US 20020198598 A1
A dynamic bone fusion device for facilitating fusion between bone sections, particularly vertebrae, is selected having certain stiffness to induce specific strain conditions associated with high success rates in bone fusion. Temporary stiffeners that are absorbable by the body may be implemented with the fusion device.
 The present application claims priority from U.S. application Ser. No. 09/545,949 filed Apr. 10, 2000, now U.S. Pat. No. 6,395,033 B1, the disclosure of which is hereby incorporated by reference herein.
 The present invention relates to dynamic bone fusion devices and associated techniques and, more particularly, to such fusion devices and associated techniques for effecting optimal spinal fusion.
 It is known generally that, according to Wolff's law, every change in the form and function of a bone, or in its function alone, is followed by certain definite changes in its internal architecture and secondary alterations in its external conformation. (Stedman's Medical Dictionary, 26th Ed., 1995.) Based on this principle and others, dynamic bone fusion devices and procedures are designed to simulate strain conditions in which compressive forces are applied to the junction of bone segments to be fused, thereby initiating and sustaining fusion.
 The success rates of fusion depend on a variety of factors including the location and types of bones to be fused, and the techniques and devices used. There currently does not exist specific available data and correlating guidelines on the types of devices and techniques that, for a given set of parameters, provides ideal or optimum strain or loading conditions to initiate and sustain high success rate dynamic fusion. Nor does there currently exist specific available data for identifying ideal strain and loading conditions for vertebral dynamic fusion.
 It is an object of the present invention to provide devices and associated techniques for initiating and sustaining optimum dynamic bone fusion procedures and, particularly, such procedures for vertebral fusion. These objects and others are achieved by the present invention described herein.
 The present invention is directed to dynamic fusion devices, such as spinal implant devices for vertebral fusion, that are selected within the parameters of available data and modeling to determine optimum ranges of strain and loading for initiating and sustaining highly successful rates of fusion. In summary, various available data for a variety of fusion cases has been analyzed and is used as a basis for modeling the fusion conditions of vertebrae. Specifically, data available from intra medullary nail systems is used with beam deflection principles to arrive at stiffness constants and applicable strain conditions for ideal states in which high fusion success rates are likely.
FIG. 1 is a table illustrating bone fusion strain ranges and corresponding ossification characteristics.
FIG. 2 is a schematic, side view of an intervertebral dynamic fusion device implanted between adjacent vertebrae according to the present invention.
FIG. 3 is a table illustrating strain properties associated with typical bone fusion devices.
FIG. 4 is a schematic, side view of an intervertebral dynamic fusion device implanted between adjacent vertebrae and having absorbable stiffening elements according to the present invention.
 Applying Wolff's Law and analyzing data from various studies on bone mechanostat reaction to various strain rates, the present invention dynamic fusion device and its properties can be modeled. An active zone for achieving successful rates of bone fusion is generally in the range of 0.0008-0.002 unit bone surface strain. (Frost, H. M., Clin Orthop May 1983, 286-92.) Microstrains of 1700 have been used to perform studies on cell response to mechanical stimuli. (Brighton et al., J Bone Joint Surg Am, September 1986, 78(9): 1337-47.) Differences in mediators at rates of 200, 400 and 1000 microstrain have been observed. (Brighton, JBJS 73A, March 1991, 320.) Data from tests applying a spatially uniform biaxial strain (1.3% applied strain) have been analyzed. (Toma, J Bone Miner Res, Oct. 12, 1997, 1626-36.)
 The highest strains were observed during distraction osteogenesis. Average maximum cyclic strains within the distraction zone during ambulation were estimated to be between 14% and 15%, and supported using fluoroscope imaging. These strains are higher than would be expected in spinal fusion, and thus serve as a high end limit for modeling. (Waanders et al., Clin Orthop, April 1993, (349) 225-34.) Magnitudes of local strain are indicative of the type of fracture healing. (Claes, J Biomech, March 1999, 32(3): 255-66.) As shown in FIG. 1, up to 4% strain had more osteoblast proliferation than non-strained bone. Intramembranous bone formation was found for strains smaller than approximately 5% and small hydrostatic pressure. Strains less than 15% and hydrostatic pressure more than 0.15 MPa stimulated endochondral ossification. Larger strains led to connective tissue. (Claes, Clin Orthop, October 1998, (355 Suppl) S132-47.)
 The strain-related variable which had the greatest influence on every remodeling parameter investigated was the ratio between the maximum strain rate of the artificial regime and the maximum strain rate during walking, or ambulation. The variation in this ratio accounts for approximately 70%-80% of the variation in the measurement of surface bone deposit. (O'Conner et al., J Biomech, 1982, 15(10): 767-81.)
 As a result of test data analysis and modeling using basic beam deflection equations for medullar nail systems, it is determined that the best range of strain for initiating and sustaining vertebral fusion between adjacent vertebrae for a dynamic fusion device 10 implanted between adjacent vertebrae 14 and 16 as shown schematically in FIG. 2, is 4-8%. Depending on other various factors including patient condition, the range may be expanded to 2-10% and, in less critical instances 0.5-15%. A schematic spring element 12 represents the stiffness constant element.
 Shown in FIG. 3, is a strain graph for various commercially available products including pedicle screws, vertebral implant cages, and long bone rods. Also included is the strain for a typical vertebral disc. As shown, the existing vertebral implants are outside of the target range of 0.5-15% strain, and certainly outside of the optimal range of 4-8%.
 The target or optimal ranges may be achieved by selecting dynamic fusion device materials and geometries that, together with physical parameters of the patient, create the ideal strain conditions identified above. As shown schematically in FIG. 4, a dynamic fusion device 10 for implanting between adjacent vertebrae 14 and 16 to be fused can be provided with compressive spring characteristics 12 along a vertical axis. Optionally, performance may be enhanced with features that initially maintain the stiffness of the device and gradually reduce overall stiffness. For example, polylactic acid inserts 18 designed to absorb after a predetermined time may be used to bolster the dynamic fusion device, adding stiffness and gradually reducing overall stiffness. Such a feature will, in appropriate instances, withhold excessive loading while ossification initiates and, after a desired period, increase the loading.
 While the preferred embodiment has been herein disclosed, it is understood and acknowledged that variation and modification to the preferred embodiment may be made without departing from the scope of the present invention.