WO2000074605A1 - Intervertebral implant and assembly for setting same - Google Patents

Intervertebral implant and assembly for setting same Download PDF

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Publication number
WO2000074605A1
WO2000074605A1 PCT/FR2000/001444 FR0001444W WO0074605A1 WO 2000074605 A1 WO2000074605 A1 WO 2000074605A1 FR 0001444 W FR0001444 W FR 0001444W WO 0074605 A1 WO0074605 A1 WO 0074605A1
Authority
WO
WIPO (PCT)
Prior art keywords
implant
shells
core
intermediate configuration
interior volume
Prior art date
Application number
PCT/FR2000/001444
Other languages
French (fr)
Inventor
Henry Graf
Original Assignee
Henry Graf
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Henry Graf filed Critical Henry Graf
Priority to AU52264/00A priority Critical patent/AU5226400A/en
Publication of WO2000074605A1 publication Critical patent/WO2000074605A1/en

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    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special 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
    • A61F2/4611Special 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
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    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30884Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
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    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/30767Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
    • A61F2/30771Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
    • A61F2002/30878Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
    • A61F2002/30891Plurality of protrusions
    • A61F2002/30892Plurality of protrusions parallel
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    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/3094Designing or manufacturing processes
    • A61F2002/30975Designing or manufacturing processes made of two halves
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    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2/4603Special 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
    • A61F2002/4625Special 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
    • A61F2002/4627Special 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
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    • A61F2220/00Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
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    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
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    • A61F2230/0006Rounded shapes, e.g. with rounded corners circular
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    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017Angular shapes
    • A61F2230/0019Angular shapes rectangular
    • AHUMAN NECESSITIES
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    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0017Angular shapes
    • A61F2230/0026Angular shapes trapezoidal
    • AHUMAN NECESSITIES
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    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063Three-dimensional shapes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0063Three-dimensional shapes
    • A61F2230/0069Three-dimensional shapes cylindrical
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2310/00Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
    • A61F2310/00005The prosthesis being constructed from a particular material
    • A61F2310/00011Metals or alloys
    • A61F2310/00023Titanium or titanium-based alloys, e.g. Ti-Ni alloys

Definitions

  • the present invention relates to an intervertebral implant and a delivery assembly for such an implant.
  • such an implant which may be partial or total, is intended to replace all or part of an intervertebral disc, when the latter has been destroyed by surgery or by disease.
  • an intervertebral implant formed by a rigid body of frustoconical shape, the transverse dimensions of which increase towards the anterior part of the implant, with reference to the latter once placed between the vertebrae .
  • This implant is provided with two threaded coatings, in the form of a circular arc, intended to come into contact with each of the vertebrae.
  • the spacing between these two coatings that is to say the greatest distance separating them, in cross section, varies continuously from the rear of the implant, towards the front thereof.
  • This known implant has drawbacks, however. Since, for anatomical reasons, its front longitudinal end has larger transverse dimensions, it is difficult to insert this implant from the back of the spine. Indeed, it is first of all necessary to provide, in the vertebral bone, a housing whose dimensions correspond to the maximum spacing between the coatings, at the level of the anterior part of the prosthesis. This is first of all at the origin of a destructive surgery, detrimental to the physical integrity of the patient. On the other hand, this implant has high risks of being ejected from the intervertebral space, insofar as, once placed, this implant is placed in a housing whose transverse dimensions are larger than those of the majority of the implant itself, particularly in the vicinity of the rear end of the latter. Such an implant can therefore only be placed, satisfactorily, from the front of the spine, which implies the implementation of surgery particularly delicate.
  • the invention proposes to produce an intervertebral implant which, while having an advantageous conformation from a physiological point of view, can be introduced easily from behind 'a vertebra, by the implementation of a relatively little destructive surgery, and which has a satisfactory stability once established within the intervertebral space.
  • an intervertebral implant intended to be inserted between two neighboring vertebrae, said implant comprising, on a part of its periphery, two rigid coatings intended to be in contact respectively with the two neighboring vertebrae, the vertical dimension implant implant increasing towards the anterior part of the implant and varying between a minimum dimension and a maximum dimension, characterized in that said implant also comprises a removable core, provided with two upper and lower peripheral zones of contact with each coating, the vertical distance separating the two peripheral zones increasing towards the anterior part of the implant, and in that the two coatings are shells suitable for adopting an intermediate configuration in which the vertical spacing between their external surfaces is substantially constant or decreasing towards the front, said shells forming, in said intermediate configuration, an interior volume adapted to receive said removable core.
  • the invention also proposes to produce an installation assembly for the implant as defined above, which ensures easy implantation of the latter and which makes it possible to preserve the integrity of the various organs in the vicinity of which this assembly is moved during all the laying operations.
  • the invention also relates to a fitting assembly for the implant as defined above, characterized in that it comprises means for forming a second interior volume, in communication with the interior volume formed by said shells, in said intermediate configuration.
  • FIG. 1 is a perspective view of the various components of an implant according to a first embodiment of the invention
  • FIG. 2 is an exploded perspective view of the various components of a delivery assembly for the implant of Figure 1;
  • FIG 3 is a longitudinal sectional view of the two coatings of the prosthesis of Figure 1, secured with a fitting insert of Figure 2;
  • FIG. 4 is a longitudinal sectional view illustrating the phase of insertion of the implant core into the interior volume defined by the two coatings of the implant of Figure 1;
  • FIG. 1 represents, seen in perspective, an intervertebral implant in accordance with a first embodiment of the invention, generally designated by the reference 2.
  • This implant comprises a core 4 made of a substantially rigid biocompatible material, such as a metal, for example titanium, or even a polymer.
  • This core can also be made of a bone substitute material or even comprise a hollow metallic reinforcement, the surface of which is pierced with orifices.
  • the cross section of the core 4 is composed of two end portions 6, the outer periphery of which describes an arc of a circle and which are connected by two flats 8 forming a middle portion 10.
  • the transverse dimension, or width, of the portions end 6 is substantially constant throughout the implant 2, while the height of the flats 8 increases towards the front of the implant, with reference to the latter once placed in the intervertebral space .
  • Each end portion 6 is hollowed out with two grooves
  • the core 4 is also pierced with a central longitudinal orifice, which is through. The vertical spacing between the two end portions
  • the implant 2 also comprises two coatings 16, 16 'forming shells, which are removable both relative to one another and relative to the core 4.
  • Each shell 16, 16 ' comprises a central cap 18, 18' cylindrical, intended to come into contact with the core 4.
  • This cap is connected to a peripheral cap 20, 20 'having, in cross section, an arc shape of circle.
  • the outer surface of these caps is provided with a thread 22, 22 ', intended to facilitate the implantation of the prosthesis.
  • connection zone between each cap 18, 18 ′ and its adjacent cap 20, 20 ′ is hollowed out with a longitudinal through opening 24, 24 ′, in the form of an arc of a circle, intended to accommodate the tongues of a set of pose, as will be explained in the following figures.
  • Each shell, 16, 16 ' is provided with two radial notches 26, 26', projecting inwards, from the front end of each cap 18, 18 '. It should be noted that these notches extend only over a small part of the longitudinal dimension of the shells 16, 16 '. The respective positions of the notches 26, 26 'and the grooves 12 allows them to cooperate, by sliding of these notches within these grooves.
  • Each shell 16, 16 ' is provided with two side skirts 28, 28', 30, 30 'extending in the direction of the shell opposite, from the ends of each cap 18, 18 ′, substantially perpendicular to the main axis of the prosthesis. These skirts, seen from the side, have an almost sinusoidal profile. Skirts 28, 30 or 28 ', 30' of the same shell 16, 16 'are arranged asymmetrically with respect to each other. On the other hand, the facing skirts 28, 28 ′ or 30, 30 ′ of the shells 16, 16 ′ have conjugate shapes, so that they are able to bear on one another, by their respective edges. To this end, the latter can be provided with male-female elements, not shown, for example of the mortise-tenon type, making it possible to avoid the relative translation of these two shells, in directions that are both longitudinal and transverse.
  • Each shell is provided with a respective front flap 32, 32 '.
  • These flaps are offset longitudinally with respect to each other and, as shown in FIG. 3, extend along main dimensions such that they overlap, when the shells are in abutment against one another .
  • the flap 32 'adjacent to the notches 26, 26' is further provided with a threaded through hole 34 ', intended to cooperate with a threaded rod, as will be explained in the following. Provision may be made for the other flap 32 to be provided with a similar hole.
  • the shell 16 ' is further provided with a terminal lug 35 forming, with the flap 32', a housing 35 'in the form of a U in which the flap 32 is received.
  • Each shell 16, 16 ' is pierced with a notch 36, 36' extending over part of the longitudinal dimension of the shell, at the level of the median radial part of the latter.
  • An elastic tab 38, 38 ′ terminated, at its front part, by a point 40, 40 ′ projecting outwards, is articulated on the front wall of each notch 36, 36 ′.
  • the dimensions of the tip 40, 40 ' are such that it does not protrude beyond the outer surface of the cap when the core 4 is not in contact with the latter ( Figure 4).
  • each point 40, 40' protrudes by compared to the external surface of these shells, so as to constitute a means of anchoring the implant in the corresponding vertebra.
  • FIG. 2 represents the various constituent elements of a set for placing the implant 2, designated as a whole by the reference 42.
  • This set comprises an insert 44, which is made up, in cross section, of two end portions 46, the outer periphery of which describes an arc of a circle and which are connected by two flats 48 forming a middle part 50. It should be noted that the vertical spacing between these end portions is constant along this insert and is located substantially equal to the spacing of existing between the end portions 6 of the core 4, at the rear part of the latter.
  • Each end portion 46 of the insert 44 is hollowed out with three longitudinal grooves, namely a central groove 52 and two external grooves 54. The depth of these grooves is substantially constant along the prosthesis.
  • the outer grooves 54 are arranged in such a way that they cooperate, by sliding, with the notches 26, 26 'of the shells 16, 16'.
  • the outer groove 54 is arranged in such a way that the insert 44, when it is secured to the shells 16, 16 ', as shown in FIG. 3, does not lead to the projecting of the legs 38, 38' relative to at the outer periphery of the shells 16, 16 '.
  • the insert 44 is hollowed out with a central longitudinal orifice, which passes through. It should be noted that the longitudinal dimensions of this insert 44 are larger than those of the shells 16, 16 '.
  • the installation assembly 42 also comprises a tool 58 comprising a handle 60 extended by two tongues 62, 62 'in the form of an arc of a circle.
  • the latter have dimensions such that they are capable of penetrating into the openings 24, 24 'formed in the shells 16, 16'.
  • Each tongue 62, 62 ' is provided with an internal radial recess 64, 64' defining a thinned distal portion 66, 66 'of this tongue.
  • Each distal portion 66, 66 ' is further hollowed out with a longitudinal lumen 68, 68', which makes it possible to avoid any contact between the tongues 62, 62 'and the tips 40, 40', as shown in particular in Figure 3.
  • the installation assembly 42 finally comprises a rod 70, one end 72 of which is threaded.
  • the two shells 16, 16 ′ are first placed around the insert 44.
  • the inner surface of the caps 18, 18 ′ is brought against the end portions 46 of this insert, the notches 26, 26 'penetrating into the outer grooves 54.
  • One end of this insert is abutted against the flap 32', while the other end of this insert projects longitudinally relative to the corresponding end of the shells 16, 16 ' .
  • the rod 70 is then threaded into the central orifice 56 of the insert 44, then the rod is secured to the shells, by cooperation of the threaded end 72 of this rod 70 with the tapped hole 34 'of the flap 32' .
  • each tongue 62, 62' is then threaded into the openings 24, 24 ', until the recesses 64, 64' abut against the rear wall of the shells.
  • the inner surface of the caps 18, 18 'and that of the tongues 62, 62' are continuous.
  • the two shells 16, 16 ′ thus form an intermediate implant I, the transverse dimensions of which are substantially constant and are close to the smallest transverse dimension of the final implant.
  • the establishment of the intermediate implant which is generally cylindrical, in the intervertebral space, consists first of all in providing, in the latter, a housing whose transverse dimensions correspond to those of this intermediate implant. Then, this implant is introduced by screwing, by means of the handle 60 of the setting tool 58.
  • the threads 22, 22 ′ with which the shells are provided are advantageous with regard to this operation.
  • the outer surface of the tongues 62, 62 ′ is preferably smooth, which allows easy removal of these tongues once the intermediate implant has been put in place.
  • the handle 60 is removed from the tool 58, which is removable relative to the tongues 62, 62 ′, the distal portion of which 66, 66 'remains in place in the openings 24, 24'.
  • the insert 44 is then removed from the interior volume V of the shells 16, 16 ', taking advantage of the fact that this insert 44 has large longitudinal dimensions.
  • the core 4 is introduced into the interior volume V of the tongues 62, 62 '.
  • the core 4 is introduced by its front end, of larger dimension, which has the effect of spreading the tongues mutually, as well as the facing edges of the skirts 28, 30 and 28 ', 30' of the shells.
  • the flap 32 ' has a certain elasticity, in order to compensate for this separation.
  • the core 4 is advanced towards the interior volume V of the shells 16, 16 '.
  • a plate 74 hollowed out from a central hole 76 is threaded with respect to the tongues 62, 62 ′.
  • a tubular member 78 disposed around the threaded rod 70 and the outer surface of which is threaded.
  • One of the ends of this tubular member 78 is provided with an operating button 80, while its opposite end receives, with ball joint, a discoidal piston bearing against the rear face of the core 4.
  • the tubular member moves, relative to the plate 74, in the direction of the shells 16, 16 ', which has the effect of bringing the core 4 closer to the latter.
  • the notches 26, 26 ′ of the shells 16, 16 ′ penetrate into the longitudinal grooves 12 of the core 4. It is then possible to separate the threaded rod 70 relative to the flaps 32, 32 ', then remove this rod from the interior volumes of the shells 16, 16' and the tabs 62, 62 '.
  • the rod can also be removed threaded 70 at the same time as the insert 44, taking advantage of the fact that the caps cannot move longitudinally relative to each other, the flap 32 being received in the housing 35 'in a U shape. '' actuate the operating button 80, the core
  • the front wall of the core 4 bears against the flap 32', while the notches 26, 26 'bear against the rear face of this core 4. Since the grooves 12 have zero depth in the vicinity of this rear end, the notches 26, 26 'prevent any longitudinal movement of the core 4 relative to the shells 16, 16' in a first direction, such longitudinal movement being prevented, in the other direction, due the presence of the rear flap 32 '.
  • the opposite skirts 28, 30 'and 28', 30 of the caps namely a skirt of a cap and the skirt of the other cap, generally symmetrical of this first skirt with respect to the longitudinal axis of the implant have, in cross section, a covering zone. This reduces the lateral shear to which the implant is subjected.
  • the height, or vertical dimension of the implant, once placed, increases from a value d at the back of the implant, to a value D at the front of it.
  • FIG. 6 represents the various constituent elements of an implant according to a second embodiment of the invention, designated as a whole by the reference 102.
  • This implant comprises a core 104, the cross section of which consists of two end portions 106, connected by two walls 108, perpendicular to these end portions 106, so as to form a middle portion 110.
  • the transverse dimension, or width, of this core 104 is substantially constant all along the latter, while the height, or vertical dimension, of this core increases towards the front thereof, with reference to the implant. once placed in the intervertebral space.
  • the core 104 is hollowed out by four lateral grooves 112, namely two pairs of respectively upper and lower grooves extending parallel to the end portion 106 of which they are adjacent.
  • the core 104 is also pierced with a central longitudinal orifice 114, which is through.
  • the implant 102 also comprises two shells 116, 116 ′, which are removable both with respect to each other and with respect to the core 104.
  • Each shell has a U shape and has a core 118, 118 ', intended to come into contact with the end portions 106, as well as two wings 120, 120' intended to bear against the flats 108.
  • the core 118, 118 ' is pierced with a longitudinal opening 124, 124 ', as well as a notch 136, 136', the walls of which receive a tab, not shown, similar to that 38, 38 'described with reference to the preceding figures.
  • the outer surface of the core is further provided with pins 137, 137 'intended to penetrate a corresponding vertebra.
  • the inner wall of the wings 120, 120 ' is provided with longitudinal ribs 138, 138' adapted to cooperate with the grooves 112 of the core 104.
  • Each shell is provided, at its front end, with flaps, of which only the one 132 'is shown, similar to those described with reference to FIGS. 3 to 5.
  • the positioning of this implant 102 is carried out by means of a fitting assembly comprising an insert 144, of rectangular cross section, constant all along this insert.
  • the latter is provided with six grooves, namely two grooves 152, 152 ', respectively upper and lower, as well as four lateral grooves 154, intended to cooperate with the ribs 138, 138'.
  • the grooves 152, 152 ' allow the free passage of the elastic anchoring tab in the vertebra.
  • the implant 102 is placed in the following manner.
  • the insert 144 is first secured to the shells 116, 116 ', by cooperation of the ribs 138, 138' with the lateral grooves 154.
  • the two shells are then secured by means of a threaded rod, not shown, of analogously to what has been described with reference to the previous embodiment.
  • the wings 120, 120 ′ facing the two shells are in mutual support.
  • An intermediate implant is thus formed which is introduced into the intervertebral space by impaction.
  • tongues similar to those 62, 62 ′, are placed in the openings 124, 124 ′ of the shells 116, 116 ′.
  • the core 104 is introduced into the interior volume defined by these tabs which are not shown, then this core 104 is introduced into the interior volume of the shells 116, 116 ′, by impaction, by means of a tool which is not shown.
  • the operations for removing the insert 144, the threaded rod and the tongues, not shown, operate in a similar manner to what has been described with reference to the preceding figures.
  • the invention makes it possible to achieve the objectives mentioned above.
  • the two shells, removable with respect to the core, which is provided with the implant of the invention allow the production of an intermediate implant of small transverse dimension, capable of being introduced into the intervertebral space by providing a housing for limited dimensions, which is advantageous for the physical integrity of the patient.
  • This intermediate implant has good stability with respect to the vertebral bones and constitutes a lever arm for the insertion of the core into the interior volume of the shells.
  • the final implant has a very satisfactory stability, once in place.
  • the implant of the invention is also advantageous, in that it allows the carrying out of preliminary tests, by only partially introducing the core into the interior volume of the cap. In this way, it is possible to remove this core, in the case where its conformation is not favorable to the patient, so as to replace it with another core, of appropriate profile.

Abstract

The invention concerns an implant (2) comprising, over part of its periphery, two rigid linings (16) designed to be in contact with two neighbouring vertebrae respectively, the vertical dimension of the set implant increasing towards the front part thereof and varying between a minimum dimension and a maximum dimension. Said implant further comprises a removable core (4), provided with two upper and lower peripheral contact zones (6) with each lining, the vertical distance separating the two peripheral zones (6) increasing towards the front part of the implant, and the two linings (16) are shells capable of adopting an intermediate configuration wherein the vertical spacing between their outer surfaces is substantially constant or decreasing towards the front, said shells (16) forming, in said intermediate configuration, an internal volume adapted to receive said removable core (4).

Description

IMPLANT INTERVERTEBRAL ET ENSEMBLE DE POSE D'UN TEL IMPLANT INTERVERTEBRAL IMPLANT AND POSITIONING ASSEMBLY OF SUCH AN IMPLANT
La présente invention concerne un implant intervertébral et un ensemble de pose pour un tel implant .The present invention relates to an intervertebral implant and a delivery assembly for such an implant.
De manière habituelle, un tel implant, qui peut être partiel ou total, est destiné à remplacer tout ou partie d'un disque intervertébral, lorsque ce dernier a été détruit par la chirurgie ou par la maladie.Usually, such an implant, which may be partial or total, is intended to replace all or part of an intervertebral disc, when the latter has been destroyed by surgery or by disease.
On connaît, par O-A-97/31517 , un implant intervertébral formé par un corps rigide de forme tronconique, dont les dimensions transversales augmentent vers la partie antérieure de l'implant, en faisant référence à ce dernier une fois mis en place entre les vertèbres. Cet implant est pourvu de deux enrobages filetés, en forme d'arc de cercle, destinés à entrer en contact avec chacune des vertèbres. L'écartement entre ces deux enrobages, c'est-à-dire la plus grande distance les séparant, en section transversale, varie continûment depuis l'arrière de l'implant, vers l'avant de celui-ci.We know, from OA-97/31517, an intervertebral implant formed by a rigid body of frustoconical shape, the transverse dimensions of which increase towards the anterior part of the implant, with reference to the latter once placed between the vertebrae . This implant is provided with two threaded coatings, in the form of a circular arc, intended to come into contact with each of the vertebrae. The spacing between these two coatings, that is to say the greatest distance separating them, in cross section, varies continuously from the rear of the implant, towards the front thereof.
Cet implant connu présente cependant des inconvénients. Etant donné que, pour des raisons anatomiques, son extrémité longitudinale avant possède des dimensions transversales plus importantes, il est délicat d'insérer cet implant depuis l'arrière de la colonne vertébrale. En effet, il est tout d'abord nécessaire de ménager, dans l'os vertébral, un logement dont les dimensions correspondent à l'écartement maximal entre les enrobages, au niveau de la partie antérieure de la prothèse. Ceci est tout d'abord à l'origine d'une chirurgie destructrice, préjudiciable à l'intégrité physique du patient. D'autre part, cet implant possède de forts risques d'être éjecté de l'espace intervertébral, dans la mesure où, une fois mis en place, cet implant est disposé dans un logement dont les dimensions transversales sont plus importantes que celles de la majorité de l'implant lui-même, en particulier au voisinage de l'extrémité arrière de ce dernier. Un tel implant ne peut donc être mis en place, de manière satisfaisante, que depuis l'avant de la colonne vertébrale, ce qui implique la mise en oeuvre d'une chirurgie particulièrement délicate .This known implant has drawbacks, however. Since, for anatomical reasons, its front longitudinal end has larger transverse dimensions, it is difficult to insert this implant from the back of the spine. Indeed, it is first of all necessary to provide, in the vertebral bone, a housing whose dimensions correspond to the maximum spacing between the coatings, at the level of the anterior part of the prosthesis. This is first of all at the origin of a destructive surgery, detrimental to the physical integrity of the patient. On the other hand, this implant has high risks of being ejected from the intervertebral space, insofar as, once placed, this implant is placed in a housing whose transverse dimensions are larger than those of the majority of the implant itself, particularly in the vicinity of the rear end of the latter. Such an implant can therefore only be placed, satisfactorily, from the front of the spine, which implies the implementation of surgery particularly delicate.
Afin de pallier les inconvénients de l'art antérieur évoqués ci-dessus, l'invention se propose de réaliser un implant intervertébral qui, tout en possédant une conformation avantageuse d'un point de vue physiologique, puisse être introduit aisément depuis l'arrière d'une vertèbre, par la mise en oeuvre d'une chirurgie relativement peu destructrice, et qui possède une stabilité satisfaisante une fois mis en place au sein de l'espace intervertébral. A cet effet, elle a pour objet un implant intervertébral, destiné à être inséré entre deux vertèbres voisines, ledit implant comprenant, sur une partie de sa périphérie, deux enrobages rigides destinés à être en contact respectivement avec les deux vertèbres voisines, la dimension verticale de l'implant posé augmentant vers la partie antérieure de l'implant et variant entre une dimension minimale et une dimension maximale, caractérisé en ce que ledit implant comprend en outre une âme amovible, pourvue de deux zones périphériques supérieure et inférieure de contact avec chaque enrobage, la distance verticale séparant les deux zones périphériques augmentant vers la partie antérieure de l'implant, et en ce que les deux enrobages sont des coquilles propres à adopter une configuration intermédiaire dans laquelle l'écartement vertical entre leurs surfaces extérieures est sensiblement constant ou décroissant vers l'avant, lesdites coquilles formant, dans ladite configuration intermédiaire, un volume intérieur adapté pour recevoir ladite âme amovible.In order to overcome the drawbacks of the prior art mentioned above, the invention proposes to produce an intervertebral implant which, while having an advantageous conformation from a physiological point of view, can be introduced easily from behind 'a vertebra, by the implementation of a relatively little destructive surgery, and which has a satisfactory stability once established within the intervertebral space. For this purpose, it relates to an intervertebral implant, intended to be inserted between two neighboring vertebrae, said implant comprising, on a part of its periphery, two rigid coatings intended to be in contact respectively with the two neighboring vertebrae, the vertical dimension implant implant increasing towards the anterior part of the implant and varying between a minimum dimension and a maximum dimension, characterized in that said implant also comprises a removable core, provided with two upper and lower peripheral zones of contact with each coating, the vertical distance separating the two peripheral zones increasing towards the anterior part of the implant, and in that the two coatings are shells suitable for adopting an intermediate configuration in which the vertical spacing between their external surfaces is substantially constant or decreasing towards the front, said shells forming, in said intermediate configuration, an interior volume adapted to receive said removable core.
L'invention se propose également de réaliser un ensemble de pose pour l'implant tel que défini ci -dessus, qui assure une implantation aisée de ce dernier et qui permette de préserver l'intégrité des différents organes au voisinage desquels cet ensemble est déplacé durant l'ensemble des opérations de pose. A cet effet, l'invention a également pour objet un ensemble de pose pour l'implant tel que défini ci-dessus, caractérisé en ce qu'il comprend des moyens de formation d'un second volume intérieur, en communication avec le volume intérieur formé par lesdites coquilles, dans ladite configuration intermédiaire . L'invention est décrite ci-dessous, en référence aux dessins annexés, donnés uniquement à titre d'exemple non limitatif et dans lesquels :The invention also proposes to produce an installation assembly for the implant as defined above, which ensures easy implantation of the latter and which makes it possible to preserve the integrity of the various organs in the vicinity of which this assembly is moved during all the laying operations. To this end, the invention also relates to a fitting assembly for the implant as defined above, characterized in that it comprises means for forming a second interior volume, in communication with the interior volume formed by said shells, in said intermediate configuration. The invention is described below, with reference to the accompanying drawings, given only by way of nonlimiting example and in which:
- la figure 1 est une vue en perspective des différents éléments constitutifs d'un implant conforme à un premier mode de réalisation de l'invention ;- Figure 1 is a perspective view of the various components of an implant according to a first embodiment of the invention;
- la figure 2 est une vue en perspective éclatée des différents éléments constitutifs d'un ensemble de pose pour l'implant de la figure 1 ; - la figure 3 est une vue en coupe longitudinale des deux enrobages de la prothèse de la figure 1, solidarisés avec un insert de pose de la figure 2 ;- Figure 2 is an exploded perspective view of the various components of a delivery assembly for the implant of Figure 1; - Figure 3 is a longitudinal sectional view of the two coatings of the prosthesis of Figure 1, secured with a fitting insert of Figure 2;
- la figure 4 est une vue en coupe longitudinale illustrant la phase d'insertion de l'âme de l'implant dans le volume intérieur défini par les deux enrobages de l'implant de la figure 1 ;- Figure 4 is a longitudinal sectional view illustrating the phase of insertion of the implant core into the interior volume defined by the two coatings of the implant of Figure 1;
- la figure 5 est une vue en coupe longitudinale de l'implant de la figure 1, une fois mis en place dans l'espace intervertébral ; et - la figure 6 est une vue en perspective illustrant, d'une part les différents éléments constitutifs d'un implant intervertébral conforment à un second mode de réalisation de l'invention et, d'autre part, un des éléments appartenant à un ensemble de pose pour cet implant . La figure 1 représente, vu en perspective, un implant intervertébral conforme à un premier mode de réalisation de l'invention, désigné dans son ensemble par la référence 2. Cet implant comprend une âme 4 réalisée en un matériau biocompatible sensiblement rigide, tel qu'un métal, par exemple du titane, ou bien encore un polymère. Cette âme peut également être réalisée en un matériau de substitution osseuse ou encore comprendre une armature métallique creuse et dont la surface est percée d'orifices.- Figure 5 is a longitudinal sectional view of the implant of Figure 1, once placed in the intervertebral space; and - Figure 6 is a perspective view illustrating, on the one hand the different components of an intervertebral implant conform to a second embodiment of the invention and, on the other hand, one of the elements belonging to a set placement for this implant. FIG. 1 represents, seen in perspective, an intervertebral implant in accordance with a first embodiment of the invention, generally designated by the reference 2. This implant comprises a core 4 made of a substantially rigid biocompatible material, such as a metal, for example titanium, or even a polymer. This core can also be made of a bone substitute material or even comprise a hollow metallic reinforcement, the surface of which is pierced with orifices.
La section transversale de l'âme 4 se compose de deux portions d'extrémité 6 dont la périphérie extérieure décrit un arc de cercle et qui sont reliées par deux méplats 8 formant une portion médiane 10.The cross section of the core 4 is composed of two end portions 6, the outer periphery of which describes an arc of a circle and which are connected by two flats 8 forming a middle portion 10.
La dimension transversale, ou largeur, des portions d'extrémité 6 est sensiblement constante tout le long de l'implant 2, alors que la hauteur des méplats 8 augmente vers l'avant de l'implant, en faisant référence à celui-ci une fois mis en place dans l'espace intervertébral. Chaque portion d'extrémité 6 est creusée de deux rainuresThe transverse dimension, or width, of the portions end 6 is substantially constant throughout the implant 2, while the height of the flats 8 increases towards the front of the implant, with reference to the latter once placed in the intervertebral space . Each end portion 6 is hollowed out with two grooves
12, dont la profondeur décroît continûment vers l'arrière de la prothèse, cette profondeur étant nulle au niveau de l'extrémité longitudinale arrière de l'implant. L'âme 4 est également percée d'un orifice longitudinal central, qui est traversant. L'écartement vertical entre les deux portions d'extrémité12, the depth of which decreases continuously towards the rear of the prosthesis, this depth being zero at the rear longitudinal end of the implant. The core 4 is also pierced with a central longitudinal orifice, which is through. The vertical spacing between the two end portions
6, en faisant référence à un patient debout, est compris entre d' , au niveau de la partie arrière de la prothèse, et D' , au niveau de la partie avant de celle-ci.6, with reference to a standing patient, is between d ', at the rear part of the prosthesis, and D', at the front part of the latter.
L'implant 2 comprend également deux enrobages 16, 16' formant coquilles, qui sont amovibles à la fois l'un par rapport à l'autre et par rapport à l'âme 4.The implant 2 also comprises two coatings 16, 16 'forming shells, which are removable both relative to one another and relative to the core 4.
Chaque coquille 16, 16' comprend une calotte centrale 18, 18' cylindrique, destinée à entrer en contact avec l'âme 4. Cette calotte est reliée à une coiffe périphérique 20, 20' présentant, en coupe transversale, une forme d'arc de cercle. La surface extérieure de ces coiffes est munie d'un filetage 22, 22', destiné à faciliter l'implantation de la prothèse .Each shell 16, 16 'comprises a central cap 18, 18' cylindrical, intended to come into contact with the core 4. This cap is connected to a peripheral cap 20, 20 'having, in cross section, an arc shape of circle. The outer surface of these caps is provided with a thread 22, 22 ', intended to facilitate the implantation of the prosthesis.
La zone de liaison entre chaque calotte 18, 18' et sa coiffe adjacente 20, 20' est creusée d'une ouverture longitudinale traversante 24, 24', en forme d'arc de cercle, destinée au logement de languettes d'un ensemble de pose, comme cela sera explicité aux figures suivantes.The connection zone between each cap 18, 18 ′ and its adjacent cap 20, 20 ′ is hollowed out with a longitudinal through opening 24, 24 ′, in the form of an arc of a circle, intended to accommodate the tongues of a set of pose, as will be explained in the following figures.
Chaque coquille, 16, 16' est pourvue de deux crans radiaux 26, 26', faisant saillie vers l'intérieur, à partir de l'extrémité avant de chaque calotte 18, 18' . Il est à noter que ces crans s'étendent seulement sur une faible partie de la dimension longitudinale des coquilles 16, 16'. Les positionnements respectifs des crans 26, 26' et des rainures 12 leur permet de coopérer, par coulissement de ces crans au sein de ces rainures .Each shell, 16, 16 'is provided with two radial notches 26, 26', projecting inwards, from the front end of each cap 18, 18 '. It should be noted that these notches extend only over a small part of the longitudinal dimension of the shells 16, 16 '. The respective positions of the notches 26, 26 'and the grooves 12 allows them to cooperate, by sliding of these notches within these grooves.
Chaque coquille 16, 16' est pourvue de deux jupes latérales 28, 28', 30, 30' s'étendant en direction de la coquille opposée, à partir des extrémités de chaque calotte 18, 18', de manière sensiblement perpendiculaire à l'axe principal de la prothèse. Ces jupes présentent, vues de côté, un profil à peu près sinusoïdal. Les jupes 28, 30 ou 28', 30' d'une même coquille 16, 16' sont disposées de manière asymétrique l'une par rapport à l'autre. En revanche, les jupes en regard 28, 28' ou 30, 30' des coquilles 16, 16' possèdent des formes conjuguées, de sorte qu'elles sont aptes à prendre appui l'une sur l'autre, par leurs bordures respectives. A cet effet, ces dernières peuvent être pourvues d'éléments mâle-femelle, non représentés, par exemple du type à tenon-mortaise, permettant d'éviter la translation relative de ces deux coquilles, selon des directions à la fois longitudinale et transversale.Each shell 16, 16 'is provided with two side skirts 28, 28', 30, 30 'extending in the direction of the shell opposite, from the ends of each cap 18, 18 ′, substantially perpendicular to the main axis of the prosthesis. These skirts, seen from the side, have an almost sinusoidal profile. Skirts 28, 30 or 28 ', 30' of the same shell 16, 16 'are arranged asymmetrically with respect to each other. On the other hand, the facing skirts 28, 28 ′ or 30, 30 ′ of the shells 16, 16 ′ have conjugate shapes, so that they are able to bear on one another, by their respective edges. To this end, the latter can be provided with male-female elements, not shown, for example of the mortise-tenon type, making it possible to avoid the relative translation of these two shells, in directions that are both longitudinal and transverse.
Chaque coquille est pourvue d'un volet avant 32, 32' respectif. Ces volets sont décalés longitudinalement l'un par rapport à l'autre et, comme le montre la figure 3, s'étendent selon des dimensions principales telles qu'ils se chevauchent, lorsque les coquilles sont en appui l'une contre l'autre. Le volet 32' adjacent aux crans 26, 26' est en outre pourvu d'un trou traversant taraudé 34', destiné à coopérer avec une tige filetée, comme cela sera explicité dans ce qui suit. On peut prévoir que l'autre volet 32 soit pourvu d'un trou analogue. La coquille 16' est en outre munie d'une patte terminale 35 formant, avec le volet 32', un logement 35' en forme de U dans lequel est reçu le volet 32.Each shell is provided with a respective front flap 32, 32 '. These flaps are offset longitudinally with respect to each other and, as shown in FIG. 3, extend along main dimensions such that they overlap, when the shells are in abutment against one another . The flap 32 'adjacent to the notches 26, 26' is further provided with a threaded through hole 34 ', intended to cooperate with a threaded rod, as will be explained in the following. Provision may be made for the other flap 32 to be provided with a similar hole. The shell 16 'is further provided with a terminal lug 35 forming, with the flap 32', a housing 35 'in the form of a U in which the flap 32 is received.
Chaque coquille 16, 16' est percée d'une échancrure 36, 36' s 'étendant sur une partie de la dimension longitudinale de la coquille, au niveau de la partie radiale médiane de ce dernier. Une patte élastique 38, 38' terminée, à sa partie avant, par une pointe 40, 40' faisant saillie vers l'extérieur, est articulée sur la paroi avant de chaque échancrure 36, 36' . Les dimensions de la pointe 40, 40' sont telles qu'elle ne fait pas saillie au-delà de la surface extérieure de la coiffe lorsque l'âme 4 n'est pas en contact avec ce dernier (figure 4) . En revanche, comme le montre en particulier la figure 5, une fois l'implant mis en place, c'est-à-dire l'âme 4 au contact des coquilles 16, 16', chaque pointe 40, 40' fait saillie par rapport à la surface externe de ces coquilles, de manière à constituer un moyen d'ancrage de l'implant dans la vertèbre correspondante .Each shell 16, 16 'is pierced with a notch 36, 36' extending over part of the longitudinal dimension of the shell, at the level of the median radial part of the latter. An elastic tab 38, 38 ′ terminated, at its front part, by a point 40, 40 ′ projecting outwards, is articulated on the front wall of each notch 36, 36 ′. The dimensions of the tip 40, 40 'are such that it does not protrude beyond the outer surface of the cap when the core 4 is not in contact with the latter (Figure 4). On the other hand, as shown in particular in FIG. 5, once the implant has been put in place, that is to say the core 4 in contact with the shells 16, 16 ', each point 40, 40' protrudes by compared to the external surface of these shells, so as to constitute a means of anchoring the implant in the corresponding vertebra.
La figure 2 représente les différents éléments constitutifs d'un ensemble de pose de l'implant 2, désigné dans son ensemble par la référence 42. Cet ensemble comporte un insert 44, qui se compose, en section transversale, de deux portions d'extrémité 46, dont la périphérie extérieure décrit un arc de cercle et qui sont reliées par deux méplats 48 formant une partie médiane 50. Il est à noter que l'écartement vertical entre ces portions d'extrémité est constant le long de cet insert et se trouve sensiblement égal à l'écartement d' existant entre les portions d'extrémité 6 de l'âme 4, au niveau de la partie arrière de cette dernière.FIG. 2 represents the various constituent elements of a set for placing the implant 2, designated as a whole by the reference 42. This set comprises an insert 44, which is made up, in cross section, of two end portions 46, the outer periphery of which describes an arc of a circle and which are connected by two flats 48 forming a middle part 50. It should be noted that the vertical spacing between these end portions is constant along this insert and is located substantially equal to the spacing of existing between the end portions 6 of the core 4, at the rear part of the latter.
Chaque portion d'extrémité 46 de 1 ' insert 44 est creusée de trois rainures longitudinales, à savoir une rainure centrale 52 et deux rainures extérieures 54. La profondeur de ces rainures est sensiblement constante le long de la prothèse. Les rainures extérieures 54 sont disposées de manière telle qu'elles coopèrent, par coulissement , avec les crans 26, 26' des coquilles 16, 16' . La rainure extérieure 54 est agencée de manière telle que 1 ' insert 44, lorsqu'il est solidarisé avec les coquilles 16, 16', comme le montre figure 3, n'induit pas de mise en saillie des pattes 38, 38' par rapport à la périphérie extérieure des coquilles 16, 16' . L' insert 44 est creusé d'un orifice longitudinal central, qui est traversant. Il est à noter que les dimensions longitudinales de cet insert 44 sont plus importantes que celles des coquilles 16, 16'.Each end portion 46 of the insert 44 is hollowed out with three longitudinal grooves, namely a central groove 52 and two external grooves 54. The depth of these grooves is substantially constant along the prosthesis. The outer grooves 54 are arranged in such a way that they cooperate, by sliding, with the notches 26, 26 'of the shells 16, 16'. The outer groove 54 is arranged in such a way that the insert 44, when it is secured to the shells 16, 16 ', as shown in FIG. 3, does not lead to the projecting of the legs 38, 38' relative to at the outer periphery of the shells 16, 16 '. The insert 44 is hollowed out with a central longitudinal orifice, which passes through. It should be noted that the longitudinal dimensions of this insert 44 are larger than those of the shells 16, 16 '.
L'ensemble de pose 42 comprend également un outil 58 comportant un manche 60 prolongé par deux languettes 62, 62' en forme d'arc de cercle. Ces dernières possèdent des dimensions telles qu'elles sont aptes à pénétrer dans les ouvertures 24, 24' ménagées dans les coquilles 16, 16'. Chaque languette 62, 62' est pourvue d'un décrochement radial interne 64, 64' définissant une portion distale amincie 66, 66' de cette languette. Chaque portion distale 66, 66' est en outre creusée d'une lumière longitudinale 68, 68', qui permet d'éviter tout contact entre les languettes 62, 62' et les pointes 40, 40', comme le montre en particulier la figure 3.The installation assembly 42 also comprises a tool 58 comprising a handle 60 extended by two tongues 62, 62 'in the form of an arc of a circle. The latter have dimensions such that they are capable of penetrating into the openings 24, 24 'formed in the shells 16, 16'. Each tongue 62, 62 'is provided with an internal radial recess 64, 64' defining a thinned distal portion 66, 66 'of this tongue. Each distal portion 66, 66 'is further hollowed out with a longitudinal lumen 68, 68', which makes it possible to avoid any contact between the tongues 62, 62 'and the tips 40, 40', as shown in particular in Figure 3.
L'ensemble de pose 42 comprend enfin une tige 70 dont une extrémité 72 est filetée.The installation assembly 42 finally comprises a rod 70, one end 72 of which is threaded.
On va maintenant décrire la mise en place de l'implant 2 au moyen de l'ensemble de pose 42, en faisant référence aux figures 1 à 5.We will now describe the positioning of the implant 2 by means of the fitting assembly 42, with reference to FIGS. 1 to 5.
On place tout d'abord les deux coquilles 16, 16' autour de 1 ' insert 44. A cet effet, on rapporte la surface intérieure des calottes 18, 18' contre les portions d'extrémité 46 de cet insert, les crans 26, 26' pénétrant dans les rainures extérieures 54. Une des extrémités de cet insert est mise en butée contre le volet 32', alors que l'autre extrémité de cet insert fait saillie longitudinalement par rapport à l'extrémité correspondante des coquilles 16, 16'. Lorsque les coquilles sont disposées autour de 1 ' insertThe two shells 16, 16 ′ are first placed around the insert 44. For this purpose, the inner surface of the caps 18, 18 ′ is brought against the end portions 46 of this insert, the notches 26, 26 'penetrating into the outer grooves 54. One end of this insert is abutted against the flap 32', while the other end of this insert projects longitudinally relative to the corresponding end of the shells 16, 16 ' . When the shells are arranged around the insert
44, les bordures des jupes adjacentes 28, 28' et 30, 30' de ces coquilles sont en appui mutuel.44, the edges of the adjacent skirts 28, 28 'and 30, 30' of these shells are in mutual support.
On enfile ensuite la tige 70 dans l'orifice central 56 de l' insert 44, puis on solidarise la tige par rapport aux coquilles, par coopération de l'extrémité 72 filetée de cette tige 70 avec le trou taraudé 34' du volet 32' .The rod 70 is then threaded into the central orifice 56 of the insert 44, then the rod is secured to the shells, by cooperation of the threaded end 72 of this rod 70 with the tapped hole 34 'of the flap 32' .
On enfile ensuite la portion distale amincie 66, 66' de chaque languette 62, 62' dans les ouvertures 24, 24', jusqu'à ce que les décrochements 64, 64' viennent en butée contre la paroi arrière des coquilles. Dans cette configuration, la surface intérieure des calottes 18, 18' et celle des languettes 62, 62' sont continues.The thinned distal portion 66, 66 'of each tongue 62, 62' is then threaded into the openings 24, 24 ', until the recesses 64, 64' abut against the rear wall of the shells. In this configuration, the inner surface of the caps 18, 18 'and that of the tongues 62, 62' are continuous.
Les deux coquilles 16, 16' forment ainsi un implant intermédiaire I, dont les dimensions transversales sont sensiblement constantes et sont voisines de la dimension transversale la plus faible de l'implant définitif.The two shells 16, 16 ′ thus form an intermediate implant I, the transverse dimensions of which are substantially constant and are close to the smallest transverse dimension of the final implant.
La mise en place de l'implant intermédiaire, qui est globalement cylindrique, dans l'espace intervertébral, consiste tout d'abord à ménager, dans ce dernier, un logement dont les dimensions transversales correspondent à celles de cet implant intermédiaire. Puis, on introduit cet implant par vissage, au moyen du manche 60 de l'outil de pose 58. Les filetages 22, 22' dont sont pourvues les coquilles sont avantageux à l'égard de cette opération. De plus, la surface extérieure des languettes 62, 62' est de préférence lisse, ce qui permet un retrait aisé de ces languettes une fois l'implant intermédiaire mis en place . Lorsque les coquilles occupent la position qu'elles doivent adopter, une fois l'implant définitif formé, on retire le manche 60 de l'outil 58, qui est amovible par rapport aux languettes 62, 62', dont la portion distale 66, 66' reste en place dans les ouvertures 24, 24' . On retire ensuite 1 ' insert 44 du volume intérieur V des coquilles 16, 16' , en tirant parti du fait que cet insert 44 possède des dimensions longitudinales importantes .The establishment of the intermediate implant, which is generally cylindrical, in the intervertebral space, consists first of all in providing, in the latter, a housing whose transverse dimensions correspond to those of this intermediate implant. Then, this implant is introduced by screwing, by means of the handle 60 of the setting tool 58. The threads 22, 22 ′ with which the shells are provided are advantageous with regard to this operation. In addition, the outer surface of the tongues 62, 62 ′ is preferably smooth, which allows easy removal of these tongues once the intermediate implant has been put in place. When the shells occupy the position which they must adopt, once the final implant has been formed, the handle 60 is removed from the tool 58, which is removable relative to the tongues 62, 62 ′, the distal portion of which 66, 66 'remains in place in the openings 24, 24'. The insert 44 is then removed from the interior volume V of the shells 16, 16 ', taking advantage of the fact that this insert 44 has large longitudinal dimensions.
On introduit ensuite, comme le montre la figure 4, l'âme 4 dans le volume intérieur V des languettes 62, 62' . L'âme 4 est introduite par son extrémité avant, de plus grande dimension, ce qui a pour effet d'écarter mutuellement les languettes, ainsi que les bordures en regard des jupes 28, 30 et 28', 30' des coquilles. Le volet 32' présente une certaine élasticité, afin de compenser cet écartement . Puis, on fait avancer l'âme 4 en direction du volume intérieur V des coquilles 16, 16' . A cet effet, on solidarise, par rapport aux languettes 62, 62', une plaque 74 creusée d'un trou central 76 taraudé. Ce dernier coopère avec un organe tubulaire 78, disposé autour de la tige filetée 70 et dont la surface extérieure est filetée. L'une des extrémités de cet organe tubulaire 78 est pourvue d'un bouton de manoeuvre 80, alors que son extrémité opposée reçoit, à rotule, un piston discoïdal prenant appui contre la face arrière de l'âme 4.Next, as shown in FIG. 4, the core 4 is introduced into the interior volume V of the tongues 62, 62 '. The core 4 is introduced by its front end, of larger dimension, which has the effect of spreading the tongues mutually, as well as the facing edges of the skirts 28, 30 and 28 ', 30' of the shells. The flap 32 'has a certain elasticity, in order to compensate for this separation. Then, the core 4 is advanced towards the interior volume V of the shells 16, 16 '. To this end, a plate 74 hollowed out from a central hole 76 is threaded with respect to the tongues 62, 62 ′. The latter cooperates with a tubular member 78, disposed around the threaded rod 70 and the outer surface of which is threaded. One of the ends of this tubular member 78 is provided with an operating button 80, while its opposite end receives, with ball joint, a discoidal piston bearing against the rear face of the core 4.
Lorsque l'on actionne le bouton de manoeuvre 80, l'organe tubulaire se déplace, par rapport à la plaque 74, en direction des coquilles 16, 16', ce qui a pour effet de rapprocher l'âme 4 de ces derniers. A un moment donné de cette opération, les crans 26, 26' des coquilles 16, 16' pénètrent dans les rainures longitudinales 12 de l'âme 4. Il est alors possible de désoli- dariser la tige filetée 70 par rapport aux volets 32, 32', puis de retirer cette tige hors des volumes intérieurs des coquilles 16, 16' et des languettes 62, 62 ' .When the operating button 80 is actuated, the tubular member moves, relative to the plate 74, in the direction of the shells 16, 16 ', which has the effect of bringing the core 4 closer to the latter. At a given point in this operation, the notches 26, 26 ′ of the shells 16, 16 ′ penetrate into the longitudinal grooves 12 of the core 4. It is then possible to separate the threaded rod 70 relative to the flaps 32, 32 ', then remove this rod from the interior volumes of the shells 16, 16' and the tabs 62, 62 '.
Selon une variante, on peut également retirer la tige filetée 70 en même temps que 1 ' insert 44, en tirant parti du fait que les coiffes ne peuvent se déplacer longitudinalement l'une par rapport à l'autre, le volet 32 étant reçu dans le logement 35' en U. En continuant d'actionner le bouton de manoeuvre 80, l'âmeAlternatively, the rod can also be removed threaded 70 at the same time as the insert 44, taking advantage of the fact that the caps cannot move longitudinally relative to each other, the flap 32 being received in the housing 35 'in a U shape. '' actuate the operating button 80, the core
4 progresse le long de la surface intérieure des calottes 18, 18', alors que les crans 26, 26' coulissent dans les rainures 12. Etant donné que les portions d'extrémité 6 de l'âme 4 sont dépourvues de rainures centrales, analogues à celles 52 de 1' insert 44, le déplacement de l'âme par rapport aux coquilles 16, 16' contribue à faire basculer les pattes élastiques 38, 38' vers l'extérieur de ces coquilles, jusqu'à ce que les pointes 40 ,40' adoptent une position saillante, telle qu'illustrée à la figure 5. En fin de déplacement de l'âme 4 par rapport aux coquilles4 progresses along the inner surface of the caps 18, 18 ′, while the notches 26, 26 ′ slide in the grooves 12. Since the end portions 6 of the core 4 are devoid of central grooves, the like to those 52 of the insert 44, the displacement of the core relative to the shells 16, 16 'contributes to tilting the elastic tabs 38, 38' towards the outside of these shells, until the tips 40 , 40 'adopt a projecting position, as illustrated in FIG. 5. At the end of displacement of the core 4 relative to the shells
16, 16', la paroi avant de l'âme 4 prend appui contre le volet 32', alors que les crans 26, 26' prennent appui contre la face arrière de cette âme 4. Etant donné que les rainures 12 ont une profondeur nulle au voisinage de cette extrémité arrière, les crans 26, 26' empêchent tout déplacement longitudinal de l'âme 4 par rapport aux coquilles 16, 16' dans un premier sens, un tel déplacement longitudinal étant empêché, dans l'autre sens, du fait de la présence du volet arrière 32' .16, 16 ', the front wall of the core 4 bears against the flap 32', while the notches 26, 26 'bear against the rear face of this core 4. Since the grooves 12 have zero depth in the vicinity of this rear end, the notches 26, 26 'prevent any longitudinal movement of the core 4 relative to the shells 16, 16' in a first direction, such longitudinal movement being prevented, in the other direction, due the presence of the rear flap 32 '.
Une fois l'implant 2 en place, les jupes opposées 28, 30' et 28', 30 des coiffes, à savoir une jupe d'une coiffe et la jupe de l'autre coiffe, globalement symétrique de cette première jupe par rapport à l'axe longitudinal de l'implant possèdent, en section transversale, une zone de recouvrement. Ceci permet de réduire le cisaillement latéral auquel est soumis l'implant. La hauteur, ou dimension verticale de l'implant, une fois posé, augmente depuis une valeur d à l'arrière de l'implant, jusqu'à une valeur D à l'avant de celui-ci .Once the implant 2 is in place, the opposite skirts 28, 30 'and 28', 30 of the caps, namely a skirt of a cap and the skirt of the other cap, generally symmetrical of this first skirt with respect to the longitudinal axis of the implant have, in cross section, a covering zone. This reduces the lateral shear to which the implant is subjected. The height, or vertical dimension of the implant, once placed, increases from a value d at the back of the implant, to a value D at the front of it.
La figure 6 représente les différents éléments constitu- tifs d'un implant conforme à un second mode de réalisation de l'invention, désigné dans son ensemble par la référence 102.FIG. 6 represents the various constituent elements of an implant according to a second embodiment of the invention, designated as a whole by the reference 102.
Cet implant comprend une âme 104, dont la section transversale se compose de deux portions d'extrémité 106, reliées par deux parois 108, perpendiculaires à ces portions d'extrémité 106, de manière à former une portion médiane 110.This implant comprises a core 104, the cross section of which consists of two end portions 106, connected by two walls 108, perpendicular to these end portions 106, so as to form a middle portion 110.
La dimension transversale, ou largeur, de cette âme 104 est sensiblement constante tout le long de cette dernière, alors que la hauteur, ou dimension verticale, de cette âme augmente vers l'avant de celle-ci, en faisant référence à l'implant une fois mis en place dans l'espace intervertébral. L'âme 104 est creusée de quatre rainures latérales 112, à savoir deux paires de rainures respectivement supérieures et inférieures s 'étendant parallèlement à la portion d'extrémité 106 dont elles sont adjacentes. L'âme 104 est également percée d'un orifice longitudinal central 114, qui est traversant.The transverse dimension, or width, of this core 104 is substantially constant all along the latter, while the height, or vertical dimension, of this core increases towards the front thereof, with reference to the implant. once placed in the intervertebral space. The core 104 is hollowed out by four lateral grooves 112, namely two pairs of respectively upper and lower grooves extending parallel to the end portion 106 of which they are adjacent. The core 104 is also pierced with a central longitudinal orifice 114, which is through.
L'implant 102 comprend également deux coquilles 116, 116', qui sont amovibles à la fois l'une par rapport à l'autre et par rapport à l'âme 104. Chaque coquille présente une forme de U et possède une âme 118, 118', destinée à entrer en contact avec les portions d'extrémité 106, ainsi que deux ailes 120, 120' destinées à prendre appui contre les méplats 108. L'âme 118, 118' est percée d'une ouverture longitudinale 124, 124', ainsi que d'une échancrure 136, 136', dont les parois reçoivent une patte non représentée, analogue à celle 38, 38' décrite en référence aux figures précédentes . La surface extérieure de l'âme est en outre pourvue de picots 137, 137' destinés à pénétrer dans une vertèbre correspondante . La paroi intérieure des ailes 120, 120' est pourvue de nervures longitudinales 138, 138' propres à coopérer avec les rainures 112 de l'âme 104. Chaque coquille est munie, à son extrémité avant, de volets, dont seul celui 132' est représenté, analogues à ceux décrits en référence aux figures 3 à 5. La mise en place de cet implant 102 est réalisée au moyen d'un ensemble de pose comprenant un insert 144, de section transversale rectangulaire, constante tout le long de cet insert. Ce dernier est pourvu de six rainures, à savoir deux rainures 152, 152', respectivement supérieure et inférieure, ainsi que quatre rainures latérales 154, destinées à coopérer avec les nervures 138, 138' . Les rainures 152, 152' permettent le libre passage de la patte élastique d'ancrage dans la vertèbre . La pose de l'implant 102 est réalisée de la manière suivante. On solidarise tout d'abord l' insert 144 par rapport aux coquilles 116, 116', par coopération des nervures 138, 138' avec les rainures latérales 154. On solidarise ensuite les deux coquilles au moyen d'une tige filetée non représentée, de façon analogue à ce qui a été décrit en référence au mode de réalisation précédent. Dans cette configuration, les ailes 120, 120' en regard des deux coquilles sont en appui mutuel .The implant 102 also comprises two shells 116, 116 ′, which are removable both with respect to each other and with respect to the core 104. Each shell has a U shape and has a core 118, 118 ', intended to come into contact with the end portions 106, as well as two wings 120, 120' intended to bear against the flats 108. The core 118, 118 'is pierced with a longitudinal opening 124, 124 ', as well as a notch 136, 136', the walls of which receive a tab, not shown, similar to that 38, 38 'described with reference to the preceding figures. The outer surface of the core is further provided with pins 137, 137 'intended to penetrate a corresponding vertebra. The inner wall of the wings 120, 120 'is provided with longitudinal ribs 138, 138' adapted to cooperate with the grooves 112 of the core 104. Each shell is provided, at its front end, with flaps, of which only the one 132 'is shown, similar to those described with reference to FIGS. 3 to 5. The positioning of this implant 102 is carried out by means of a fitting assembly comprising an insert 144, of rectangular cross section, constant all along this insert. The latter is provided with six grooves, namely two grooves 152, 152 ', respectively upper and lower, as well as four lateral grooves 154, intended to cooperate with the ribs 138, 138'. The grooves 152, 152 'allow the free passage of the elastic anchoring tab in the vertebra. The implant 102 is placed in the following manner. The insert 144 is first secured to the shells 116, 116 ', by cooperation of the ribs 138, 138' with the lateral grooves 154. The two shells are then secured by means of a threaded rod, not shown, of analogously to what has been described with reference to the previous embodiment. In this configuration, the wings 120, 120 ′ facing the two shells are in mutual support.
On forme ainsi un implant intermédiaire que l'on introduit dans l'espace intervertébral par impaction. On met ensuite en place des languettes, analogues à celles 62, 62', dans les ouvertures 124, 124' des coquilles 116, 116' . Puis, on introduit l'âme 104 dans le volume intérieur défini par ces languettes non représentées, puis on introduit cette âme 104 dans le volume intérieur des coquilles 116, 116', par impaction, au moyen d'un outil non représenté. Les opérations de retrait de 1 ' insert 144, de la tige filetée et des languettes non représentées s'opèrent de façon analogue à ce qui a été décrit en référence aux figures précédentes. L'invention permet de réaliser les objectifs précédemment mentionnés. Les deux coquilles, amovibles par rapport à l'âme, dont est pourvu l'implant de l'invention permettent la réalisation d'un implant intermédiaire de faible dimension transversale, susceptible d'être introduit dans l'espace intervertébral en ménageant un logement de dimensions restreintes, ce qui est avantageux pour l'intégrité physique du patient.An intermediate implant is thus formed which is introduced into the intervertebral space by impaction. Next, tongues, similar to those 62, 62 ′, are placed in the openings 124, 124 ′ of the shells 116, 116 ′. Then, the core 104 is introduced into the interior volume defined by these tabs which are not shown, then this core 104 is introduced into the interior volume of the shells 116, 116 ′, by impaction, by means of a tool which is not shown. The operations for removing the insert 144, the threaded rod and the tongues, not shown, operate in a similar manner to what has been described with reference to the preceding figures. The invention makes it possible to achieve the objectives mentioned above. The two shells, removable with respect to the core, which is provided with the implant of the invention allow the production of an intermediate implant of small transverse dimension, capable of being introduced into the intervertebral space by providing a housing for limited dimensions, which is advantageous for the physical integrity of the patient.
Cet implant intermédiaire possède une bonne stabilité par rapport aux os vertébraux et constitue un bras de levier pour l'insertion de l'âme dans le volume intérieur des coquilles. De plus, étant donné les faibles dimensions du logement ménagé initialement, l'implant définitif possède une stabilité très satisfaisante, une fois mis en place.This intermediate implant has good stability with respect to the vertebral bones and constitutes a lever arm for the insertion of the core into the interior volume of the shells. In addition, given the small dimensions of the housing initially provided, the final implant has a very satisfactory stability, once in place.
L'implant de l'invention est également avantageux, en ce sens qu'il autorise la réalisation d'essais préalables, par introduction seulement partielle de l'âme dans le volume intérieur de la coiffe. De la sorte, il est possible de retirer cette âme, dans le cas où sa conformation n'est pas favorable au patient, de manière à la remplacer par une autre âme, de profil approprié.The implant of the invention is also advantageous, in that it allows the carrying out of preliminary tests, by only partially introducing the core into the interior volume of the cap. In this way, it is possible to remove this core, in the case where its conformation is not favorable to the patient, so as to replace it with another core, of appropriate profile.
Il est à noter que la réalisation d'un logement de faibles dimensions ne permet pas l'introduction d'un implant monobloc de l'art antérieur. En effet, si on essaie d'introduire cet implant, en écartant les parois d'un logement, il se produit un effondrement des os vertébraux, dont l'invention permet de s'affranchir par l'utilisation de l'implant intermédiaire comprenant les deux coquilles. It should be noted that the realization of a housing of small dimensions does not allow the introduction of a one-piece implant of the prior art. Indeed, if one tries to introduce this implant, by spreading the walls of a housing, there occurs a collapse of the vertebral bones, the invention of which makes it possible to overcome by the use of the intermediate implant comprising the two shells.

Claims

REVENDICATIONS
1. Implant intervertébral (2 ; 102) , destiné à être inséré entre deux vertèbres voisines, ledit implant comprenant, sur une partie de sa périphérie, deux enrobages rigides (16 ; 116) destinés à être en contact respectivement avec les deux vertèbres voisines, la dimension verticale de l'implant posé augmentant vers la partie antérieure de l'implant et variant entre une dimension minimale (d) et une dimension maximale (D) , caractérisé en ce que ledit implant comprend en outre une âme amovible (4 ; 104), pourvue de deux zones périphériques supérieure et inférieure (6 ; 106) de contact avec chaque enrobage, la distance verticale séparant les deux zones périphériques (6 ; 106) augmentant vers la partie antérieure de l'implant, et en ce que les deux enrobages (16 ; 116) sont des coquilles propres à adopter une configuration intermédiaire (I) dans laquelle l'écartement vertical entre leurs surfaces extérieures est sensiblement constant ou décroissant vers l'avant, lesdites coquilles (16 ; 116) formant, dans ladite configuration intermédiaire (I) , un volume intérieur (V) adapté pour recevoir ladite âme amovible (4 ; 104) .1. Intervertebral implant (2; 102), intended to be inserted between two neighboring vertebrae, said implant comprising, on a part of its periphery, two rigid coatings (16; 116) intended to be in contact respectively with the two neighboring vertebrae, the vertical dimension of the implant implant increasing towards the anterior part of the implant and varying between a minimum dimension (d) and a maximum dimension (D), characterized in that said implant also comprises a removable core (4; 104 ), provided with two upper and lower peripheral zones (6; 106) of contact with each coating, the vertical distance separating the two peripheral zones (6; 106) increasing towards the anterior part of the implant, and in that both coatings (16; 116) are shells suitable for adopting an intermediate configuration (I) in which the vertical spacing between their outer surfaces is substantially constant or decreasing towards the front ant, said shells (16; 116) forming, in said intermediate configuration (I), an interior volume (V) adapted to receive said removable core (4; 104).
2. Implant selon la revendication 1, caractérisé en ce que, dans ladite configuration intermédiaire, l'écartement entre les coquilles (16 ; 116) est voisin de l'écartement minimal (d) dudit implant intervertébral .2. Implant according to claim 1, characterized in that, in said intermediate configuration, the spacing between the shells (16; 116) is close to the minimum spacing (d) of said intervertebral implant.
3. Implant selon la revendication 2, caractérisé en ce que, dans ladite configuration intermédiaire, des extrémités adjacentes (28, 28' et 30, 30') desdites coquilles (16) sont en appui mutuel.3. Implant according to claim 2, characterized in that, in said intermediate configuration, adjacent ends (28, 28 'and 30, 30') of said shells (16) are in mutual support.
4. Implant selon la revendication 3, caractérisé en ce qu'il comprend des moyens de solidarisation en translation desdites coquilles (16 ; 116) dans ladite configuration intermédiaire . 4. Implant according to claim 3, characterized in that it comprises means for securing in translation said shells (16; 116) in said intermediate configuration.
5. Implant selon l'une des revendications 1 à 4, caractérisé en ce que, dans ladite configuration intermédiaire (I), lesdites coquilles (16 ; 116) sont propres à recevoir ladite âme amovible (4 ; 104) par coulissement , et en ce qu'il est prévu des moyens (12, 26 ; 112, 138) de solidarisation en rotation desdites coquilles (16 ; 116) par rapport à ladite âme (4 ; 104) lors dudit coulissement.5. Implant according to one of claims 1 to 4, characterized in that, in said intermediate configuration (I), said shells (16; 116) are adapted to receive said removable core (4; 104) by sliding, and in what he is provided means (12, 26; 112, 138) for securing in rotation said shells (16; 116) relative to said core (4; 104) during said sliding.
6. Implant selon l'une des revendications 1 à 5, caracté- risé en ce qu'il comprend des moyens (26, 32') de solidarisation en translation longitudinale, selon deux sens opposés, desdites coquilles (16) par rapport à ladite âme (4) .6. Implant according to one of claims 1 to 5, characterized in that it comprises means (26, 32 ') for securing in longitudinal translation, in two opposite directions, said shells (16) relative to said soul (4).
7. Implant selon l'une des revendications 1 à 6, caractérisé en ce que ledit implant est pourvu de moyens (28, 28', 30, 30') de réduction du cisaillement latéral.7. Implant according to one of claims 1 to 6, characterized in that said implant is provided with means (28, 28 ', 30, 30') for reducing lateral shear.
8. Implant selon la revendication 7, caractérisé en ce que les moyens de réduction du cisaillement latéral comprennent au moins des premières (28, 28') et secondes (30, 30') jupes latérales opposées, dont, sont pourvues respectivement les coquilles (16) , lesdites jupes opposées possédant une zone de recouvrement .8. Implant according to claim 7, characterized in that the means for reducing the lateral shear comprise at least first (28, 28 ') and second (30, 30') opposite side skirts, with which the shells are provided respectively ( 16), said opposite skirts having an overlap zone.
9. Implant selon l'une quelconque des revendications précédentes, caractérisé en ce qu'il comprend des moyens d'ancrage (40) desdites coquilles (16) auxdites vertèbres, mobiles entre une position escamotée, lorsque l'âme (4) n'est pas au contact desdites zones périphériques (6) , et une position saillante, lorsque lesdites zones périphériques (6) de l'âme (4) sont au contact desdits enrobages (6) .9. Implant according to any one of the preceding claims, characterized in that it comprises means for anchoring (40) said shells (16) to said vertebrae, movable between a retracted position, when the core (4) does not is not in contact with said peripheral zones (6), and a projecting position, when said peripheral zones (6) of the core (4) are in contact with said coatings (6).
10. Ensemble de pose pour l'implant suivant l'une quelcon- que des revendications précédentes, caractérisé en ce qu'il comprend des moyens (62) de formation d'un second volume intérieur (V ) , en communication avec le volume intérieur (V) formé par lesdites coquilles (16 ; 116) , dans ladite configuration intermédiaire (I) . 10. Installation assembly for the implant according to any one of the preceding claims, characterized in that it comprises means (62) for forming a second interior volume (V), in communication with the interior volume (V) formed by said shells (16; 116), in said intermediate configuration (I).
11. Ensemble selon la revendication 10, caractérisé en ce que les moyens (62) de formation d'un second volume intérieur (V ) possèdent une surface intérieure continue avec la surface intérieure desdites coquilles (16 ; 116) , dans ladite configuration intermédiaire (I) . 11. An assembly according to claim 10, characterized in that the means (62) for forming a second interior volume (V) have a continuous interior surface with the interior surface of said shells (16; 116), in said intermediate configuration ( I).
12. Ensemble selon l'une des revendications 10 ou 11, caractérisé en ce que les moyens de formation d'un second volume intérieur (V) comprennent des languettes (62) propres à être engagées partiellement dans des ouvertures (24 ; 124) longitudinales dont sont pourvues les coquilles (16 ; 116) .12. Assembly according to one of claims 10 or 11, characterized in that the means for forming a second interior volume (V) comprise tongues (62) suitable for being partially engaged in openings (24; 124) longitudinal with which the shells (16; 116) are provided.
13. Ensemble de pose selon l'une des revendications 10 à 12, caractérisé en ce qu'il comprend des moyens (44 ; 144) de stabilisation desdites coquilles (16 ; 116) dans ladite configuration intermédiaire (I) , propres à être engagés dans le volume intérieur (V) desdites coquilles. 13. Installation assembly according to one of claims 10 to 12, characterized in that it comprises means (44; 144) for stabilizing said shells (16; 116) in said intermediate configuration (I), suitable for being engaged in the interior volume (V) of said shells.
PCT/FR2000/001444 1999-06-02 2000-05-26 Intervertebral implant and assembly for setting same WO2000074605A1 (en)

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FR2794362B1 (en) 2001-09-21
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