DE3943485C1 - Vertebral surgical instrument - has cannula with feed for selected volume of fluid - Google Patents

Vertebral surgical instrument - has cannula with feed for selected volume of fluid

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Publication number
DE3943485C1
DE3943485C1 DE3943485A DE3943485A DE3943485C1 DE 3943485 C1 DE3943485 C1 DE 3943485C1 DE 3943485 A DE3943485 A DE 3943485A DE 3943485 A DE3943485 A DE 3943485A DE 3943485 C1 DE3943485 C1 DE 3943485C1
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Germany
Prior art keywords
cannula
fluid
surgical instrument
balloon
intervertebral disc
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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 - Lifetime
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DE3943485A
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German (de)
Inventor
Martin Dr.Med. 8000 Muenchen De Nolde
Thomas Dr.Med. Muri Bern Ch Markwalder
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Individual
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Individual
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Priority to DE3943485A priority Critical patent/DE3943485C1/en
Priority claimed from DE3922203A external-priority patent/DE3922203C1/en
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Publication of DE3943485C1 publication Critical patent/DE3943485C1/en
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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Classifications

    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4684—Trial or dummy prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • 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
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/441—Joints for the spine, e.g. vertebrae, spinal discs made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
    • 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
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2/4611—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • 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
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30405—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by screwing complementary threads machined on the parts themselves
    • 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
    • A61F2002/30581—Special structural features of bone or joint prostheses not otherwise provided for having a pocket filled with fluid, e.g. liquid
    • 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
    • A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/442—Intervertebral or spinal discs, e.g. resilient
    • A61F2002/444—Intervertebral or spinal discs, e.g. resilient for replacing the nucleus pulposus
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
    • A61F2002/4625—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use
    • A61F2002/4627—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4663—Measuring instruments used for implanting artificial joints for measuring volumes or other three-dimensional shapes
    • 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
    • A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4657—Measuring instruments used for implanting artificial joints
    • A61F2002/4666—Measuring instruments used for implanting artificial joints for measuring force, pressure or mechanical tension
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • 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
    • A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00389—The prosthesis being coated or covered with a particular material
    • A61F2310/00395—Coating or prosthesis-covering structure made of metals or of alloys
    • A61F2310/00407—Coating made of titanium or of Ti-based alloys

Abstract

Surgical instrument determines fluid filling for inserted vertebral disc prostheses. A cannula (7) should have an outside diameter smaller than the operation entry (4) in the disc fibre ring (3) and the front part of the canula should be enclosed in a flexible balloon (9) sealably fixed to the canula. A fluid feed device (12) introduces a preset volume of fluid through the canula into the balloon. USE/ADVANTAGE - Surgery, disc prosthesis Disc filled with preset fluid volume to simulate natural disc using canula and balloon metering device.

Description

Die vorliegende Erfindung betrifft ein chirurgisches Instrument zum Bestimmen der benötigten Größe einer Bandscheibenkernprothese, die einen mit einem Fluid befüllbaren Hüllkörper aufweist, der in einem unbefüllten oder nur teilweise mit dem Fluid befüllten Zustand in einen Zwischenwirbelraum einführbar und dort mit dem Fluid befüllbar ist, nach dem Oberbegriff des Patentanspruchs 1.The present invention relates to a surgical instrument to determine the required size of an intervertebral disc core prosthesis, the one can be filled with a fluid envelope has in an unfilled or only partially filled with the fluid in an intervertebral space is insertable and can be filled with the fluid there, according to Preamble of claim 1.

Nach der operativen Entfernung des natürlichen Bandscheibenkernes aus dem Zwischenwirbelraum bzw. Bandscheibenraum kommt es häufig zu einer Instabilität des betreffenden Bewegungs- Segments und zu Folgebeschwerden aufgrund einer Höhenminderung im vorderen Bereich dieses operiativen Bewegungs- Segmentes. Eine auch heute noch angewendete Operationstechnik bei anhaltenden Beschwerden dieser Art besteht in der Versteifung des betreffenden Segmentes.After the surgical removal of the natural intervertebral disc core from the intervertebral space or intervertebral disc space there is often instability of the movement in question Segments and subsequent complaints due to a Height reduction in the front area of this operative movement Segment. A surgical technique that is still used today with persistent complaints of this type in the stiffening of the segment concerned.

Um Abhilfe für die oben beschriebenen Probleme, die nach Entfernung des natürlichen Bandscheibenkernes auftreten, zu schaffen, sind bereits verschiedene Bandscheibenkernprothesen vorgeschlagen worden, die in der Patentliteratur näher erläutert sind. To remedy the problems described above Removal of the natural intervertebral disc core occur, too create, are already different intervertebral disc core prostheses have been proposed in the patent literature are explained.  

Eine derartige Nucleusprothese oder Bandscheibenkernprothese ist bereits aus der US-A 38 75 595 bekannt. Die bekannte Bandscheibenkernprothese hat einen mit einem Fluid befüllbaren Hüllkörper, der in einem unbefüllten Zustand dorsal in einer nicht näher beschriebenen Art in den Zwischenwirbelraum einführbar sein soll. Zum Schutz der benachbarten Nerven und Gefäßstrukturen erfolgt die Einführung der erschlafften, unbefüllten Bandscheibenkernprothese durch ein transparentes Rohr, das bis an den rückwärtigen Bereich der Wirbelkörper heranreicht und vor dem Bandscheibenfaserring endet. Vor Einführung des Hüllkörpers werden in die Wirbelkörper vom Zwischenwirbelraum aus hohle Zentrierungsstifte eingepreßt, in die Fortsätze des Hüllkörpers zu dessen Positionierung und Lagesicherung eingreifen sollen, wenn dieser mit Fluid befüllt wird. Die Fluidbefüllung dieser bekannten Bandscheibenkernprothese erfolgt über eine Röhre, die an einem Ventilbereich des Hüllkörpers mündet. Ein Grund dafür, daß sich diese in der Patentliteratur beschriebene Band­ scheibenkernprothese in der Praxis nicht durchsetzen konnte, liegt darin, daß diese Art einer Prothese nur dann ein mechanisch stabiles Verhalten zeigt, wenn der Hüllkörper von dem Fluid prall ausgefüllt wird, was jedoch ohne Deformation des Bandscheibenfaserringes nur dann denkbar ist, wenn das Volumen und die Form der Prothese genau mit der Gestalt des Hohlraumes übereinstimmt, der durch Extraktion des prolabierten Bandscheibenfaserring-Materials und partielle Ausräumung des Zwischenwirbelraumes erzeugt ist. Ist jedoch der Hüllkörper beispielsweise geringfügig größer als der Hohlraum im Zwischenwirbelbereich, so führt dessen Fluidbefüllung nicht zur Erzeugung eines faltenfreien, prall-elastischen Kissens mit einem Verhalten, das dem mechanischen Verhalten des natürlichen Bandscheibenkernes entspricht.Such a nucleus prosthesis or intervertebral disc core prosthesis is already known from US-A 38 75 595. The well-known Intervertebral disc core prosthesis has a fluid that can be filled with it Envelope that dorsally in in an unfilled state of a kind not described in detail in the intervertebral space should be able to be introduced. To protect the neighboring nerves and vascular structures, the slack, unfilled intervertebral disc core prosthesis by a transparent tube that extends to the rear of the Vertebral body reaches and in front of the disc fiber ring ends. Before introducing the enveloping body into the vertebral body Hollow centering pins from the intervertebral space pressed into the extensions of the enveloping body for its positioning and position security should intervene if this is filled with fluid. The fluid filling of this known Intervertebral disc core prosthesis is carried out via a tube a valve area of the envelope body opens. One reason that this band described in the patent literature disc core prosthesis could not get through in practice, lies in the fact that this type of prosthesis is only a shows mechanically stable behavior when the envelope of the fluid is filled to the brim, but without deformation the disc fiber ring is only conceivable if that Volume and shape of the prosthesis exactly with the shape of the Cavity coincides by extraction of the prolapsed Intervertebral disc fiber ring material and partial clearance of the intervertebral space is generated. However, it is Envelope body, for example, slightly larger than the cavity in the intervertebral area, its fluid filling leads not to create a wrinkle-free, plump-elastic Pillow with a behavior that is mechanical Behavior of the natural intervertebral disc core corresponds.

Gegenüber diesem Stand der Technik liegt der vorliegenden Erfindung die Aufgabe zugrunde, ein chirurgisches Instrument zu schaffen, mit dem sichergestellt werden kann, daß eine implantierte Bandscheibenkernprothese der oben beschriebenen Art soweit als möglich dem mechanischen Verhalten des natürlichen Bandscheibenkernes entspricht.The present is in relation to this prior art Invention based on the object of a surgical instrument to create, with which it can be ensured that a implanted intervertebral disc core prosthesis of the type described above  Kind as far as possible the mechanical behavior of the natural Intervertebral disc core corresponds.

Diese Aufgabe wird durch ein chirurgisches Instrument nach dem Oberbegriff des Patentanspruchs 1 durch die im kennzeichnenden Teil des Patentanspruchs 1 angegebenen Merkmale gelöst.This task is performed by a surgical instrument the preamble of claim 1 by the in the characterizing Part of claim 1 specified features solved.

Die Erfindung schafft erstmals ein chirurgisches Instrument zum Bestimmen der benötigten Größe einer Bandscheibenkernprothese, die einen mit einem Fluid befüllbaren Hüllkörper aufweist.The invention creates a surgical instrument for the first time to determine the required size of an intervertebral disc core prosthesis, the one can be filled with a fluid envelope having.

Der Erfindung liegt die Erkenntnis zugrunde, daß die unbefriedigenden mechanischen Eigenschaften der bekannten, fluidbefüllbaren Bandscheibenkernprothese aus einer nicht optimalen Anpassung der jeweils verwendeten Bandscheibenkernprothese an den Hohlraum im Zwischenwirbelbereich herrühren. Die Erfindung löst diese Problematik durch Schaffung eines chirurgischen Instrumentes zum Bestimmen der benötigten Größe einer mit Fluid befüllbaren Bandscheibenkernprothese mit einer Kanüle, deren Außendurchmesser geringer als die Abmessung eines Operationszuganges im Bandscheibenfaserring ist, welche einen den vorderen Bereich der Kanüle umgebenden, elastischen Ballon aufweist, der an der Kanüle dichtend befestigt ist, und welche ferner mit einer Fluidzuführvorrichtung versehen ist, mit der eine volumenmäßig bestimmbare Fluidmenge durch die Kanüle zu dem in den Bereich des Ballons zuführbar ist.The invention is based on the finding that the unsatisfactory mechanical properties of the known fluid-filled intervertebral disc core prosthesis from a non optimal adaptation of the intervertebral disc core prosthesis used in each case touch the cavity in the intervertebral region. The invention solves this problem by creating of a surgical instrument for determining the required size with one Fluid fillable disc prosthesis with a cannula, whose outer diameter is smaller than the dimension of a Operation access in the intervertebral disc ring is which an elastic surrounding the front area of the cannula Has balloon that sealingly attached to the cannula and which further includes a fluid supply device is provided with a volume of fluid that can be determined by volume through the cannula to the in the area of the balloon is feedable.

Die im Anspruch 2 beschriebene Ausgestaltung der Fluidzuführvorrichtung durch eine Spritze ermöglicht nicht nur die gleichzeitige Volumenbestimmung der zugeführten Fluidmenge durch einfache Sichtanzeige, sondern auch die abschließende Entfernung der dem Ballon zugeführten Fluidmenge nach Durchführung der Volumenmessung. The embodiment of the fluid supply device described in claim 2 made possible by a syringe not only the simultaneous volume determination of the supplied Fluid quantity through simple visual display, but also the final removal of the amount of fluid delivered to the balloon after performing the volume measurement.  

Die ballige Ausgestaltung der Kanüle gemäß Anspruch 3 verhindert eine mechanische Beeinträchtigung oder Zerstörung des Ballones bei der Handhabung der Sonde.The spherical configuration of the cannula is prevented according to claim 3 a mechanical impairment or destruction of the balloon when handling the probe.

Die Manschette mit der in Anspruch 4 angegebenen Struktur erzeugt einen sicheren Abschluß der Sonde am Operationszugang im Bandscheibenfaserring, wodurch der auszumessende Hohlraum eine klare Begrenzung erfährt. Dies trägt zur Steigerung der Meßgenauigkeit bei.The cuff with the structure specified in claim 4 creates a secure closure of the probe at the access to the operation in the intervertebral disc fiber ring, whereby the one to be measured Cavity is clearly defined. This contributes to the increase the measuring accuracy at.

Die Anordnung wenigstens einer Durchgangsöffnung nach Anspruch 5, die durch zackenförmige Ausnehmungen der Manschette gebildet sein kann, gewährleistet ein Entweichen von Luft und gegebenenfalls Blut aus dem Hohlraum im Zwischenwirbelbereich, um Verfälschungen des Meßergebnisses durch Luftrückstände oder Blutrückstände in dem auszumessenden Hohlraum auszuschließen.The arrangement of at least one through opening according to claim 5, through the serrated recesses of the cuff can be formed, ensures escape of Air and possibly blood from the cavity in the intervertebral region, to falsify the measurement result Air residues or blood residues in the measured Exclude cavity.

Letztlich bewirkt die in Anspruch 6 definierte Ausgestaltung des Ballones, daß dieser sich zunächst an die Wandbereiche des Hohlraumes im Zwischenwirbelbereich anlegt, die dem Operationszugang im Bandscheibenfaserring gegenüberliegen, so daß ein Herausdrängen von Luft, Flüssigkeiten und Blut aus dem auszumessenden Hohlraum während des Auffüllens des Ballones erzielt wird.Ultimately, the configuration defined in claim 6 brings about of the balloon, that this is initially to the Creates wall areas of the cavity in the intervertebral area, which are opposite the operation access in the intervertebral disc ring, so that air, liquids and Blood from the cavity to be measured during filling of the balloon is achieved.

Nachfolgend wird unter Bezugnahme auf die beiliegenden Zeichnungen eine bevorzugte Ausführungsform der Sonde zum Bestimmen der benötigten Größe einer mit Fluid befüllbaren Bandscheibenkernprothese näher erläutert. Es zeigtThe following will refer to the accompanying Drawings a preferred embodiment of the probe for Determine the required size of a fluid fillable Intervertebral disc core prosthesis explained in more detail. It shows

Fig. 1 eine Ausführungsform der erfindungsgemäßen Sonde bei ihrer Einführung in einen Zwischenwirbelraum, teilweise in Schnittdarstellung; Fig. 1 shows an embodiment of the probe according to the invention when introduced into an intervertebral space, partly in section;

Fig. 2 eine Längsschnittdarstellung eines Abschnittes der Ausführungsform des chirurgischen Instrumente gemäß Fig. 1 im Bereich ihrer Manschette; und FIG. 2 shows a longitudinal sectional illustration of a section of the embodiment of the surgical instrument according to FIG. 1 in the region of its cuff; and

Fig. 3 eine Querschnittsdarstellung durch die Ausführungsform des chirurgischen Instruments gem. Fig. 1 im Bereich der Manschette. Fig. 3 is a cross-sectional view through the embodiment of the surgical instrument acc. Fig. 1 in the area of the cuff.

Wie in Fig. 1 gezeigt ist, liegt zwischen zwei Wirbelkörpern 1, 2 ein Bandscheibenfaserring 3, der normalerweise den (in Fig. 1 nicht gezeigten) Bandscheibenkern umschließt. Nach erfolgter Extraktion des prolabierten Bandscheibenkern-Materiales und Bandscheibenfaserring-Materiales durch den dorsalen Operationszugang 4 entsteht im Zwischenwirbelbereich ein Hohlraum oder Zwischenwirbelraum 5. Zum Bestimmen der benötigten Größe einer mit Fluid befüllbaren Bandscheibenkernprothese (nicht dargestellt) wird die in Fig. 1 gezeigte Ausführungsform des chirurgischen Instruments verwendet, das in seiner Gesamtheit mit dem Bezugszeichen 6 bezeichnet ist. Das chirurgische Instrument umfaßt eine Kanüle 7, deren Außendurchmesser geringer ist als die Abmessung des Operationszuganges 4 durch den Bandscheibenfaserring 3, und die an ihrem vorderen Ende eine ballige Abrundung 8 aufweist. Das chirurgische Instrument 6 ist an ihrem vorderen Bereich von einem elastischen Ballon 9 umgeben, der mit der Kanüle 7 über eine konische oder kegelstumpfförmige Manschette 10 in dichtender Verbindung steht.As shown in FIG. 1 , an intervertebral disc fiber ring 3 lies between two vertebral bodies 1, 2 , which ring normally surrounds the intervertebral disc core (not shown in FIG. 1). After extraction of the prolapsed intervertebral disc core material and intervertebral disc fiber ring material through the dorsal operation access 4 , a cavity or intervertebral space 5 is created in the intervertebral region. To determine the required size of a fluid-filled intervertebral disc core prosthesis (not shown), the embodiment of the surgical instrument shown in FIG. 1 is used, which is designated in its entirety by reference number 6 . The surgical instrument comprises a cannula 7 , the outer diameter of which is smaller than the dimension of the surgical access 4 through the intervertebral disc fiber ring 3 , and which has a spherical rounded portion 8 at its front end. The surgical instrument 6 is surrounded on its front area by an elastic balloon 9 which is in sealing connection with the cannula 7 via a conical or frustoconical sleeve 10 .

Wie insbesondere in Fig. 2 zu erkennen ist, nimmt der Durchmesser der Manschette 10 in Richtung zu dem hinteren, von der balligen Abrundung 8 abgewandten Ende zu.As can be seen in particular in FIG. 2, the diameter of the sleeve 10 increases in the direction of the rear end facing away from the spherical rounded portion 8 .

Bei der gezeigten Ausführungsform hat die Manschette eine Querschnittsform, die als zackenförmig oder sternförmig ausgestaltet ist, wie dies insbesondere der Fig. 3 zu entnehmen ist. Hierdurch wird eine Mehrzahl von Öffnungen 11 festgelegt, die auch bei festem Anliegen der Peripherie der Manschette 10 am Operationszugang 4 ein in Achsrichtung der Kanüle 7 erfolgendes Durchtreten von Luft, Blut oder sonstigen Flüssigkeiten aus dem Zwischenwirbelraum ermöglichen. Der Ballon 9 weist vorzugsweise einen derartigen stetigen Elastizitätsverlauf auf, daß dieser im Kanülenspitzenbereich leichter dehnbar ist als im Bereich seiner Befestigung an der Kanüle 7.In the embodiment shown, the cuff has a cross-sectional shape that is designed as a jagged or star-shaped, as can be seen in particular in FIG. 3. As a result, a plurality of openings 11 are defined, which allow air, blood or other liquids to pass through the intervertebral space in the axial direction of the cannula 7 even when the periphery of the cuff 10 is firmly in contact with the operation access 4 . The balloon 9 preferably has such a constant elasticity curve that it is easier to stretch in the cannula tip area than in the area of its attachment to the cannula 7 .

Das chirurgische Instrument umfaßt ferner eine Fluidzuführvorrichtung 12, die bei der in Fig. 1 gezeigten bevorzugten Ausführungsform durch eine handelsübliche Spritze gebildet wird.The surgical instrument further includes a fluid delivery device 12 which, in the preferred embodiment shown in FIG. 1, is formed by a commercially available syringe.

Nach Plazierung des Ballons 9 innerhalb des vom Bandscheibenfaserring 3 umschlossenen Zwischenwirbelraumes 5 wird der Ballon 9 durch Betätigung der Spritze 12 mit einem Fluid gefüllt, das vorzugsweise ein sterilisierbares Röntgenkontrastmittel ist. Die Füllung erfolgt, bis ein vorbestimmter Füllungsgrad und Füllungsdruck erreicht ist. Durch den oben erläuterten Elastizitätsverlauf des Ballones 9 wird im Zwischenwirbelraum 5 befindliche Luft oder Blut oder sonstige Flüssigkeiten zum Operationszugang 4 gedrängt, wo diese Medien durch die Öffnungen 11 heraustreten. Nach Erreichen des vorbestimmten Füllungsdruckes, der bei Verwenden einer Spritze 12 durch den von Hand spürbaren Gegendruck der Spritzenbetätigung bestimmbar ist, wird das injizierte Volumen des Röntgenkontrastmittels abgelesen. Aus diesem Volumen zuzüglich des im Hohlraum befindlichen Volumenanteiles des Ballones 9 sowie der Kanüle 7 abzüglich des in der zuführenden Kanüle 7 befindlichen Flüssigkeitsvolumens kann das Hohlraumvolumen im Zwischenwirbelraum 5 und damit die erforderliche Prothesengröße abgeleitet werden. Anschließend wird durch absaugende Betätigung der Spritze 12 die Flüssigkeit aus dem System abgezogen und das chirurgische Instrument 6 durch den Operationszugang 4 aus dem Zwischenwirbelraum 5 herausgezogen.After placement of the balloon 9 within the intervertebral space 5 enclosed by the intervertebral disc fiber ring 3 , the balloon 9 is filled by actuating the syringe 12 with a fluid, which is preferably a sterilizable x-ray contrast medium. The filling takes place until a predetermined filling level and filling pressure is reached. Through the above-explained history elasticity of the balloon 9 5 aerial or blood or other fluids to the surgical access 4 is urged in the intervertebral space, where these media out through the openings. 11 After reaching the predetermined filling pressure, which can be determined when using a syringe 12 by means of the hand pressure of the syringe actuation which can be felt by hand, the injected volume of the x-ray contrast medium is read off. The void volume in the intervertebral space 5 and thus the required prosthesis size can be derived from this volume plus the volume fraction of the balloon 9 and the cannula 7 located in the cavity minus the liquid volume located in the supplying cannula 7 . The liquid is then withdrawn from the system by suction actuation of the syringe 12 and the surgical instrument 6 is withdrawn from the intervertebral space 5 through the access 4 .

Nach den Operationsschritten der Entfernung des prolabierten Bandscheibenkern-Materiales und des Bandscheibenfaserring- Materiales und der partiellen Ausräumung des Zwischenwirbelraumes 5 wird nach der eingangs beschriebenen Bestimmung der geeigneten Prothesengröße eine Bandscheibenkernprothese von derartiger Größe mittels einer Einführvorrichtung durch den Operationszugang 4 im Bandscheibenfaserring 3 in denZwischenwirbelraum 5 implantiert.According to the operation steps of removing the prolapsed disc nucleus material and the Bandscheibenfaserring- material, and the partial removal of the intervertebral space 5 a prosthetic disc nucleus of such a size by means of an introducer through the surgical access 4 in the disc annulus 3 in denZwischenwirbelraum 5 is implanted after the initially described Determination of the proper prosthesis size .

Claims (6)

1. Chirurgisches Instrument zum Bestimmen der benötigten Größe einer Bandscheibenkernprothese, die einen mit einem Fluid befüllbaren Hüllkörper aufweist, der in einem unbefüllten oder nur teilweise mit dem Fluid befüllten Zustand in einen Zwischenwirbelraum einführbar und dort mit dem Fluid befüllbar ist,
gekennzeichnet durch
eine Kanüle (7), deren Außendurchmesser geringer als die Abmessung eines Operationszuganges (4) im Bandscheibenfaserring (3) ist,
einen einen vorderen Bereich der Kanüle (7) umgebenden elastischen Ballon (9), der an der Kanüle (7) dichtend befestigt ist, und
eine Fluidzuführvorrichtung (12) zum Zuführen einer volumenmäßig bestimmbaren Fluidmenge durch die Kanüle (7) zu dem Innenbereich des Ballons (9).1. Surgical instrument for determining the required size of an intervertebral disc core prosthesis which has an envelope body which can be filled with a fluid and which can be inserted into an intervertebral space in an unfilled or only partially filled state with the fluid, and can be filled there with the fluid.
marked by
a cannula ( 7 ), the outer diameter of which is smaller than the dimension of an operation access ( 4 ) in the intervertebral disc fiber ring ( 3 ),
an elastic balloon ( 9 ) which surrounds a front region of the cannula ( 7 ) and is sealingly fastened to the cannula ( 7 ), and
a fluid supply device ( 12 ) for supplying a volume-definable amount of fluid through the cannula ( 7 ) to the inner region of the balloon ( 9 ). 2. Chirurgisches Instrument nach Anspruch 1, dadurch gekennzeichnet, daß die Fluidzuführvorrichtung durch eine mit der Kanüle (7) verbindbare Spritze (12) gebildet ist. 2. Surgical instrument according to claim 1, characterized in that the fluid supply device is formed by a syringe ( 12 ) which can be connected to the cannula ( 7 ). 3. Chirurgisches Instrument nach Anspruch 1 oder 2, dadurch gekennzeichnet, daß die Kanüle (7) an ihrem ballonseitigen Ende eine ballige Abrundung (8) aufweist.3. Surgical instrument according to claim 1 or 2, characterized in that the cannula ( 7 ) has a spherical rounded portion ( 8 ) at its end on the balloon side. 4. Chirurgisches Instrument nach einem der Ansprüche 1 bis 3, gekennzeichnet durch eine konische oder kegelstumpfförmige Manschette (10), die die Kanüle (7) im Befestigungsbereich des Ballons (9) umgibt.4. Surgical instrument according to one of claims 1 to 3, characterized by a conical or frustoconical sleeve ( 10 ) which surrounds the cannula ( 7 ) in the fastening region of the balloon ( 9 ). 5. Chirurgisches Instrument nach Anspruch 4, dadurch gekennzeichnet, daß die Manschette (10) wenigstens eine Durchgangsöffnung (11) in Richtung der Kanülenlängserstreckung aufweist.5. Surgical instrument according to claim 4, characterized in that the sleeve ( 10 ) has at least one through opening ( 11 ) in the direction of the longitudinal cannula extension. 6. Chirurgisches Instrument nach einem der Ansprüche 1 bis 5, dadurch gekennzeichnet, daß die Wand des Ballons (9) einen derartigen stetigen Elastizitätsverlauf aufweist, daß der Ballon (9) im Kanülenspitzenbereich leichter dehnbar als im Bereich seiner Befestigung an der Kanüle (7) ist.6. Surgical instrument according to one of claims 1 to 5, characterized in that the wall of the balloon ( 9 ) has such a continuous course of elasticity that the balloon ( 9 ) in the cannula tip area is more easily stretchable than in the area of its attachment to the cannula ( 7 ) is.
DE3943485A 1989-07-06 1989-07-06 Vertebral surgical instrument - has cannula with feed for selected volume of fluid Expired - Lifetime DE3943485C1 (en)

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DE3943485A DE3943485C1 (en) 1989-07-06 1989-07-06 Vertebral surgical instrument - has cannula with feed for selected volume of fluid

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DE3943485A DE3943485C1 (en) 1989-07-06 1989-07-06 Vertebral surgical instrument - has cannula with feed for selected volume of fluid
DE3922203A DE3922203C1 (en) 1989-07-06 1989-07-06 Surgical instrument for the implantation of an intervertebral disc core prosthesis

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Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2002047563A1 (en) * 2000-12-15 2002-06-20 The Spineology Group, Llc. Tool to direct bond replacement material
DE102004030347A1 (en) * 2004-06-18 2006-01-19 Aesculap Ag & Co. Kg implant
WO2007092851A1 (en) * 2006-02-08 2007-08-16 Warsaw Orthopedic, Inc. Constrained balloon disc sizer

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3875595A (en) * 1974-04-15 1975-04-08 Edward C Froning Intervertebral disc prosthesis and instruments for locating same

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3875595A (en) * 1974-04-15 1975-04-08 Edward C Froning Intervertebral disc prosthesis and instruments for locating same

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2002047563A1 (en) * 2000-12-15 2002-06-20 The Spineology Group, Llc. Tool to direct bond replacement material
AU2001273680B2 (en) * 2000-12-15 2006-05-18 The Spineology Group, Llc Tool to direct bond replacement material
DE102004030347A1 (en) * 2004-06-18 2006-01-19 Aesculap Ag & Co. Kg implant
DE102004030347B4 (en) * 2004-06-18 2006-08-03 Aesculap Ag & Co. Kg implant
US7670378B2 (en) 2004-06-18 2010-03-02 Aesculap Ag Implant for insertion into a bone cavity or between vertebral bodies
WO2007092851A1 (en) * 2006-02-08 2007-08-16 Warsaw Orthopedic, Inc. Constrained balloon disc sizer

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