solches elastisches Implantat ist aus der Veröffentlichung von C. G. Attenborough und M. T. Reynolds mit dem Titel "Lumbo-Sacral Fusion with Spring Fixation" in The Journal of Bone and Joint Surgery, Vol. 57-B, No. 3 (August 1975) 283-288 bekannt. Dieses Implantat besteht aus zwei Haken als Veranke­ rungselementen, die in jeweils eine schlitzförmige Öffnung in den Wirbeln eingehängt werden, und einer Feder als elastisches Verbindungselement. Die aus der schlitzförmigen Öffnung her­ vorstehenden Teile der Haken tragen ein Gewinde, auf das die Federenden aufgeschraubt werden. Die Wirbelteile, die von der Feder überspannt werden, müssen mit Knochenmaterial unterlegt werden. Obwohl das Implantat in einer Reihe von Fällen erfolg­ reich eingesetzt wurde, brachen nach längerer Zeit in einigen Fällen die Federn unter dem Einfluß der mechanischen Belastung durch die Bewegungen des Patienten.Such an elastic implant is from the publication by C. G. Attenborough and M. T. Reynolds with the title "Lumbo-Sacral Fusion with Spring Fixation" in The Journal of Bone and Joint Surgery, Vol. 57-B, No. 3 (August 1975) 283-288 known. This implant consists of two hooks as anchoring tion elements, each in a slot-shaped opening the vertebrae are hung, and a spring as elastic Fastener. That from the slit-shaped opening protruding parts of the hook carry a thread on which the Spring ends are screwed on. The vertebral parts by the Spring must be spanned with bone material become. Although the implant is successful in a number of cases was used richly, broke down in some after a long time Felling the springs under the influence of mechanical stress through the patient's movements.

Ein weiteres elastisches Implantat ist aus der EP 0 381 588 A1 bekannt. Bei diesem Implantat bestehen die Verankerungsele­ mente vorzugsweise aus Knochenschrauben. Das elastische Ver­ bindungselement zwischen den Befestigungspunkten, die durch die Schraubenköpfe der Knochenschrauben geschaffen werden, be­ steht aus einem oder mehreren elastischen Bändern.Another elastic implant is from EP 0 381 588 A1 known. The anchoring elements are present on this implant elements preferably from bone screws. The elastic ver binding element between the attachment points through the screw heads of the bone screws are created, be consists of one or more elastic bands.

Die bekannten elastischen Implantate können lediglich Zug­ kräfte ausüben. Die Wirbel werden nur bei einer Dehnung in die Ausgangslage zurückgebracht, nicht jedoch bei einer Stauchung. Aufgabe der Erfindung ist daher, ein elastisches Implantat der eingangs genannten Art vorzuschlagen, das die Wirbel sowohl bei Dehnungen als auch bei Stauchungen in die Ausgangslage zu­ rückbringt. Das Implantat soll außerdem mechanisch belastbarer sein. The known elastic implants can only pull exert forces. The vertebrae are only stretched into the Starting position brought back, but not in the case of a compression. The object of the invention is therefore an elastic implant Propose the kind mentioned above, which both the vertebrae in the case of stretching as well as compression in the initial position brings back. The implant should also be mechanically stronger his.  

Die Aufgabe wird erfindungsgemäß durch die kennzeichnenden Merkmale im ersten Patentanspruch gelöst. In den weiteren An­ sprüchen werden bevorzugte Ausgestaltungen der Erfindung ange­ geben.The object is achieved by the characterizing Features solved in the first claim. In the further An Sayings are preferred embodiments of the invention give.

Erfindungsgemäß besteht das Verbindungselement aus zwei Stä­ ben, die über einen federnden Körper miteinander verbunden sind. Im Gegensatz zu den bekannten Implantaten wird der fe­ dernde Körper so gewählt, daß er sowohl Zug- als auch Druck­ kräfte elastisch aufnehmen kann. Das erfindungsgemäße Implan­ tat hat daher auch eine Stoßdämpferfunktion, die mit den be­ kannten Implantaten nicht erzielt werden kann. Der federnde Körper wird von einem Gehäuse umgeben, das die Stäbe in axi­ aler Richtung führt und verhindert, daß das Verbindungselement unter Druckbelastung ausknickt. Vorzugsweise weist das Gehäuse einen zylinderförmigen Innenraum auf.According to the invention, the connecting element consists of two rods ben connected by a resilient body are. In contrast to the known implants, the fe body chosen so that it has both tensile and pressure can absorb forces elastically. The implan according to the invention tat therefore also has a shock absorber function that works with the be known implants can not be achieved. The resilient Body is surrounded by a housing that the rods in axi aler direction leads and prevents the connecting element buckles under pressure. The housing preferably has a cylindrical interior.

Als federnde Körper eignen sich insbesondere Schraubenfedern, deren Windungen im kräftefreien Zustand nicht aneinander lie­ gen, ein Stapel von Tellerfedern oder ein vorzugsweise durch­ bohrter Block aus Gummi, einem gummiartigen Material oder einem Elastomer. Der federnde Körper kann auch aus einem Ver­ bund dieser Materialien bestehen.Coil springs are particularly suitable as resilient bodies, the turns of which do not lie against one another in the force-free state gene, a stack of disc springs or a preferably by Drilled block made of rubber, a rubber-like material or an elastomer. The resilient body can also from a ver made of these materials.

Prinzipiell gibt es verschiedene Möglichkeiten, zwei Stäbe in der Weise über einen federnden Körper miteinander zu verbin­ den, daß sowohl Druck- als auch Zugkräfte aufgenommen werden können. Beispielsweise können die beiden Stäbe an den beiden Enden der Schraubenfeder oder des elastischen Blocks befestigt werden. Die Schraubenfeder oder der elastische Block sind von einem Gehäuse umgeben, in dem die federnden Körper geführt werden. Das Gehäuse läuft beidseitig in zwei Führungen aus, die die Stäbe mit geringem Spiel umgeben. Durch die Anordnung der Führungen kann die Dehnung des Verbindungselements be­ grenzt werden. Die Führungen können in an sich bekannter Weise so ausgestaltet werden, daß das Gehäuse den federnden Körper dicht einschließt.In principle there are different ways to put two bars in the way to connect with each other via a resilient body that that both compressive and tensile forces are absorbed can. For example, the two rods on the two Fixed ends of the coil spring or the elastic block become. The coil spring or the elastic block are from surrounded in a housing in which the resilient body become. The housing ends in two guides on both sides, that surround the rods with little play. By the arrangement the guides can be the expansion of the connecting element  be limited. The guides can be done in a manner known per se be designed so that the housing the resilient body tightly encloses.

Eine bevorzugte Ausgestaltung des Verbindungselements besteht darin, auf einem Ende des ersten Stabs ein im Innern zylinder­ förmiges Gehäuse vorzusehen, in das ein Endstück des zweiten Stabs, der auf diesem Endstück den federnden Körper trägt, eingesetzt ist. Der federnde Körper umgibt das Endstück und ist auf diesem Endstück zwischen zwei auf dem Stab beweglichen Scheiben angeordnet. Der federnde Körper und die beweglichen Scheiben befinden sich zwischen zwei auf dem Endstück fest an­ gebrachten Scheiben, die vorzugsweise so angebracht sind, daß sie im kräftefreien Zustand den federnden Körper und die be­ weglichen Scheiben ohne Spiel einschließen. Es kann aber auch eine Vorspannung realisiert werden, so daß das Implantat erst bei einer Kraft größer der Vorspannkraft elastisch reagiert. Vorzugsweise ist der Durchmesser der fest angebrachten Schei­ ben kleiner als der Durchmesser der beweglichen Scheiben. Im Gehäuse sind in diesem Fall zwei Ringe oder ringförmige Ab­ sätze am Mantel des zylinderförmigen Innenraums fest ange­ bracht, die die beiden beweglichen Scheiben auf dem zweiten Stab im kräftefreien Zustand ohne Spiel fixieren.There is a preferred embodiment of the connecting element inside, on one end of the first rod, an inside cylinder provide shaped housing in which an end piece of the second Rod that carries the resilient body on this end piece, is inserted. The resilient body surrounds the end piece and is on this end piece between two movable on the rod Disks arranged. The resilient body and the agile Discs are firmly between two on the end piece brought discs, which are preferably attached so that the resilient body and the be include moving disks without play. But it can also a preload can be realized so that the implant only reacts elastically at a force greater than the preload force. Preferably the diameter of the fixed disc is ben smaller than the diameter of the movable disks. in the In this case, housings are two rings or ring-shaped sentences firmly attached to the jacket of the cylindrical interior brings the two movable disks on the second Fix the rod in the force-free state without play.

In dieser Ausführungsform wird der zweite Stab über den fe­ dernden Körper im Innern des Gehäuses geführt. Die Führung kann weiter verbessert werden, wenn der erste Stab in das In­ nere des Gehäuses hinein verlängert wird und der zweite Stab an seinem ersten Ende als Rohr mit einem geringfügig größeren Innendurchmesser ausgebildet ist, in das der erste Stab einge­ schoben ist.In this embodiment, the second rod is over the fe changing body inside the housing. The leadership can be further improved if the first rod in the In nere of the housing is extended and the second rod at its first end as a tube with a slightly larger one Is formed inside diameter, in which the first rod is inserted is pushed.

In einer bevorzugten Ausführungsform trägt einer der beiden Stäbe an seinem freien Ende eine ellipsoid- oder kugelförmige Verdickung, während am freien Ende des anderen Stabs ein Ge­ winde eingeschnitten ist, auf das eine ellipsoid oder kugel­ förmige Mutter aufgeschraubt werden kann. Vorzugsweise sind die Form von Verdickung und Mutter sowie die Durchmesser der Stäbe gleich, so daß nur eine Art von Pedikelschrauben benö­ tigt wird.In a preferred embodiment, one of the two wears Rods at its free end an ellipsoidal or spherical Thickening, while at the free end of the other rod a Ge winch is cut, on which an ellipsoid or ball  shaped nut can be screwed on. Are preferred the shape of the thickening and nut as well as the diameter of the Rods the same so that only one type of pedicle screw is needed is done.

Als Verankerungselemente werden Knochen- bzw. Pedikelschrauben eingesetzt, die eine axialsymmetrisch angeordnete, auf der Schraubenachse verlaufende, vorzugsweise zylinderförmige Aus­ nehmung enthalten. In einer besonders bevorzugten Ausge­ staltung endet die zylinderförmige Ausnehmung in einer Kalotte oder kegelförmigen Einsenkung. Der Durchmesser der zylinder­ förmigen Ausnehmung ist größer als der Durchmesser der Ver­ dickung und/oder der in diesem Fall kugelförmigen Mutter, so daß die Verdickung und/oder die Mutter in die zylinderförmige Ausnehmung eingesetzt werden kann. Vorzugsweise ist der Durch­ messer der zylinderförmigen Ausnehmung nur um ein solches Maß größer, das eine ungehinderte Drehung von Verdickung und/oder Mutter in der Ausnehmung zuläßt.Bone or pedicle screws are used as anchoring elements used, which is arranged axially symmetrically, on the Screw axis extending, preferably cylindrical Aus acceptance included. In a particularly preferred version design, the cylindrical recess ends in a spherical cap or conical depression. The diameter of the cylinder shaped recess is larger than the diameter of the ver thickening and / or the spherical nut in this case, so that the thickening and / or the nut in the cylindrical Recess can be used. Preferably the through knife of the cylindrical recess only to such an extent larger that an unimpeded rotation of thickening and / or Allows nut in the recess.

Der Schraubenkopf der Pedikelschrauben weist zusätzlich minde­ stens einen parallel zur Schraubenachse verlaufenden Schlitz auf, dessen Breite größer ist als der Durchmesser der Stäbe. Wenn die Verdickung und die kugelförmige Mutter in die Ausneh­ mung eingesetzt sind, ragen die Stäbe durch den Schlitz aus dem Schraubenkopf heraus.The screw head of the pedicle screws also has at least at least one slot running parallel to the screw axis whose width is larger than the diameter of the rods. If the thickening and the spherical nut in the recess are inserted, the rods protrude through the slot the screw head out.

Bei der Operation werden zuerst die Pedikelschrauben gesetzt. Danach wird der Abstand zwischen den Pedikelschrauben be­ stimmt. Durch Verdrehen der kugelförmigen Mutter auf dem Ge­ winde eines Stabes wird der gleiche Abstand zwischen der Ver­ dickung und der Mutter eingestellt. Die Mutter wird an­ schließend in dieser Position fixiert. Das Fixieren erfolgt z. B. durch Auftragen eines körperverträglichen Klebstoffs auf der entsprechendem Gewindestelle oder durch Beseitigen der be­ nachbarten Gewindegänge mit Hilfe eines feinen Meißels. Danach kann das überstehende Gewindestück auf dem Stab entfernt wer­ den.The pedicle screws are placed first during the operation. Then the distance between the pedicle screws is Right. By twisting the spherical nut on the Ge wind of a rod is the same distance between the ver thickening and the mother set. The mother is on finally fixed in this position. The fixing is done for. B. by applying a body-compatible adhesive the corresponding thread or by removing the be  neighboring threads with the help of a fine chisel. After that the protruding threaded piece on the rod can be removed the.

Wird das überstehende Gewindestück entfernt und bildet die Verdickung das Ende des betreffenden Stabs, so sind Pedikel­ schrauben mit jeweils nur einem Schlitz notwendig, der die Stäbe aufnimmt. Wird das überstehende Gewindestück nicht ent­ fernt oder bildet die Verdickung nicht das Ende des betreffen­ den Stabs, so müssen zwei Schlitze vorgesehen werden. Pedikel­ schrauben mit zwei Schlitzen sind insbesondere dann notwendig, wenn mehr als zwei Wirbel mit jeweils einem erfindungsgemäßen Verbindungselement stabilisiert werden müssen.If the protruding threaded piece is removed and forms the Thickening the end of the rod in question is pedicles screws with only one slot each, which the Rods. If the protruding threaded piece is not removed does not remove or form the thickening of the end of the concern the rods, two slots must be provided. Pedicle screws with two slots are particularly necessary if more than two vertebrae, each with one according to the invention Connection element must be stabilized.

Die Mutter bzw. die Verdickung werden vorzugsweise mit einer Verschlußschraube in ihrer Position gehalten. Die Ver­ schlußschraube wird in ein Innengewinde eingedreht, das in der zylindrischen Ausnehmung eingeschnitten ist.The nut or the thickening are preferably with a Locking screw held in position. The Ver The closing screw is screwed into an internal thread that is in the cylindrical recess is cut.

Die Verschlußschraube kann so ausgeführt werden, daß die Mut­ ter bzw. die Verdickung nicht berührt werden, die sich daher - begrenzt durch den oder die Schlitze im Schraubenkopf, die den Stab aufnehmen - senkrecht zur Schraubenachse drehen kön­ nen. Dies ist insbesondere dann von Vorteil, wenn lediglich zwei Pedikelschrauben eingesetzt werden, weil hierdurch eine Drehung der Wirbel gegeneinander möglich ist, ohne daß die stabilisierende Wirkung des erfindungsgemäßen Implantats auf­ gehoben wird. Durch eine Kalotten- oder Halbkugelform am Ende der zylinderförmigen Ausnehmung wird die Kontaktfläche zwi­ schen kugelförmiger Mutter bzw. Verdickung und Schraubenkopf vergrößert. Die Verschlußschraube kann in diesem Fall in einer konkaven, kalotten- oder halbkugelförmigen Aushöhlung enden, so daß die Mutter bzw. die Verdickung von an die Kugelform an­ gepaßten Flächen mit geringem Spiel in ihrer Lage gehalten wird. The screw plug can be designed so that the courage ter or the thickening, which is therefore not affected - limited by the slot or slots in the screw head, the pick up the rod - can turn perpendicular to the screw axis nen. This is particularly advantageous if only two pedicle screws are used because this makes one Rotation of the vertebrae against each other is possible without the stabilizing effect of the implant according to the invention is lifted. With a spherical or hemispherical shape at the end the cylindrical recess is the contact surface between spherical nut or thickening and screw head enlarged. The screw plug can in this case concave, spherical or hemispherical cavity end, so that the nut or the thickening of the spherical shape fit surfaces held in place with little play becomes.  

Sollen aus medizinischen Gründen solche Drehungen ausgeschlos­ sen werden, so werden mit der Verschlußschraube die Verdickung bzw. die Mutter blockiert. Durch die zuvor beschriebene Ausge­ staltung der zylinderförmigen Ausnehmung und der Ver­ schlußschraube wird eine vergrößerte Kontaktfläche geschaffen.Such turns should be excluded for medical reasons sen, so the thickening with the screw or the mother blocked. By the previously described Ausge staltung the cylindrical recess and the Ver closing screw creates an enlarged contact area.

Zur leichteren Anbringung des erfindungsgemäßen Implantats können die Pedikelschrauben mit einem Außensechskant und die Verschlußschrauben mit einem Innensechskant versehen werden.For easier attachment of the implant according to the invention can the pedicle screws with an external hexagon and the Screw plugs can be provided with a hexagon socket.

Die Erfindung wird im folgenden anhand eines Ausführungsbei­ spiels näher erläutert.The invention is illustrated below with the aid of an embodiment explained in more detail.

Fig. 1 zeigt eine bevorzugte Ausgestaltung des erfindungsge­ mäßen Verbindungselements. Fig. 1 shows a preferred embodiment of the connecting element according to the invention.

Das Verbindungselement ist aus zwei Stäben 1, 5 aufgebaut, wo­ bei sich der erste Stab 1 an seinem ersten Ende zu einem Ge­ häuse 11 erweitert. Der zweite Stab 5 trägt an seinem ersten Ende mehrere Tellerfedern 9 als federnden Körper. Die Teller­ federn 9 haben eine annähernd ideale Kennlinie. Die Teller­ federn 9 sind zwischen zwei auf dem Stab 5 beweglichen Schei­ ben 6, 13 angeordnet. Die Tellerfedern 9 und die beweglichen Scheiben 6, 13 werden von einer festen Scheibe 12 und von einer scheibenartigen Mutter 4 gehalten. Die Mutter 4 wird auf ein kurzes Gewindestück am Ende des Stabs 5 aufgedreht. Der Durchmesser der Mutter 4 und der festen Scheibe 12 ist kleiner als der Durchmesser der beweglichen Scheiben 6, 13.The connecting element is composed of two rods 1 , 5 , where the first rod 1 extends at its first end to a housing 11 Ge. The second rod 5 carries a plurality of disc springs 9 as a resilient body at its first end. The plate springs 9 have an approximately ideal characteristic. The plate springs 9 are arranged between two movable on the rod 5 Schei ben 6 , 13 . The plate springs 9 and the movable disks 6 , 13 are held by a fixed disk 12 and by a disk-like nut 4 . The nut 4 is screwed onto a short threaded piece at the end of the rod 5 . The diameter of the nut 4 and the fixed washer 12 is smaller than the diameter of the movable washers 6 , 13 .

Das erste Ende des zweiten Stabs 5 ist mitsamt den Tellerfe­ dern 9, den beweglichen Scheiben 6, 13, der festen Scheibe 12 und der Mutter 4 in das Gehäuse 11 eingelassen. Der Durchmes­ ser des Gehäuses 11 ist nur geringfügig größer als der Durch­ messer der Tellerfedern und der beweglichen Scheiben 6, 13. The first end of the second rod 5 is together with the Tellerfe 9 , the movable discs 6 , 13 , the fixed disc 12 and the nut 4 embedded in the housing 11 . The diameter of the housing 11 is only slightly larger than the diameter of the plate springs and the movable disks 6 , 13th

Die beweglichen Scheiben 6, 13 stützen sich bei Zug- oder Druckbelastung des Verbindungselements auf dem ringförmigen Absatz 15 und dem Ring 7 ab. Der Ring 7 ist entweder z. B. durch Schweifen fest mit dem Gehäuse verbunden oder er wird durch den Verschußdeckel 8 in seiner Lage gehalten, der sei­ nerseits entweder auf das Gehäuse aufgeschraubt oder aufge­ schweißt ist.The movable disks 6 , 13 are supported on the annular shoulder 15 and the ring 7 when the connecting element is subjected to tensile or compressive loads. The ring 7 is either z. B. firmly connected by swiveling to the housing or it is held in place by the closure cover 8 , which is either screwed onto the housing or welded up.

Der Endbereich des zweiten Stabs 5 ist ab der festen Scheibe 12 als Rohr ausgeführt. In dem Rohr wird ein senkrecht zur Rohrachse angeordneter Splint 10 gehalten. Der erste Stab ist in den Bereich des Gehäuses hinein verlängert, wobei sein Durchmesser in diesem Bereich kleiner ist als der Innendurch­ messer des Rohres. Er endet in einer Gabel, die den Splint um­ faßt. Auf diese Weise wird eine bessere Führung der zwei Stäbe zueinander erreicht; ferner wird verhindert, daß sich die Stäbe gegeneinander verdrehen.The end region of the second rod 5 is designed as a tube from the fixed disc 12 . A split pin 10 arranged perpendicular to the tube axis is held in the tube. The first rod is extended into the area of the housing, its diameter in this area being smaller than the inside diameter of the tube. It ends in a fork that holds the split pin around. In this way, better guidance of the two rods to one another is achieved; it also prevents the rods from rotating against each other.

An ihren freien Enden tragen die Stäbe eine kugelförmige Ver­ dickung 14 (zweiter Stab 5) und eine kugelförmige Mutter 2 (erster Stab 1). Der Abstand zwischen der Verdickung 14 und der kugelförmigen Mutter 2 kann durch Drehen der Mutter auf einem eingeschnittenen Gewinde verändert werden.At their free ends, the rods carry a spherical thickening 14 (second rod 5 ) and a spherical nut 2 (first rod 1 ). The distance between the thickening 14 and the spherical nut 2 can be changed by turning the nut on a cut thread.

Claims (8)

1. Elastisches Implantat zur Stabilisierung degenerierter Seg­ mente der Wirbelsäule bestehend aus
  • a) mindestens zwei Verankerungselementen, die zu einem Teil im Knochen fixiert werden und deren freier Teil einen Befestigungspunkt aufweist,
  • b) einem elastischen Verbindungselement zwischen zwei Be­ festigungspunkten, dadurch gekennzeichnet, daß
  • c) das Verbindungselement aus zwei axial angeordneten Stäben (1, 5) besteht, die
  • d) über einen federnden, sowohl Druck- als auch Zugbela­ stungen elastisch aufnehmenden Körper (9) miteinander verbunden sind,
  • e) der federnde Körper (9) von einem Gehäuse (11) umgeben ist, mit dem die Stäbe (1, 5) axial geführt werden.
1. Elastic implant to stabilize degenerated segments of the spine
  • a) at least two anchoring elements, some of which are fixed in the bone and the free part of which has an attachment point,
  • b) an elastic connecting element between two loading points, characterized in that
  • c) the connecting element consists of two axially arranged rods ( 1 , 5 )
  • d) are connected to one another by means of a resilient body ( 9 ) which absorbs both compressive and tensile loads,
  • e) the resilient body ( 9 ) is surrounded by a housing ( 11 ) with which the rods ( 1 , 5 ) are guided axially.
2. Elastisches Implantat nach Anspruch 1, dadurch gekennzeichnet, daß
  • - der erste Stab (1) an seinem ersten Ende das im Innern zylinderförmige Gehäuse (11) trägt,
  • - der zweite Stab (5) an seinem ersten Ende den federnden Körper (9) trägt, der den Stab umgibt und zwischen zwei auf dem Stab (5) beweglich angeordneten Scheiben (6, 13) angebracht ist,
  • - sowohl die beweglich angeordneten Scheiben (6, 13) als auch der federnde Körper (9) zwischen zwei auf dem zwei­ ten Stab (5) fest angebrachten Scheiben (4, 12) angeord­ net sind,
  • - das erste Ende des zweiten Stabs (5) mit dem federnden Körper (9), den beweglich angeordneten Scheiben (6, 13) und den fest angebrachten Scheiben (4, 12) in das Gehäuse (11) des ersten Stabs (1) eingelassen ist,
  • - im Gehäuse (11) zwei Ringe oder ringförmige Absätze (7, 15) fest angebracht sind, die mit den beweglich angeord­ neten Scheiben (6, 13) in Kontakt stehen.
2. Elastic implant according to claim 1, characterized in that
  • - The first rod ( 1 ) carries at its first end the cylindrical housing ( 11 ) inside,
  • the second rod ( 5 ) carries at its first end the resilient body ( 9 ) which surrounds the rod and is mounted between two disks ( 6 , 13 ) which are movably arranged on the rod ( 5 ),
  • - Both the movably arranged discs ( 6 , 13 ) and the resilient body ( 9 ) between two on the two th rod ( 5 ) fixed discs ( 4 , 12 ) are net angeord,
  • - The first end of the second rod ( 5 ) with the resilient body ( 9 ), the movably arranged discs ( 6 , 13 ) and the fixed discs ( 4 , 12 ) in the housing ( 11 ) of the first rod ( 1 ) is
  • - In the housing ( 11 ) two rings or annular shoulders ( 7 , 15 ) are firmly attached, which are in contact with the movably arranged disks ( 6 , 13 ).
3. Elastisches Implantat nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß der federnde Körper aus einer Schraubenfeder mit im kräfte­ freien Zustand nicht aneinander anliegenden Windungen be­ steht.3. Elastic implant according to claim 1 or 2, characterized in that the resilient body made of a helical spring is part of the strength free state not be adjacent turns stands. 4. Elastisches Implantat nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß der federnde Körper aus einem Stapel von Tellerfedern be­ steht.4. Elastic implant according to claim 1 or 2, characterized in that the resilient body be from a stack of disc springs stands. 5. Elastisches Implantat nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß der federnde Körper aus Gummi oder einem gummiartigen Material oder einem Elastomer besteht.5. Elastic implant according to claim 1 or 2, characterized in that the resilient body made of rubber or a rubber-like Material or an elastomer. 6. Elastisches Implantat nach einem der Ansprüche 1 bis 5, dadurch gekennzeichnet, daß einer der beiden Stäbe (1, 5) an seinem zweiten Ende eine ellipsoid- oder kugelförmige Verdickung (14) trägt und im andern Stab (5, 1) ausgehend von seinem zweiten Ende ein Gewinde eingeschnitten ist, auf das eine ellipsoid- oder kugelförmige Mutter (2) aufgeschraubt werden kann. 6. Elastic implant according to one of claims 1 to 5, characterized in that one of the two rods ( 1 , 5 ) carries at its second end an ellipsoidal or spherical thickening ( 14 ) and in the other rod ( 5 , 1 ) starting from a thread is cut into its second end onto which an ellipsoidal or spherical nut ( 2 ) can be screwed. 7. Elastisches Implantat nach Anspruch 3, dadurch gekennzeichnet, daß
  • - als Verankerungselemente Pedikelschrauben mit einem Ge­ windeschaft und einem Schraubenkopf eingesetzt werden, deren Schraubenkopf eine axialsymmetrisch angeordnete zylinderförmige Ausnehmung enthält, deren Durchmesser größer ist als der Durchmesser der Verdickung und/oder der Mutter, und
  • - in der Mantelfläche der zylinderförmigen Ausnehmung min­ destens ein parallel zur Schraubenachse verlaufender Schlitz vorgesehen ist, dessen Breite und Höhe minde­ stens dem Durchmesser der Stäbe entspricht.
7. Elastic implant according to claim 3, characterized in that
  • - Pedicle screws are used as anchoring elements with a threaded shaft and a screw head, the screw head of which contains an axially symmetrically arranged cylindrical recess, the diameter of which is larger than the diameter of the thickening and / or the nut, and
  • - In the lateral surface of the cylindrical recess min least a parallel to the screw axis slot is provided, the width and height of which corresponds at least to the diameter of the rods.
8. Elastisches Implantat nach Anspruch 7, dadurch gekennzeichnet, daß die zylinderförmige Ausnehmung mit einem Innengewinde ver­ sehen ist, in das sich eine Verschlußschraube eindrehen läßt.8. Elastic implant according to claim 7, characterized in that ver the cylindrical recess with an internal thread can be seen in which screw a screw plug leaves.
DE19924239716 1992-11-26 1992-11-26 Elastic implant for stabilising degenerated spinal column segments Expired - Fee Related DE4239716C1 (en)

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Application Number Priority Date Filing Date Title
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