U.S. patent application number 09/776590 was filed with the patent office on 2001-07-26 for flexible implant using partially demineralized bone.
Invention is credited to Boyd, Lawrence M., Pafford, John A..
Application Number | 20010010021 09/776590 |
Document ID | / |
Family ID | 22855238 |
Filed Date | 2001-07-26 |
United States Patent
Application |
20010010021 |
Kind Code |
A1 |
Boyd, Lawrence M. ; et
al. |
July 26, 2001 |
Flexible implant using partially demineralized bone
Abstract
Implantable devices useful for creating bony fusion particularly
in intervetebral spinal fusion. The device is formed of bone and
has an at least partially demineralized portion between two rigid
bone portions creating an area of flexibility. In one application,
the area of flexibility may be used to move the device between a
reduced size insertion configuration and an expanded implanted
configuration. In another use, the area of flexibility may be
useful to dampen shock applied to the implant. A method is also
disclosed for making the implants and inserting the implants into
an intervertebral disc space to promote interbody fusion.
Inventors: |
Boyd, Lawrence M.; (Durham,
NC) ; Pafford, John A.; (Germantown, TN) |
Correspondence
Address: |
Woodard, Emhardt, Naughton, Moriarty and McNett
Bank One Center/Tower
Suite 3700
111 Monument Circle
Indianapolis
IN
46204-5137
US
|
Family ID: |
22855238 |
Appl. No.: |
09/776590 |
Filed: |
February 2, 2001 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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09776590 |
Feb 2, 2001 |
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09227976 |
Jan 8, 1999 |
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6206923 |
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Current U.S.
Class: |
623/17.13 ;
623/17.16; 623/23.63; 623/908; 623/919 |
Current CPC
Class: |
A61F 2002/30565
20130101; A61L 27/365 20130101; A61F 2/4611 20130101; A61F
2002/30593 20130101; A61F 2002/30059 20130101; A61F 2/30724
20130101; A61L 27/3687 20130101; A61F 2002/30131 20130101; A61F
2002/2839 20130101; A61F 2002/30594 20130101; A61F 2/28 20130101;
A61F 2002/30795 20130101; A61F 2230/0054 20130101; A61L 2430/38
20130101; A61F 2002/30777 20130101; A61F 2230/0065 20130101; A61F
2002/30894 20130101; A61F 2002/3085 20130101; A61F 2230/0013
20130101; Y10S 623/919 20130101; A61F 2002/30879 20130101; A61F
2230/0019 20130101; A61F 2002/30579 20130101; A61L 27/3608
20130101; A61F 2230/0069 20130101; A61F 2002/30224 20130101; A61F
2002/2835 20130101; A61F 2/447 20130101; A61L 27/3658 20130101;
A61F 2002/30176 20130101; A61F 2/4455 20130101; A61F 2002/30845
20130101; A61F 2002/30563 20130101; A61F 2002/30892 20130101; A61F
2002/30153 20130101; A61F 2230/0021 20130101; A61F 2250/0029
20130101; A61F 2310/00359 20130101; A61F 2/3094 20130101; A61L
27/3683 20130101; A61F 2002/30154 20130101; A61F 2002/30014
20130101; A61F 2002/302 20130101; A61F 2/442 20130101 |
Class at
Publication: |
623/17.13 ;
623/17.16; 623/23.63; 623/919; 623/908 |
International
Class: |
A61F 002/44; A61F
002/28 |
Claims
What is claimed is:
1. An implant, comprising: a first bone portion, a second bone
portion, and a flexible bone portion joining said first bone
portion and said second bone portion, said flexible bone portion
permitting movement of said first bone portion in relation to said
second bone portion.
2. The implant of claim 1, wherein said flexible bone portion is at
least partially demineralized bone.
3. The implant of claim 1, wherein said flexible bone portion
includes an area of completely demineralized bone.
4. The implant of claim 1, wherein said first portion includes an
upper bearing surface and a lower bearing surface separated by a
first height, and said second bone portion includes an upper
bearing surface and a lower bearing surface separated by a second
height, said first and second heights adapted to maintain spacing
between adjacent bone.
5. The implant of claim 4, wherein said first height and said
second height are substantially equal.
6. The implant of claim 4, wherein each of said upper and lower
bearing surfaces includes a bone engaging surface to inhibit
expulsion from a disc space between two adjacent vertebra.
7. The implant of claim 1, wherein said implant is a spinal fusion
device and said first and second bone portions are adapted to
maintain a desired spacing between a first vertebral body and a
second vertebral body.
8. The implant of claim 7, wherein said first and second bone
portions have corresponding tapered bearing surfaces to provide an
implant having a spacing height gradually increasing from a first
end to an opposite second end, wherein said implant is adapted for
use in maintaining lordosis.
9. The implant of claim 1, wherein said first bone portion, said
second bone portion, and said flexible bone portion are formed of a
single bone segment.
10. An implant, comprising: a bone segment having a cortical bone
portion extending between a first bearing surface and a second
bearing surface, said portion being at least partially
demineralized to create a flexible segment disposed between said
first and second bearing surfaces.
11. The implant of claim 10, wherein said bone segment is a ring
shaped bone segment, said bone segment includes a cut opposite said
flexible segment, said cut dividing said bone segment into a first
portion extending between said cut and said flexible segment and an
opposite second portion extending between said cut and said
flexible segment.
12. The implant of claim 10, wherein said first bearing surface is
adapted to engage an upper vertebral body and said second bearing
surface is adapted to engage an adjacent lower vertebral body, said
flexible segment disposed between said first and second bearing
surfaces to transmit forces therebetween, wherein said flexible
segment functions as a shock absorber.
13. A spinal fusion implant adapted for insertion into the space
between adjacent first and second vertebral bodies, comprising: a
first bone portion having a first bearing surface for engaging a
first vertebral body; a second bone portion having a second bearing
surface for engaging a second vertebral body; and at least one
flexible portion disposed between said first and second bone
portions, said flexible portion permitting movement between said
first bone portion and said second bone portion.
14. The spinal fusion implant of claim 13, wherein said first bone
portion has a third bearing surface opposite said first bearing
surface, said third bearing surface adapted for engaging said
second vertebral body and said second bone portion has a fourth
bearing surface opposite said second bearing surface, said fourth
bearing surface adapted for engaging said first vertebral body,
wherein said first and second bone portions cooperate to maintain
the space between the first and second vertebral bodies.
15. The spinal fusion implant of claim 13, wherein flexible portion
acts as a shock absorber between said first and second vertebral
bodies.
16. The spinal fusion implant of claim 13, wherein the implant has
a proximal end and an opposite distal end, and said flexible
portion is disposed adjacent said proximal end.
17. The implant of claim 16, further including a second flexible
portion disposed adjacent said distal end and extending between
said first and second bone portions.
18. The implant of claim 17, wherein said bearing surface and said
second bearing surface including cooperating thread patterns
permitting threaded insertion of the implant into the space between
the first and second vertebral bodies.
19. The implant of claim 15, wherein said implant is formed of a
single segment of bone.
20. A method of preparing a flexible bone implant, comprising:
providing a rigid bone segment; delineating an intermediate portion
of the bone segment; and at least partially demineralizing the
intermediate portion of the bone to create a flexible segment
between adjacent sections of rigid bone.
21. The method of claim 20, wherein said at least partially
demineralizing includes exposing said intermediate portion to a
demineralizing fluid.
22. The method of claim 21, further including limiting contact of
bone adjacent the intermediate portion with the demineralizing
fluid.
23. The method of claim 22, wherein said limiting utilizes
hydrostatic pressure to limit the movement of the demineralizing
fluid into the bone adjacent the intermediate portion.
24. The method of claim 20, further including forming a
bone-engaging surface on the implant.
25. The method of claim 24, wherein said bone engaging surface is
configured to prevent movement of the implant.
26. A method of inserting an interbody fusion implant made of bone,
comprising: providing an insertion tube and an implant formed of
bone and having a first portion, a second portion and a central
flexible portion joining the first and second portions; positioning
the insertion tube adjacent a disc space between two vertebra;
inserting the implant into the insertion tube; advancing the
implant through the insertion tube and into the disc space; moving
the first portion with respect to the second portion.
27. A method of implanting a bone implant for spinal spacing,
comprising: providing a bone implant with at least a portion
thereof moveable from a reduced insertion configuration to an
expanded spacing configuration; moving the implant to the reduced
insertion configuration; delivering the implant to the disc space
in the reduced insertion configuration; and positioning the implant
in the expanding spacing configuration.
28. The method of claim 27, wherein said implant is at least
partially resilient and said moving includes compressing the
implant with a compressing device.
29. The method of claim 28, wherein said delivering is accomplished
by a tube having an internal passageway configured to receive said
implant in the reduced insertion configuration.
Description
BACKGROUND OF THE INVENTION
[0001] The present invention relates to implantable fusion devices
and methods for their use. More particularly, the present invention
relates to interbody fusion devices formed of bone that may be
utilized in spinal fusions.
[0002] A variety of interbody fusion implants are available for
spinal fusion procedures. These implants have been manufactured of
various materials including steel, titanium, composites, allograft,
xenograft or other biocompatible materials. These implants may be
inserted using fixed protective tubes to protect surrounding
neurological and vascular structures or through an unprotected open
procedure. One limitation on the size of a device inserted into the
disc space is the size of the opening through surrounding tissue
that is available to gain access to the disc space. From a
posterior approach to the spine, the dura and nerve roots must be
mobilized to gain access to the disc space. Similarly, from an
anterior approach, the aorta and vena cava must be mobilized to
gain access to the disc space. Such mobilization is often limited
by the anatomical structures, thus resulting in a relatively small
access site in comparison to the size of the disc space. Removal of
additional ligaments and bone to enlarge an entrance to the disc
space may de-stabilize and weaken the joint between two adjacent
vertebra. Moreover, excessive retraction of vessels and neural
structures to create a large access opening may result in damage to
these tissues. Thus, prior procedures have been limited to placing
a first device passable through the available opening on one side
of the spine and mobilizing the tissue or vessels to place another
similar implant on the opposite side of the spine. Each implant
being limited in size by the available access site.
[0003] In response, expandable implants have been developed from
biocompatible materials such as titanium and composites. These
devices rely on hinges or selective deformation of the implant
material to permit expansion after they are positioned in the disc
space. While such devices have a reduced insertion configuration
and an expanded spacing configuration, the materials utilized to
form the implants are synthetic and will not incorporate into
adjacent bony tissues. While bone offers much improved
incorporation, the inherent brittle nature of bone resulting from a
high mineral content, particularly load-bearing cortical bone,
severely limits its potential deformation. Typically, for example,
cortical bone consists of approximately 70% mineral content and 30%
non-mineral matter. Of this non-mineral matter, approximately 95%
is type I collagen, with the balance being cellular matter and
non-collagenous proteins.
[0004] Bone grafts, in conjunction with other load-bearing
implants, have commonly been used in a fixed shape, pulverized, or
as pliable demineralized bone. One form of a pliable bone graft is
a demineralized bone material typically in the form of a sponge or
putty having very little structural integrity. While a
demineralized bone segment may retain properties suitable to
support bone ingrowth, the structural properties of the bone are
altered by removal of its mineral content. Thus, such bone sponges
and putties may not typically be used in load-bearing
applications.
[0005] Therefore, there remains a need for a strong bone implant
having an area of flexibility.
SUMMARY OF THE INVENTION
[0006] In one aspect, the present invention provides a flexible
bone implant. The bone implant of the present invention comprises a
first bone portion, a second bone portion, and a flexible bone
portion joining the first and second bone portions. The
intermediate flexible bone portion permits movement of the first
bone portion in relation to the second bone portion. In a preferred
embodiment, the movement of the first and second bone portions
would be between a reduced size insertion configuration and an
expanded configuration suitable for maintaining two bony structures
in a spaced relation and permitting bone ingrowth, if desired.
Optionally, the movement between the first and second bone portions
may be utilized as an elastic damper when the device is positioned
between adjacent bony structures.
[0007] In accordance with another aspect of the invention, the bone
implant comprises a bone segment having at least one partially
demineralized area creating a flexible segment of the demineralized
bone segment. In one embodiment, an opposite portion of the
cortical femoral ring segment is severed such that the ring segment
may be expanded once it has been inserted into an intervertebral
disc space. In yet another embodiment, the device includes at least
two partially demineralized bone portions on substantially opposing
portions of the bone segment. In this configuration, the
substantially rigid portions are placed in contact with the load
bearing surfaces between two adjacent bony structures such that the
flexible portions perform an elastic function, allowing more normal
motion or to better load bone adjacent the disc space.
[0008] In yet a further aspect of the present invention, there is
provided a method for the preparation of a bone implant. The method
includes providing a rigid bone segment and delineating an
intermediate portion of that segment. The central portion is then
at least partially demineralized to create a flexible segment
between two adjacent sections of bone. The method of at least
partially demineralizing a segment of bone between two adjacent
rigid bone segments may be repeated as often as necessary to create
the desired structure for implantation.
[0009] The present invention further contemplates a method of
inserting a device formed in accordance with the present invention.
Specifically, the method includes providing an insertion tube and
an implant formed of bone having a first and second portions joined
by a flexible central portion. The insertion tube is positioned
adjacent a disc space formed by adjoining vertebrae. The first and
second portions of the bone implant are then positioned into a
reduced size configuration for insertion into the insertion tube.
The implant is then inserted into the tube and advanced until it is
positioned in the disc space. Once the implant is in the desired
position, the first and second portions are moved with respect to
one another by flexing of the flexible portion into an expanded
implantation configuration. In a preferred embodiment of the
insertion method, bone ingrowth material is placed between the
first and second portions to encourage further bone ingrowth into
and around the fusion devices.
[0010] These and other objects of the present invention will be
apparent to those skilled in the art based on the following
descriptions of the preferred embodiment of the present
invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0011] FIG. 1 is perspective view of an implant according to the
present invention.
[0012] FIG. 2 is a top view of the implant in its insertion
configuration.
[0013] FIG. 3 is a top view of the implant in its expanded
implanted condition.
[0014] FIG. 4 is a side view of an implant according to the present
invention inserted between two adjacent vertebra.
[0015] FIG. 5 is a top view of an alternative embodiment of the
present invention.
[0016] FIG. 6 is an end view of the embodiment of FIG. 5.
[0017] FIG. 7 is a top view of the implant of FIG. 5 in an expanded
configuration.
[0018] FIG. 8 is a side view of yet a further embodiment according
to the present invention disposed between two adjacent
vertebra.
[0019] FIG. 9 is a top view of a ring-shaped bone segment prepared
in accordance with another aspect of the present invention.
[0020] FIG. 10(a) is a top view of an alternative embodiment
according to the present invention.
[0021] FIG. 10(b) is a modified embodiment of FIG. 10(a).
DESCRPITION OF THE PREFERRED EMBODIMENTS
[0022] For the purposes of promoting an understanding of the
principles of the invention, reference will now be made to the
embodiments illustrated in the drawings and specific language will
be used to describe the same. It will nevertheless be understood
that no limitation of the scope of the invention is thereby
intended, such alterations and further modifications in the
illustrated devices, and such further applications of the
principles of the invention as illustrated therein being
contemplated as would normally occur to one skilled in the art to
which the invention relates.
[0023] Referring now to FIG. 1, there is shown an implant according
to a preferred embodiment of the present invention. Although
implants according to the present invention may have many uses, the
embodiment shown in FIG. 1 is particularly adapted for promoting
interbody fusion in the spine. Specifically, FIG. 1 illustrates a
bone implant 10 having a first substantially rigid portion 12 and a
second substantially rigid portion 14. The first and second rigid
portions 12 and 14 are joined by intermediate portion 16.
Intermediate portion 16 has been at least partially demineralized
to create an area of flexibility in the bone implant. Preferably,
an area of intermediate portion 16 has been completely
demineralized to provide maximum flexibility. The flexibility
created by demineralization of intermediate portion 16 permits
rigid portions 12 and 14 to be moved with respect to each other.
The advantages of this feature will be further described
herein.
[0024] Bone portion 12 includes bone engagement ridges 20 defined
on upper bearing surface 17 with an identical set of ridges 21
defined on the bottom-bearing surface (not shown). In a similar
manner, bone portion 14 includes bone engaging ridges 18 defined on
upper bearing surface 15 and identical ridges 19 defined on the
bottom-bearing surface (not shown). It will be understood that
while ridges have been shown in a preferred embodiment, it is
contemplated that there are a variety of structures, which could
provide a surface for effective engagement with the vertebral
bodies to limit expulsion from the disc space.
[0025] The rigid bone portions 12 and 14 are adapted to provide
structural support between the respective upper and lower bearing
surfaces. Specifically, the bone implant may be selected from donor
bone having sufficient resistance to compression between the upper
and lower surfaces to find application in the intended environment.
The pair of rigid bone portions cooperate to provide support for
spacing between adjacent vertebra. While the preferred embodiments
of the implants according to the present invention have been shown
with two rigid bone portions, it is contemplated that further rigid
bone portions may be interconnected by flexible bone areas to offer
further implant shapes.
[0026] Referring now to FIGS. 2-4, there is shown a method of
inserting a device according to the present invention for interbody
fusion between adjacent vertebral bodies. Specifically referring to
FIG. 2, implant 10 is shown in its reduced size insertion
configuration with first portion 12 positioned substantially
adjacent second portion 14. As shown in FIG. 2, it is contemplated
that the rigid portions may be positioned in substantially parallel
alignment. However, in some applications, this amount of
flexibility in intermediate portion 16 may not be necessary. In a
preferred embodiment, the implant is constrained in the insertion
configuration within insertion tube 30.
[0027] Access to the disc space between adjacent vertebra is
achieved as known in the art. Although access may be achieved from
any direction without deviating from the invention, for the purpose
of illustration and without limitation, FIGS. 2 and 3 illustrate
access via a posterior approach. Once access is achieved, a
protective sleeve may be positioned adjacent the disc space and the
disc space distracted if necessary. Implant 10 is moved to the
insertion configuration with the longitudinal extent of bone
portions 12 and 14 in substantial parallel alignment. The implant,
in the reduced size configuration, is positioned in protective
sleeve 30 and advanced toward the disc space D It will be
understood that while implant 10 may have a much greater size after
placement, dura 34 need only be retracted within cavity 38 enough
to allow passage of protective sleeve 30 and the reduced size
implant.
[0028] Implant 10 is advanced through protective sleeve 30 by use
of a pushing device (not shown) until it exits protective sleeve 30
into the disc space D (FIGS. 3 and 4). Once in disc space D, the
device either expands by release of an elastic deformation formed
in the central portion 16 or a separate instrument (not shown) may
be inserted between first portion 12 and second portion 14 to urge
movement between the respective portions to manipulate the device
into the expanded spacing configuration shown in FIG. 3. Expansion
of the device creates an implant having greater stability to the
intervertebral space via a broader support area and less tendency
to topple over in the disc space. Further cavity 33 between
portions 12 and 14 provides an area to receive material to promote
bony incorporation and fusion. Once implant 10 has been properly
positioned, bone growth promoting material 32 may be positioned
between first portion 12 and second portion 14 to encourage bone
growth into and through implant 10. Although not illustrated, it
will be understood that typically a second implant will be placed
in disc space D to provide further stability.
[0029] As shown more clearly in FIG. 4, implant 10 has a height H
which is substantially equal to the height of disc space D formed
between vertebra 36 and vertebra 38. It will understood by those
skilled in the art that in the preferred embodiment illustrated
herein, the height H is substantially constant from the insertion
shown in FIG. 3 to the expanded configuration shown in FIG. 4.
Furthermore, while a uniform height implant is shown in FIG. 2, it
will be understood that implant 10 may have a tapering height such
that the implant could be utilized for establishing or maintaining
the proper lordotic curvature in the spine. With reference to rigid
bone portion 14, upper bearing surface 25 engages and supports
upper vertebral body 38 while lower bearing surface 27 engages and
supports the implant on lower vertebral body 36. Rigids 18 and 19
engage the surface of vertebral bodies 38 and 36, respectively, to
resist expulsion. Rigid bone portion 14, in conjunction with rigid
bone portion 12 having similar engagement with the vertebrae, has
sufficient rigid and structural integrity to substantially maintain
height H and to withstand normal forces applied to the spinal
column. Flexible area 16 need not have such structural
requirements, although, preferably, it assists in the implant
stability by maintaining the connection between the two support
walls.
[0030] Flexible bone implant 10 provides the desirable features of
being formed of a highly successful bone fusion material, i.e.
natural bone, with the advantages of having a reduced size
insertion configuration and an expanded spacing configuration.
Thus, while the implant maintains the desired height of disc space
distraction, the width of the implant opposite central portion 16
is readily expandable from the insertion configuration of FIG. 2 to
the expanded configuration of FIG. 3 This feature permits insertion
through a smaller access site and increases implant stability in
the disc space.
[0031] Referring now to FIGS. 5 through 7, there is shown a further
embodiment of an implant according to the present invention. FIG. 5
shows a threaded cortical bone dowel 50 modified in accordance with
the present invention. Bone dowel 50 includes a thread 58 for
engaging adjacent vertebra to advance the implant in a controlled
manner and to resist expulsion. Implant 50 has a recessed slot 64
for engaging a driving tool adapted to rotate the device. In
accordance with the invention, threaded bone dowel 50 is divided
into a first side wall 52 and second side wall 54 separated by
flexible area 56 and slot 62. As described further herein, flexible
area 56 is created by at least partial demineralization of the bone
in this area of the implant. Each of the first and second side
walls 52 and 54 include upper and lower bearing surfaces. Threaded
dowel 50 further includes a central opening 60. This opening may be
created by the natural medullary canal of a diaphyseal bone or by
removal of a cancellous portion of a donor bone, although this
depends on the configuration of the donor bone.
[0032] In the configuration of FIG. 5, the device may be inserted
through an insertion tube or other device into a disc space as
previously described. Once positioned with opening 60 adjacent the
upper and lower vertebral bodies, first side wall 52 and second
side wall 54 are urged away from each other with the implant
flexing at flexible portion 56. The implant 50 is shown in its
expanded condition in FIG. 7. Once the desired expansion has been
created, bone growth promoting material 64 may be inserted into the
interior area 60 between first side wall 52 and second side wall
54. The side walls provide structured support to maintain the disc
space height. As shown in FIGS. 5 through 7, bone implant 50 has a
reduced-size insertion configuration and an expanded spacing
configuration.
[0033] Referring to FIG. 8, in still a further embodiment of the
present invention, a threaded, cylindrical bone dowel has been
modified in accordance with the present invention. Specifically,
bone implant 80 has been modified to include at least two areas 86
and 88 of reduced mineral content, providing a degree of
flexibility in the implant. Demineralized sections 86 and 88 are
disposed between rigid portions 82 and 84. Thus, sudden changes in
forces applied to rigid portions 82 or 84 may be dampened by the
intervening flexible areas. Referring to FIG. 8, such a device is
implanted in disc space 94 between vertebral body V1 and vertebral
body V2 with rigid portions 92 and 94 positioned adjacent vertebral
bodies V1 and V2, respectively. It will be understood that as force
is applied to vertebral bodies V1 and V2, there will be a tendency
for the implant to flex at demineralized areas 86 and 88 to provide
a degree of flexibility in the implant and to provide physiologic
loading environment. Specifically, compressive forces represented
by arrows 102, 103, 104 and 105 may be more normally transferred by
flexing of flexible portions 86 and 88 to positions 110 and 112,
respectively. Such devices may have application in both fusion
(normal loading) and arthroplasty (normal motion).
[0034] Referring to FIG. 9, there is shown yet a further aspect of
the present invention. Donor bone 120 is a substantially
ring-shaped bone segment having an internal cavity 30, such as a
femoral ring. A slot 128 is formed in ring 120. Opposite slot 128,
portion 126 is treated to remove at least a portion of the bone
minerals. This creates an area of flexibility at portion 126. Thus,
the bone is divided into side walls 122 and 124, separated by slot
128 and flexible portion 126. As previously described, the bone
graft may be expanded after insertion by movement of side wall 124
away from side wall 122.
[0035] Referring now to FIG. 10(a), there is shown an alternative
embodiment according to the present invention. Spacer 180 is a
Smith-Robinson type bone graft that is typically used in the
cervical region of the spine. Spacer 180 includes an internal
cavity 188 defined by walls 182, 183, 184 and 191. Cavity 188 is
suitable for receiving bone graft material to promote fusion
between adjacent vertebrae. To provide for expansion, an opening
186 in wall 183 is created and an opposing flexible hinge area 190
is created in wall 191 by at least partial demineralization. In
this manner, walls 182 and 184 may be moved in the direction of
arrows 192 and 194, respectively, to expand the implant after
insertion between adjacent vertebrae. It will be understood that
wall 191 will be at least partially deformed during the expansion
process.
[0036] FIG. 10(b) shows a modified embodiment of the implant of
FIG. 10(a). In FIG. 10(b), spacer 195 has an internal chamber 208
defined by walls 199, 200, 201, and 202. Wall 201 includes an
opening 196 formed there through. Flexible areas of bone are
created by at least partial demineralization at hinge areas 197 and
198 on walls 200 and 202, respectively, adjacent the connection to
wall 199. Walls 200 and 202 may be moved in the direction of arrows
204 and 206 to permit expansion of spacer 195. The use of dual
hinge areas on the implant permits precise placement of wall 199 in
the disc space and permits the expansion to take place laterally
without the location of a portion of wall 199 being altered during
expansion.
[0037] In addition to the above described embodiments, the present
invention may have further uses. Specifically, but without
limitation, one such may be to reform donor bone segments to
conform more closely to spaces needing implants. In some cases,
donor bone segments may have shapes incompatible with the shape of
the implantation site. These bone segments may have flexible areas
to reform the bone graft to more closely match its intended use.
Such segments may have one or more flexible areas such that the
overall shape of the donor bone segment may be modified by flexing
at the flexible segments. This may preserve much of the load
bearing strength of the implants. This use of the present invention
may increase the potentially useable portions of the limited supply
of donor bone. Full utilization of donor bone and alternative graft
shapes is more fully disclosed in U.S. patent application Ser. No.
09/181,353 filed Oct. 29, 1998, entitled IMPACTED BONE IMPLANTS AND
INSTRUMENTATION, incorporated herein by reference.
[0038] Creation of the demineralized portion of the bone will now
be described. The processing involves the use of donor bone with
processing in a clean room environment within a bone processing
facility. Such donor bone may include allograft from human sources
or xenograft from animal sources. Further, it is contemplated that
as technology advances in the area of bone processing, the donor
bone may be generated in the manufacturing process, either by bone
growth or by a processing of constituent components of bone to
create artificial materials having properties very similar to bone.
More specifically, while any available allogenic or xenogenic bone
stock may be utilized for the procedure, cortical bone is
conventionally preferred for spinal fusion for its structural
properties, although cortical cancellous or cancellous bone may be
used depending upon the particular requirements for the implantable
device.
[0039] In further processing, the connective tissues are removed
and the bone is cleaned, rinsed, and defatted using a solvent such
as ethanol or hydrogen peroxide. The bone is then machined or
otherwise shaped using conventional techniques to create its final
shape, such as a wedge, dowel, or other shape. An intermediate
portion of the bone is delineated as needing an increased degree of
flexibility. Demineralization takes place solely at the location
requiring the flexible capability. Penetration of the
demineralization fluid into the bone adjacent the desired area of
flexibility may be controlled by hydrostatic pressure thereby
limiting the area of demineralization. The amount of mineral
removed from the bone may be adjusted to create the desired amount
of flexibility. This demineralization conventionally uses an
organic acid such as hydrochloric, nitric, or citric acid.
Preferably, the demineralization solution comprises 0.1 to 1.0 N
HCl, most preferably 0.3 N HCl. If a xenograft is used, known
techniques on the utilization of organic solvents to inactivate
bone proteins and reduce antigenecity may be applied at this point.
Additionally, the use of glutaraldehyde may take place in order to
further cross-line the collagen structure following removal of the
mineral portion. Once the device has been machined and partially
demineralized, it may be stored prior to insertion.
[0040] Although the above-described processing is disclosed herein
as a preferred embodiment, it is contemplated that other suitable
processes may be used.
[0041] While the invention has been illustrated and described in
detail in the drawings and foregoing description, the same is to be
considered as illustrative and not restrictive in character, it
being understood that only the preferred embodiments have been
shown and described and that all changes and modifications that
come within the spirit of the invention are desired to be
protected.
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