WO1995022291A1 - Occipito-cervical osteosynthesis instrumentation - Google Patents
Occipito-cervical osteosynthesis instrumentation Download PDFInfo
- Publication number
- WO1995022291A1 WO1995022291A1 PCT/IB1995/000095 IB9500095W WO9522291A1 WO 1995022291 A1 WO1995022291 A1 WO 1995022291A1 IB 9500095 W IB9500095 W IB 9500095W WO 9522291 A1 WO9522291 A1 WO 9522291A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- cervical
- plate
- rod
- occipital
- occiput
- Prior art date
Links
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
- A61B17/7055—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant connected to sacrum, pelvis or skull
-
- 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
- A61B17/7056—Hooks with specially-designed bone-contacting part
Definitions
- the present invention relates to an occipito-cervical osteosynthesis instrumentation and a hook adapted to be part of this instrumentation. It is known that in the orthopaedic surgery of the cervical spine, when an instrumentation is required to realize an occipito-cervical artrodesis, the surgeon usually employs an instrumentation composed of plates and screws. There has thus been put on the market an assembly having the general shape of a horseshoe consisting of two rods in one piece with a curved connection plate, the rods being knurled and disposed in the cervical part, while the curved plate is in the occipital part. The fastening to the cervical vertebrae is achieved by thoracic and pediatric laminar hooks, whereas the connection of the plate to the occiput is achieved by a plurality of screws.
- This device has a drawback in that it cannot be shaped in a satisfactory manner to the anatomical configuration of the patient, above all in the cervical part. Indeed, it is difficult to adapt the distance between the two rods in the cervical part while achieving an appropriate bending of the incurvate connection plate.
- the means for connecting these various plates to the bone comprise the following elements: a) articular screws (inserted in the articular massives) and occipital screws, b) occipital screws and laminar hooks bearing against the vertebrae, c) metal wires constituting a bone lacing.
- the screwed plates provide a solid occipito-cervical connection, but have some drawbacks: indeed, some are difficult to bend to the required curvature and have a fixed distance between the two rods of the cervical part. Others have a connection with the bone such as lacing, which is incompatible with laminectomies and lacks solidity, and are difficult to place in position.
- An object of the invention is to provide an occipito- cervical instrumentation which is arranged in such manner as to enable it to be better adaptable to the occipito- cervical anatomy of the patient, and which largely reduces projections under the skin.
- the occipito-cervical instrumentation comprises: a) two separate similar parts, namely a right and a left part, each formed by a cervical rod having asperities and an elongate occipital plate which forms one piece with said rod and extends said rod toward the occiput in the position of use, b) adjustable means for anchoring the rod to the vertebrae and the plate to the occiput, c) each part being so preangulated and shaped as to be adapted to the anatomy of the occipito-cervical connection.
- the ends of the two occipital plates are not interconnected, which permits easily shaping them to the occipital anatomy of the patient, in the same way as the rods having asperities with which they respectively form one piece.
- the invention therefore affords the surgeon an improved flexibility and greater facility of adaptation of the assembly to the anatomical particularities of the patient.
- This instrumentation may be advantageously completed by a transverse connection device which is positioned, either at the cervical level, or at the base of the occiput, by interconnecting the rods having asperities.
- each rod has two substantially rectilinear sections making therebetween an angle of between about 70 and 90°, with a small angulation radius, one of the sections being shorter than the other and connected to the occipital plate, which is so bent as to correspond to the curvature of the occipital shell, the shortest rod section extending along the base of the occiput in the position of use.
- a "small” radius is intended to mean for example a radius of about 4 mm.
- an oblong opening and a circular opening are formed in each elongate occipital plate and adapted to receive hooks and/or screws for fixing the plate to the occiput, it being possible to fix the hooks in different positions in the oblong openings.
- the circular opening and the oblong opening may be replaced by three circular openings.
- said adjustable anchoring means comprise, for each occipital plate , a hook having a laminar portion adapted to the shape of the occipito-cervical lamina, and a body which has a small height relative to its width and in which is provided a groove for receiving and guiding an occipital plate, a tapped hole being provided in said body in facing relation to the oblong opening or to the circular opening of the plate for receiving a screw fixing the plate to the hook.
- the head of the screw has a shape corresponding to a spotfacing formed around the periphery of the oblong opening and can in this way be made flush with the end surface of the hook and with the surface of the plate.
- the small thickness of the body of the hook achieved by means of this configuration reduces the overall size of the device and consequently in large part eliminates the projection under the skin created by certain screws in prior instrumentations (screws having a U-shaped open body and an internally threaded plug or a screw having a closed body) .
- Fig. 1 is a longitudinal elevational view of a cervical rod having asperities extended by an occipital plate before the bending of the rod and representing a first embodiment of the invention.
- Fig. 2 is a longitudinal elevational view of the rod- plate shown in Fig. 1 in another direction.
- Fig.3 is a side elevational view of the rod-plate shown in Figs. 1 and 2, after its occipital part has been bent.
- Fig. 4 is a half-sectional and half-elevational detail view of an opening in the occipital plate shown in Figs. 1 to 3.
- Fig. 5 is a half-sectional and half-elevational view to a larger scale of an embodiment of an occipital hook with which the plate shown in Figs. 1 to 4 may be equipped for connecting it to the occiput.
- Fig. 6 is a side elevational view of the laminar hook shown in Fig. 5.
- Fig. 7 is a top plan view of the occipital hook shown in Figs. 5 and 6.
- Fig. 8 is an elevational view to a smaller scale of an embodiment of the occipito-cervical instrumentation according to the invention, mounted on the first cervical vertebrae and on the occiput of a patient.
- Fig. 9 is a side elevational view of the instrumentation, of the cervical vertebrae and of the occiput shown in Fig. 8.
- Fig. 10 is an elevational view to a smaller scale of the rod-plate shown in Fig. 3, the cervical rod being provided with two laminar hooks for fixing it to the cervical vertebrae.
- Fig. 11 is a view similar to Fig. 10 of the cervical rod provided with articular screws for fixing to the vertebrae.
- Fig. 12 is an elevational view of a second embodiment of the instrumentation according to the invention mounted on the first cervical vertebrae and on the occiput of a patient.
- Fig. 13 is a partial side elevational view of a third embodiment of the instrumentation according to the invention in which the occipital part is fixed to the occiput by hooks.
- Figs. 14 and 15 are partial side elevational views similar to Fig. 13 of two other embodiments of the instrumentation according to the invention.
- Fig. 16 is a partial elevational of an alternative embodiment of the rod-plate shown in Fig. 1.
- the occipito-cervical osteosynthesis instrumentation shown in Figs. 1 to 9 comprises two separate parts, namely a left part 1 and a right part 2 respectively (Figs. 8 and 9 being views of the back of the patient), which are identical as manufactured.
- Each part is formed by a cervical rod 3 having asperities 4, such as knurling or diamond points, and an elongate occipital plate 5. The latter forms one piece with the rod 1 (2) and extends it toward the occiput 6 in the position of use.
- the instrumentation further comprises adjustable means for anchoring the rod 1, 2 to the vertebrae Cl, C2, C3 and the plate 5 to the occiput 6, each part 1 and 2 being so angulated and shaped as to be adapted to the anatomy of the occipito-cervical connection.
- each rod 1, 2 consists of two substantially rectilinear sections 7 and 8 making therebetween an angle A of between about 70° and 90° (Fig. 3).
- the occipital section 8 of the rod has a length much shorter than that of the cervical section 7 of the rod and is connected to the occipital plate 5. The latter is so bent as to have the shape 5a (Fig. 3) to enable it to correspond to the curvature of the occipital shell.
- the rod section 8 connected to the plate 5 is adapted to extend along the base of the occiput 6 in the position of use.
- each elongate plate 5 Formed in each elongate plate 5 are an oblong opening 9 and a circular opening 11, the latter being provided in the vicinity of the junction between the plate 5 and the end portion 8 of the rod 3. chamfers 12, 13 are machined around the openings 9 and 11 respectively.
- the occipital plate 5 is connected to the adjacent section 8 of the rod 3 in a continuous manner by a junction portion 14 adjacent to the occipital bone 6 and by rounded fillets 15 on the opposite side. Thus, any change in level between the rod 3 and the plate 5 adjacent to the occiput is avoided.
- Figs. 5 to 7 show a laminar hook 16 which comprises a laminar or plate portion 17 whose curvature is adapted to the thickness of the occipito-cervical shell, and a body 18 whose height h is small relative to its width L (Fig. 5).
- a groove 19 is delimited by two parallel branches 21 of the body 18 defining with its bottom 20 a U-shaped channel which is shallow relative to its width.
- a tapped hole 22 is provided in the body 18 and opens out onto the bottom 20, and is in facing relation to the oblong opening 9 when the plate 5 is inserted between the branches 19 of the U.
- the plate 5 is fixed to the hook 16 by a screw 24 whose head 24a is so shaped and dimensioned that its periphery corresponds to the spotfacing 12 around the oblong opening 9 and also corresponds to the spotfacing 12 around the opening 11.
- the size of the head 24a may be reduced to such a thickness that its surface is flush with the surface of the plate 5 and with transverse end surfaces of the branches 21 of the body 18.
- a large reduction in the overall thickness of the system for assembling and anchoring in the bone results as compared to that possible with the aforementioned prior screws.
- the screws 24 may be inserted both in the oblong openings 9 and in the circular openings 11 and in each case bear against the respective spotfacings 12, 11 owing to the corresponding shape of their heads.
- FIG. 8 An embodiment of a complete instrumentation, mounted on a cervical segment C1-C3 and on the occiput 6 is shown in Figs. 8 and 9.
- Hooks 16, whose laminar or plate portions 17 are inserted in openings formed in the occiput 6, are fixed to the respective plates 5 by screws 24.
- Other hooks 26 having a closed body are mounted on the rod sections 7 just before the bend that the rod sections 7 form with the terminal sections 8, the laminar portions of the hooks 26 extending into the foramen opening 27 at the base of the occiput 6 against which they bear. Screws fix the hooks 26 to the rods 3 in the known manner.
- Mounting the occipital hook 16 requires no specific instrumentation.
- the surgeon forms an opening in the occipital bone 6 (trepanation) so as to be able to insert the laminar portion 17 of the hook.
- This operation is carried out on both sides of the median line of the occiput 6 so as to permit mounting two plates 5.
- the bent plate 5a is then mounted in the groove 19 and fixed by a screw 24 to the hook 16.
- An accessory permits moving the occipital hook 16 toward the foramen hook 26 (the laminar portion of which is inserted in the foramen opening 27).
- Figs. 10 to 15 shown various types of the fixing of each part 1, 2 of the instrumentation to the cervical vertebrae and to the occiput 6.
- the cervical part 7 of the rod 3 is provided with two cervical laminar hooks 32 of a known type which is open or closed.
- the same cervical part 7 of the rod 3 is provided with two articular screws 33 having a cortical thread adapted to the articular massive parts of the cervical vertebrae. The screws 33 penetrate these massive parts with a given inclination relative to the rod 3 and are connected by a connector 34 to the rod 3 in the known manner. The latter may be bent.
- the rods 3 may be long enough to reach the thoracic vertebra T2.
- the instrumentation shown in Fig. 12 comprises for each part 1 and 2 three screws 24 for fixing the occipital plates 5 to the occiput 6, two of these screws 24 being inserted in each oblong opening 9.
- the instrumentation comprises a transverse connection device 35 between the rods 3, this device being constituted by a transverse rod 36 and two cervical hooks
- the occipital plate 5 is secured to the occiput 6 by means of two laminar hooks, namely a first cervical hook 39, which is open or closed, has a large groove and is mounted on the section 8 having asperities of the rod 3, its laminar portion being disposed in the foramen opening 27, and an occipital hook 16.
- the laminar or plate portion 17 of the hook 16 is engaged by the surgeon between the inner table 6a of the occiput 6 and the dura-mater 40.
- the hook 16 is fixed to the plate 5 by means of a screw 24.
- Fig. 14 shows an alternative embodiment in which the occipital hook 16 is replaced by three screws 24 two of which are engaged in the oblong opening 9, the third being inserted in the circular opening 11 of the plate 5.
- a cervical hook 39 is engaged on the end part 8 of the rod 3 having asperities in the region of the foramen opening 27.
- Fig. 15 differs from that shown in Fig. 14 in that the cervical hook 39 is eliminated, the plate 5 being fixed to the occiput 6 solely by the three screws 24.
- the alternative embodiment shown in Fig. 16 comprises three circular openings 11 in the plate 5 which may be provided with screws 24 or hooks.
- the rod 3 having asperities and the plate 5 are both bendable, provided this remains within the limits imposed by the elongation of the material and care is taken to avoid any initiation of a crack.
- the instrumentation according to the invention has other advantages: thus, the fact that it has two rods and not a plate in one piece, on one hand permits an easier differentiated bending of each rod having asperities and, on the other hand, facilitates the adaptation to the considered specific mounting of the distance between the two rods 3.
- the transverse connection device 31 or 35 supports and reinforces the assembly, either in the cervical part or in the occipital part, or in both these regions.
- the two rods 3 may be employed indifferently in the left part and the right part of the occiput, since they are initially identical as manufactured, which affords the surgeon an additional facility.
- the presence of the rod section 8 in the occipital part and therefore its connection in the occipital part (and not in the cervical part), not only improves the performance as concerns fatigue of the part 1 or 2 of the instrumentation, but also enables the surgeon to employ either hooks or screws, or both,in the occipital part.
Abstract
Description
Claims
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP95907122A EP0744923B1 (en) | 1994-02-18 | 1995-02-13 | Occipito-cervical osteosynthesis instrumentation |
DE69510039T DE69510039T2 (en) | 1994-02-18 | 1995-02-13 | INSTRUMENTATION FOR THE MAIN NECK ESSENTIAL SYNTHESIS |
CA002183563A CA2183563A1 (en) | 1994-02-18 | 1995-02-13 | Occipito-cervical osteosynthesis instrumentation |
AU15447/95A AU1544795A (en) | 1994-02-18 | 1995-02-13 | Occipito-cervical osteosynthesis instrumentation |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/198,986 | 1994-02-18 | ||
US08/198,986 US5507745A (en) | 1994-02-18 | 1994-02-18 | Occipito-cervical osteosynthesis instrumentation |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1995022291A1 true WO1995022291A1 (en) | 1995-08-24 |
Family
ID=22735737
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/IB1995/000095 WO1995022291A1 (en) | 1994-02-18 | 1995-02-13 | Occipito-cervical osteosynthesis instrumentation |
Country Status (7)
Country | Link |
---|---|
US (1) | US5507745A (en) |
EP (1) | EP0744923B1 (en) |
AT (1) | ATE180650T1 (en) |
AU (1) | AU1544795A (en) |
CA (1) | CA2183563A1 (en) |
DE (1) | DE69510039T2 (en) |
WO (1) | WO1995022291A1 (en) |
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Also Published As
Publication number | Publication date |
---|---|
US5507745A (en) | 1996-04-16 |
EP0744923B1 (en) | 1999-06-02 |
ATE180650T1 (en) | 1999-06-15 |
EP0744923A1 (en) | 1996-12-04 |
DE69510039D1 (en) | 1999-07-08 |
CA2183563A1 (en) | 1995-08-24 |
AU1544795A (en) | 1995-09-04 |
DE69510039T2 (en) | 1999-11-18 |
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