U.S. patent application number 11/304271 was filed with the patent office on 2006-11-02 for inter-cervical facet joint fusion implant.
This patent application is currently assigned to St. Francis Medical Technologies, Inc.. Invention is credited to Ken Y. Hsu, Steven T. Mitchell, Charles J. Winslow, Scott A. Yerby, James F. Zucherman.
Application Number | 20060247650 11/304271 |
Document ID | / |
Family ID | 59462913 |
Filed Date | 2006-11-02 |
United States Patent
Application |
20060247650 |
Kind Code |
A1 |
Yerby; Scott A. ; et
al. |
November 2, 2006 |
Inter-cervical facet joint fusion implant
Abstract
Systems and method in accordance with the embodiments of the
present invention can include an implant for positioning within a
cervical facet joint for distracting the cervical spine, thereby
increasing the area of the canals and openings through which the
spinal cord and nerves must pass, and decreasing pressure on the
spinal cord and/or nerve roots. The implant can be inserted
laterally or posteriorly.
Inventors: |
Yerby; Scott A.; (Montara,
CA) ; Winslow; Charles J.; (Walnut Creek, CA)
; Zucherman; James F.; (San Francisco, CA) ; Hsu;
Ken Y.; (San Francisco, CA) ; Mitchell; Steven
T.; (Pleasant Hill, CA) |
Correspondence
Address: |
FLIESLER MEYER, LLP
FOUR EMBARCADERO CENTER
SUITE 400
SAN FRANCISCO
CA
94111
US
|
Assignee: |
St. Francis Medical Technologies,
Inc.
Alameda
CA
|
Family ID: |
59462913 |
Appl. No.: |
11/304271 |
Filed: |
December 14, 2005 |
Related U.S. Patent Documents
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Application
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PCT/US05/44979 |
Dec 13, 2005 |
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11304271 |
Dec 14, 2005 |
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11053399 |
Feb 8, 2005 |
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11304271 |
Dec 14, 2005 |
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11053624 |
Feb 8, 2005 |
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11304271 |
Dec 14, 2005 |
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11053735 |
Feb 8, 2005 |
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11304271 |
Dec 14, 2005 |
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11053346 |
Feb 8, 2005 |
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11304271 |
Dec 14, 2005 |
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11093557 |
Mar 30, 2005 |
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11304271 |
Dec 14, 2005 |
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11093689 |
Mar 30, 2005 |
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11304271 |
Dec 14, 2005 |
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60635453 |
Dec 13, 2004 |
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60668053 |
Apr 4, 2005 |
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60679377 |
May 10, 2005 |
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60679361 |
May 10, 2005 |
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60679363 |
May 10, 2005 |
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60687765 |
Jun 6, 2005 |
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60717369 |
Sep 15, 2005 |
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Current U.S.
Class: |
606/90 ; 606/70;
623/17.14 |
Current CPC
Class: |
A61F 2002/30308
20130101; A61F 2002/30538 20130101; A61F 2/4405 20130101; A61F
2002/3013 20130101; A61F 2230/0054 20130101; A61B 17/7059 20130101;
A61B 2017/8655 20130101; A61F 2002/4661 20130101; A61B 17/025
20130101; A61F 2002/30566 20130101; A61F 2210/009 20130101; A61F
2220/0075 20130101; A61F 2/4657 20130101; A61F 2230/001 20130101;
A61F 2/4684 20130101; A61F 2220/0091 20130101; A61F 2002/30601
20130101; A61B 17/7001 20130101; A61F 2002/30378 20130101; A61F
2002/30563 20130101; A61F 2/44 20130101; A61F 2250/0006 20130101;
A61F 2310/00976 20130101; A61F 2/30771 20130101; A61F 2002/30079
20130101; A61F 2310/00796 20130101; A61B 17/8635 20130101; A61F
2220/0025 20130101; A61F 2002/30383 20130101; A61F 2002/30841
20130101; A61F 2/28 20130101; A61F 2002/30176 20130101; A61F 2/4455
20130101; A61F 2002/30517 20130101; A61F 2220/0033 20130101; A61F
2/4611 20130101; A61B 17/7028 20130101; A61B 17/7064 20130101; A61B
17/7071 20130101; A61F 2002/30578 20130101; A61F 2002/30769
20130101; A61B 17/8042 20130101; A61B 17/80 20130101; A61B 2090/061
20160201; A61F 2002/30462 20130101; A61F 2002/30878 20130101; A61B
2017/0256 20130101; A61F 2250/0084 20130101; A61F 2002/30471
20130101; A61F 2002/30092 20130101; A61B 17/562 20130101; A61B
17/7022 20130101; A61F 2002/30708 20130101; A61F 2002/4627
20130101; A61F 2210/0014 20130101; A61F 2230/0063 20130101; A61B
17/70 20130101; A61F 2002/30528 20130101; A61F 2002/30639 20130101;
A61F 2310/00011 20130101 |
Class at
Publication: |
606/090 ;
623/017.14; 606/070 |
International
Class: |
A61B 17/70 20060101
A61B017/70 |
Claims
1. A facet joint implant that addresses ailments of the spine, the
implant comprising: a first anchoring plate adapted to be fixedly
associated with a first vertebra; a second anchoring plate adapted
to be fixedly associated with a second vertebra; a facet joint
space connected with the first anchoring plate and the second
anchoring plate, the facet joint spacer adapted to be positioned in
a facet joint; and wherein the facet joint spacer is pivotable
relative to at least one of the first anchoring plate and the
second anchoring plate.
2. The implant of claim 1, wherein: the facet joint spacer includes
a superior surface and an inferior surface; at least one of the
superior surface and the inferior surface includes at least one of
a protuberance and an indent; whereas the protuberance restricts
movement of the facet joint spacer relative to the first facet or
the second facet; and whereas the indent permits bone growth within
the indent.
3. The implant of claim 1, further comprising: a hinge; wherein the
hinge is connected between the first anchoring plate, the second
anchoring plate and the facet joint spacer.
4. The implant of claim 3, wherein the hinge includes: a first
pivot point pivotably associated with the first anchoring plate; a
second pivot point pivotably associated with the second anchoring
plate; and a third pivot point pivotably associated with the facet
joint spacer.
5. The implant of claim 3, wherein the hinge is integrally formed
with one of the first anchoring plate, the second anchoring plate
and the facet joint spacer.
6. The implant of claim 5, wherein the hinge includes: a first
pivot point pivotably associated with at least one of the first
anchoring plate and the second anchoring plate; a second pivot
point pivotably associated with the facet joint spacer or the other
of the first anchoring plate and the second anchoring plate.
7. The implant of claim 3, wherein the hinge includes a ball
structure receivable within a socket thereby forming a
ball-in-socket arrangement allowing a plurality of freedom of
movement.
8. The implant of claim 1, wherein: the first anchoring plate
includes a first bore; the second anchoring plate includes a second
bore; and further comprising: a first bone screw adapted to be
arranged within the first bore; and a second bone screw adapted to
be arranged within the second bore.
9. The implant of claim 8, further comprising: a first locking
screw adapted to block the first bone screw from at least one of a
backward displacement and a rotational displacement; and a second
locking screw adapted to block the first bone screw from at least
one of a backward displacement and a rotational displacement.
10. The implant of claim 9, wherein: one or both of the first
locking screw and the second locking screw includes a chisel-point
end; and the chisel point end self-cuts the locking screw into a
vertebral structure.
11. The implant of claim 1, wherein: at least one of the first
anchoring plate and the second anchoring plate includes one or more
protuberances; the one or more protuberance restricts movement of
the first anchoring plate relative to the first vertebra or the
second anchoring plate relative to the second vertebra.
12. A facet joint implant that addresses ailments of the spine, the
implant comprising: a first anchoring plate adapted to be fixedly
associated with a first vertebra; a second anchoring plate adapted
to be fixedly associated with a second vertebra; a facet joint
spacer adapted to be positioned in a facet joint; and a hinge
connected between the first anchoring plate, the second anchoring
plate and the facet joint spacer; wherein the facet joint spacer is
pivotable relative to one or both of the first anchoring plate and
the second anchoring plate.
13. The implant of claim 12, wherein: the facet joint spacer
includes a superior surface and an inferior surface; at least one
of the superior surface and the inferior surface includes at least
one of a protuberance and an indent.
14. The implant of claim 12, wherein the hinge includes: a first
pivot point pivotably associated with the first anchoring plate; a
second pivot point pivotably associated with the second anchoring
plate; and a third pivot point pivotably associated with the facet
joint spacer.
15. The implant of claim 12, wherein the hinge is integrally formed
with one of the first anchoring plate, the second anchoring plate
and the facet joint spacer.
16. The implant of claim 15, wherein the hinge includes: a first
pivot point pivotably associated with one of the first anchoring
plate and the second anchoring plate; a second pivot point
pivotably associated with the facet joint spacer or the other of
the first anchoring plate and the second anchoring plate.
17. The implant of claim 12, wherein the hinge includes a ball
structure receivable within a socket thereby forming a
ball-in-socket arrangement allowing a plurality of freedom of
movement.
18. The implant of claim 12, wherein: the first anchoring plate
includes a first bore; the second anchoring plate includes a second
bore; and further comprising: a first bone screw adapted to be
arranged within the first bore; and a second bone screw adapted to
be arranged within the second bore.
19. The implant of claim 18, further comprising: a first locking
screw adapted to block the first bone screw from at least one of a
backward displacement and a rotational displacement; and a second
locking screw adapted to block the first bone screw from at least
one of a backward displacement and a rotational displacement.
20. The implant of claim 12, wherein: one or both of the first
anchoring plate and the second anchoring plate includes one or more
protuberances; the one or more protuberance restricts movement of
the first anchoring plate relative to the first facet or the second
anchoring plate relative to the second facet.
Description
CLAIM OF PRIORITY
[0001] This application claims priority to all the applications
listed below, all of which are incorporated by reference. This
application claims priority to United States Provisional
Application, entitled, INTER-CERVICAL FACET IMPLANT AND METHOD
filed Dec. 13, 2004, Ser. No. 60/635,453, and United States
Provisional Application entitled INTER-CERVICAL FACET IMPLANT
DISTRACTION TOOL filed Apr. 4, 2005, Ser. No. 60/668,053, and
United States Provisional Application entitled INTER-CERVICAL FACET
IMPLANT WITH IMPLANTATION TOOL filed May 10, 2005, Ser. No.
60/679,377, and United States Provisional Application entitled
INTER-CERVICAL FACET IMPLANT WITH IMPLANTATION TOOL filed May 10,
2005, Ser. No. 60/679,361, and United States Provisional
Application entitled INTER-CERVICAL FACET IMPLANT WITH IMPLANTATION
TOOL filed May 10, 2005, Ser. No. 60/679,363, and United States
Provisional Application entitled INTER-CERVICAL FACET IMPLANT WITH
MULTIPLE DIRECTION ARTICULATION JOINT AND METHOD FOR IMPLANTING
filed Jun. 6, 2005, Ser. No. 60/687,765, and United States
Provisional Application entitled INTER-CERVICAL FACET IMPLANT WITH
SURFACE ENHANCEMENTS filed Sep. 15, 2005, Serial No. 60/717,369,
and claims priority to and is a Continuation-in-Part of United
States Utility Patent Application entitled INTER-CERVICAL FACET
IMPLANT AND METHOD filed Feb. 8, 2005, Serial No. 11/053,399, and
is a Continuation-in-Part of United States Utility Patent
Application entitled INTER-CERVICAL FACET IMPLANT AND METHOD filed
Feb. 8, 2005, Ser. No. 11/053,624, and is a Continuation-in-Part of
United States Utility Patent Application entitled INTER-CERVICAL
FACET IMPLANT AND METHOD filed Feb. 8, 2005, Ser. No. 11/053,735,
and is a Continuation in Part of United States Utility Patent
Application entitled INTER-CERVICAL FACET IMPLANT AND METHOD filed
Feb. 8, 2005, Ser. No. 11/053,346, and is a Continuation in Part of
United States Utility Patent Application entitled INTER-CERVICAL
FACET IMPLANT WITH LOCKING SCREW AND METHOD filed Mar. 30, 2005,
Ser. No. 11/093,557, and is a Continuation-in-Part of United States
Utility Patent Application entitled INTER-CERVICAL FACET IMPLANT
AND METHOD FOR PRESERVING THE TISSUES SURROUNDING THE FACET JOINT
filed Mar. 30, 2005, Ser. No. 11/093,689, which are all
incorporated herein by reference. This application is
cross-referenced to related application KLYC-01135US1, which is
incorporated by reference.
TECHNICAL FIELD
[0002] This invention relates to interspinous process implants.
BACKGROUND OF THE INVENTION
[0003] The spinal column is a bio-mechanical structure composed
primarily of ligaments, muscles, vertebrae and intervertebral
disks. The bio-mechanical functions of the spine include: (1)
support of the body, which involves the transfer of the weight and
the bending movements of the head, trunk and arms to the pelvis and
legs, (2) complex physiological motion between these parts, and (3)
protection of the spinal cord and the nerve roots.
[0004] As the present society ages, it is anticipated that there
will be an increase in adverse spinal conditions which are
characteristic of older people. By way of example only, with aging
comes an increase in spinal stenosis (including, but not limited
to, central canal and lateral stenosis), and facet arthropathy.
Spinal stenosis results in a reduction foraminal area (i.e., the
available space for the passage of nerves and blood vessels) which
compresses the cervical nerve roots and causes radicular pain.
Humpreys, S. C. et al., Flexion and traction effect on C5-C6
foraminal space, Arch. Phys. Med. Rehabil., vol. 79 at 1105 (Sept.
1998). Another symptom of spinal stenosis is myelopathy, which
results in neck pain and muscle weakness. Id. Extension and
ipsilateral rotation of the neck further reduces the foraminal area
and contributes to pain, nerve root compression, and neural injury.
Id.; Yoo, J. U. et al., Effect of cervical spine motion on the
neuroforaminal dimensions of human cervical spine, Spine, vol. 17
at 1131 (Nov. 10, 1992). In contrast, neck flexion increases the
foraminal area. Humpreys, S. C. et al., supra, at 1105.
[0005] In particular, cervical radiculopathy secondary to disc
herniation and cervical spondylotic foraminal stenosis typically
affects patients in their fourth and fifth decade, and has an
annual incidence rate of 83.2 per 100,000 people (based on 1994
information). Cervical radiculopathy is typically treated
surgically with either an anterior cervical discectomy and fusion
("ACDF") or posterior laminoforaminotomy ("PLD"), with or without
facetectomy. ACDF is the most commonly performed surgical procedure
for cervical radiculopathy, as it has been shown to increase
significantly the foramina dimensions when compared to a PLF.
[0006] It is desirable to eliminate the need for major surgery for
all individuals, and in particular, for the elderly. Accordingly, a
need exists to develop spine implants that alleviate pain caused by
spinal stenosis and other such conditions caused by damage to, or
degeneration of, the cervical spine.
[0007] The present invention addresses this need with implants and
methods for implanting an apparatus into at least one facet joint
of the cervical spine to distract the cervical spine while
preferably preserving mobility and normal lordotic curvature.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] FIG. 1 shows a lateral view of two adjacent cervical
vertebrae and spinous processes, highlighting the cervical facet
joint.
[0009] FIG. 2 depicts a lateral view of the cervical spine with
spinal stenosis.
[0010] FIG. 3A depicts correction of cervical stenosis or other
ailment with a wedge-shaped embodiment of the implant of the
invention positioned in the cervical facet joint.
[0011] FIG. 3B depicts correction of cervical kyphosis or loss of
lordosis with a wedge-shaped embodiment of the invention with the
wedge positioned in the opposite direction as that depicted in FIG.
3A.
[0012] FIG. 4 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention
including a screw fixation device for attaching to a single
vertebra.
[0013] FIG. 5 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising screw fixation of two implants, one implant fixed to
each of two adjacent vertebrae.
[0014] FIG. 6 shows cervical spine kyphosis, or loss of
lordosis.
[0015] FIG. 7 shows correction of cervical kyphosis, or loss of
lordosis, with a further embodiment of the implant of the invention
comprising two facet implants with screw fixation.
[0016] FIG. 8 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising a facet implant and a keel.
[0017] FIG. 9 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising facet implant, a keel, and screw fixation.
[0018] FIG. 10 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising a facet implant with teeth.
[0019] FIG. 11 depicts correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising a facet implant with teeth and screw fixation.
[0020] FIG. 12 depicts correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising two facet implants having bony ingrowth surfaces.
[0021] FIG. 13 depicts correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising two facet implants having bony ingrowth surfaces and
posterior alignment guide.
[0022] FIG. 14 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising two facet implants with increased facet joint contact
surfaces.
[0023] FIG. 15 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising two facet implants having bony ingrowth surfaces and
screw fixation.
[0024] FIG. 16 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising two facet implants with articular inner surfaces.
[0025] FIG. 17 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising a facet joint implant with a roller.
[0026] FIG. 18 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising a facet joint implant with a plurality of rollers.
[0027] FIG. 19 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising two facet joint implants, screw fixation, and elastic
restraint.
[0028] FIG. 20 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising two facet joint implants, screw fixation, and spring
restraint.
[0029] FIG. 21 shows correction of cervical stenosis or other
ailment with a further embodiment of the implant of the invention,
comprising two facet joint implants, screw fixation, and magnetic
restraint.
[0030] FIG. 22A shows a perspective view of a further embodiment of
implant of the invention.
[0031] FIG. 22B shows a perspective exploded view of the embodiment
of the invention shown in FIG. 22A.
[0032] FIG. 23A depicts a posterior view of the embodiment of the
implant of the invention shown in FIG. 22A.
[0033] FIG. 23B shows a posterior view of a locking plate of the
embodiment of the implant of the invention shown in FIG. 22A.
[0034] FIG. 24A depicts a lateral side view of the embodiment of
the implant of the invention shown in FIG. 22A.
[0035] FIG. 24B shows a lateral side view of the keel of the
locking plate of the embodiment of the implant of the invention
shown in FIG. 22A.
[0036] FIG. 25A shows a perspective view of a further embodiment of
the implant of the invention.
[0037] FIG. 25B shows a side view of the embodiment of the implant
of the invention in FIG. 25A, having a curved, uniformly-thick
artificial facet joint including a tapered end
[0038] FIG. 26A shows a perspective view of a further embodiment of
the implant of the invention having a locking cam in a first
position.
[0039] FIG. 26B shows a perspective view of a further embodiment of
the implant of the invention having a locking cam in a second
position.
[0040] FIG. 27A shows an anterior perspective view of a further
embodiment of the implant of the invention.
[0041] FIG. 27B shows a posterior perspective view of the
embodiment of the implant of the invention depicted in FIG.
27A.
[0042] FIG. 27C depicts a side view of the embodiment of the
implant of the invention shown in FIGS. 26A and 26B, implanted in
the cervical spine.
[0043] FIG. 27D shows a posterior view of the embodiment of the
implant of the invention shown in FIGS. 27A, 27B, and 27C,
implanted in the cervical spine.
[0044] FIG. 28A depicts a posterior perspective view of a further
embodiment of the implant of the invention.
[0045] FIG. 28B depicts a side view of the embodiment of the
implant of the invention shown in FIG. 28A.
[0046] FIG. 29A depicts a side view of an embodiment of a sizing
tool of the invention.
[0047] FIG. 29B depicts a top view of an embodiment of the sizing
tool of the invention depicted in FIG. 29A.
[0048] FIG. 29C depicts a perspective view of an embodiment of the
sizing tool of the invention depicted in FIGS. 29A and 29B.
[0049] FIG. 29D depicts a side view of the head of the sizing tool
of the invention depicted in FIG. 29A
[0050] FIG. 29E depicts a cross-sectional view of the head of the
sizing tool of the invention depicted in FIGS. 29A-29C.
[0051] FIG. 30 is a flow diagram of an embodiment of a method of
the invention.
[0052] FIG. 31A is posterior view of a further embodiment of the
implant of the invention.
[0053] FIG. 31B is a side view of an embodiment of a locking screw
of the implant of the invention depicted in FIG. 31A.
[0054] FIG. 32 is a posterior view of a further embodiment of the
implant of the invention.
[0055] FIGS. 33A and 33B depict initial and final insertion
positions of the embodiment of the invention depicted in FIG.
32.
[0056] FIGS. 34A and 34B illustrate a top and bottom plan view of
an alternative embodiment of an inter-cervical facet implant in
accordance with the present invention.
[0057] FIG. 35 is a partially exploded perspective view of the
implant of FIGS. 34A and 34B.
[0058] FIGS. 36A and 36B illustrate side views of the implant of
FIGS. 34A and 34B illustrating a general range of motion of the
implant.
[0059] FIG. 37 is a side view of still another embodiment of an
implant in accordance with the present invention.
[0060] FIG. 38A is a side view of still another embodiment of an
implant in accordance with the present invention.
[0061] FIG. 38B is a top view of the implant of FIG. 38A.
[0062] FIG. 38C is a bottom view of the implant of FIG. 38A.
[0063] FIG. 38D-F are side views of the implant of FIG. 38A
illustrating the various arrangements of a bone screw associated
the implant.
[0064] FIG. 38G is an end view of the implant of FIG. 38F
illustrating the arrangement of the bone screw associated the
implant from an alternative viewing angle.
[0065] FIG. 39 is a side view of still another embodiment of an
implant in accordance with the present invention.
[0066] FIG. 40 is a flow diagram of an alternative embodiment of a
method in accordance with the present invention.
[0067] FIG. 41A is a perspective view of still a further embodiment
of an implant in accordance with the present invention.
[0068] FIG. 41B is a partial cross-sectional side view of the
implant of FIG. 41A arranged in position between adjacent
facets.
[0069] FIG. 41C is a partial cross-sectional side view of an
alternative embodiment similar to the implant of FIG. 41A further
including protuberances extending from the first and second
anchoring plates.
[0070] FIG. 41D and 41E are perspective views of an alternative
embodiment similar to the implant of FIG. 41A further including a
cam adapted to selectably obstruct the first bore of the
implant.
[0071] FIG. 41F is a side view of an alternative embodiment of an
implant in accordance with the present invention.
[0072] FIG. 41G is a side view of an alternative embodiment of an
implant in accordance with the present invention.
[0073] FIG. 42 is a flow diagram of an alternative embodiment of a
method in accordance with the present invention.
DETAILED DESCRIPTION
[0074] Embodiments of the present invention provide for a minimally
invasive surgical implantation method and apparatus for cervical
spine implants that preserves the physiology of the spine. In
particular, embodiments provide for distracting the cervical spine
to increase the foraminal dimension in extension and neutral
positions. Such implants, when implanted in the cervical facet
joints, distract, or increase the space between, the vertebrae to
increase the foraminal area or dimension, and reduce pressure on
the nerves and blood vessels of the cervical spine.
[0075] The facet joints in the spine are formed between two
vertebrae as follows. Each vertebra has four posterior articulating
surfaces: two superior facets and two inferior facets, with a
superior facet from a lower vertebra and an inferior facet of an
upper vertebra forming a facet joint on each lateral side of the
spine. In the cervical spine, the upward inclination of the
superior articular surfaces of the facet joints allows for
considerable flexion and extension, as well as for lateral
mobility. Each facet joint is covered by a dense, elastic articular
capsule, which is attached just beyond the margins of the articular
facets. The capsule is larger and looser in the cervical spine than
in the thoracic and lumbar spine. The inside of the capsule is
lined by a synovial membrane which secretes synovial fluid for
lubricating the facet joint. The exterior of the joint capsule is
surrounded by a capsular ligament. It is this ligament and the
joint capsule that must be cut in the embodiments of the method
described herein for inserting the artificial facet joint.
[0076] In a specific preferred embodiment, an implanted interfacet
spacer of 1.5 mm to 2.5 mm in width can result in interfacet
distraction that increases foraminal dimension in extension and
neutral. Other interfacet spacer dimensions also are contemplated
by the invention described herein below. The present embodiments
also preserve mobility of the facet joints.
[0077] Further embodiments of the present invention accommodate the
distinct anatomical structures of the spine, minimize further
trauma to the spine, and obviate the need for invasive methods of
surgical implantation. Embodiments of the present invention also
address spinal conditions that are exacerbated by spinal
extension.
[0078] FIG. 1 shows a simplified diagram of a portion of the
cervical spine, focusing on a cervical facet joint 1 formed between
two adjacent cervical vertebrae. The spinous processes 3 are
located posteriorly and the vertebral bodies 5 are located
anteriorly, and a nerve root canal 7 is visible. Each vertebra has
four posterior articulating surfaces: two superior facets and two
inferior facets, with a superior facet from a lower vertebra and an
inferior facet of an upper vertebra forming a facet joint on each
lateral side of the spine. In the cervical spine, the upward
inclination of the superior articular surfaces of the facet joints
allows for considerable flexion and extension, as well as for
lateral mobility. Each facet joint is covered by a dense, elastic
articular capsule, which is attached just beyond the margins of the
articular facets. The capsule is large and looser in the cervical
spine than in the thoracic and lumbar spine. The inside of the
capsule is lined by a synovial membrane which secretes synovial
fluid for lubricating the facet joint. The exterior of the joint
capsule is surrounded by a capsular ligament. It is this ligament
that may be pushed out of the way in the embodiments of the method
for inserting the artificial facet joint, described herein.
[0079] FIG. 2 depicts cervical foraminal stenosis. From the
drawing, the nerve root canal 7 is narrowed relative to the nerve
root canal 7 depicted in FIG. 1. The spinal canal and/or
intervertebral foramina also can be narrowed by stenosis. The
narrowing can cause compression of the spinal cord and nerve
roots.
[0080] FIG. 3A shows a first embodiment 100 of the present
invention, which is meant to distract at least one facet joint, in
order to increase the dimension of the neural foramen while
retaining facet joint mobility. The wedge-shaped embodiment 100 is
a wedge-shaped implant that can be positioned in the cervical facet
joint 101 to distract the joint and reverse narrowing of the nerve
root canal 107. In this embodiment 100, the implant is positioned
with the narrow portion of the wedge facing anteriorly. However, it
is also within the scope of the present invention to position
embodiment 100 (FIG. 3B) with the wide portion of the wedge facing
anteriorly, to correct for cervical kyphosis or loss of cervical
lordosis.
[0081] Referring to FIG. 4, the embodiment 200 of the implant has a
joint insert or spacer 210, also herein referred to as an
artificial facet joint, that is positioned in the cervical facet
joint 101. The joint insert or spacer 210 can be wedge-shaped with
the narrow part of the wedge facing anteriorly. Alternatively, the
joint insert or spacer 210 need not be wedge-shaped but can be of
substantially uniform thickness, the thickness determined by an
individual patient's need for distraction of the cervical facet
joint 201. As with embodiment 100, one objective of this embodiment
is facet joint distraction, and joint mobility after implantation.
The joint insert or spacer 210 is continuous with a posterior
sheath 220 bent at an angle from the joint insert or spacer 210 to
align substantially parallel with the bone. The posterior sheath
can lie against the lamina, preferably against the lateral mass.
The posterior sheath 220 can have a bore 230 which can accept a
bone screw 240. Alternatively, the bore 230 can accept any other
appropriate and/or equivalent fixation device capable of fixing the
embodiment 200 to the spine. The device is thereby affixed to the
vertebra, preferably by fixing to the lateral mass.
[0082] FIG. 5 shows embodiment 300, which is the use of two
embodiments 200, each fixed to one of two adjacent cervical
vertebrae. As with embodiment 200, the implanted facet joint is
distracted and joint mobility is retained. A joint insert or spacer
310 from each of the two implants is inserted and positioned in the
cervical facet joint 301. In this embodiment, the joint inserts or
spacers 310 are substantially flat and parallel to each other and
are not wedge-shaped. Alternatively, the joint inserts or spacers
310 can together define a wedge-shaped insert that is appropriate
for the patient. The two joint inserts or spacers 310 combined can
have, by way of example, the shape of the joint insert or spacer
210 in FIG. 4. Embodiment 300 then can be fixed to the spine with a
screw 340 or any other appropriate fixation device, inserted
through a bore 330 in the posterior sheath 320. The posterior
sheath 320 can be threaded to accept a screw. The screw can be
embedded in the lamina, preferably in the lateral mass, where
possible.
[0083] It is within the scope of the present invention to use
and/or modify the implants of the invention to correct cervical
spine kyphosis, or loss of lordosis. FIG. 6 depicts a cervical
spine lordosis. FIG. 7 demonstrates an embodiment 400 which
contemplates positioning two implants to correct for this spinal
abnormality while retaining facet joint mobility. The joint insert
or spacer 410 of each implant is shaped so that it is thicker at
its anterior portion. Alternatively, the implants can be shaped to
be thicker at the posterior ends, for example as depicted in FIG.
3A. The posterior sheath 420 of each implant is bent at an angle
from the joint insert or spacer 410 to be positioned adjacent to
the lateral mass and/or lamina, and has a bore 430 to accept a
screw 440 or other appropriate and/or equivalent fixation means to
fix the embodiment 400 to the spine, preferably to the lateral
mass. The placement of two joint inserts or spacers 410 in the
cervical facet joint 401 distracts the facet joint, which shifts
and maintains the vertebrae into a more anatomical position to
preserve the physiology of the spine.
[0084] FIG. 8 shows a further embodiment 500 of the implant of the
invention, wherein the joint insert or spacer 510 has a keel 550 on
an underside of the joint insert or spacer 510. The keel 550 can be
made of the same material or materials set forth above. The
surfaces of the keel 550 can be roughened in order to promote bone
ingrowth to stabilize and fix the implant 500. In other
embodiments, the keel 550 can be coated with materials that promote
bone growth such as, for example, bone morphogenic protein ("BMP"),
or structural materials such as hyaluronic acid "HA," or other
substances which promote growth of bone relative to and into the
keel 550.
[0085] The keel 550 can be embedded in the facet bone, to
facilitate implant retention. The keel 550 can be placed into a
channel in the facet bone. The channel can be pre-cut. Teeth (not
shown), preferably positioned posteriorly, also may be formed on
the keel 550 for facilitating retention of the implant 500 in the
cervical facet joint 501. As noted above, the joint insert or
spacer 510 can be substantially flat or wedge-shaped, depending
upon the type of distraction needed, i.e., whether distraction is
also necessary to correct abnormal curvature or lack of curvature
in the cervical spine. Because the joint is not fused, mobility is
retained, as with the embodiments described above and herein
below.
[0086] FIG. 9 illustrates that a further embodiment 600 of the
implant of the invention can have both screw fixation and a keel
650 for stability and retention of the implant 600. On embodiment
600, the joint insert or spacer 610 is continuous with a posterior
sheath 620 having a bore hole 630 to accept a screw 640 which
passes through the bore 630 and into the bone of the vertebrae,
preferably into the lateral mass, or the lamina. The bore 630 can
be threaded or not threaded where it is to accept a threaded screw
or equivalent device. Alternatively, the bore 630 need not be
threaded to accept a non-threaded equivalent device. The keel 650
is connected with the joint insert or spacer 610 and embeds in the
bone of the cervical facet joint 601 to promote implant
retention.
[0087] A further alternative embodiment 700 is illustrated in FIG.
10. In this embodiment 700, the joint insert or spacer 710 has on a
lower side at least one tooth 760. It should be clear to one of
ordinary skill in the art that a plurality of teeth 760 is
preferable. The teeth 760 are able to embed in the bone of the
cervical facet joint 701 to facilitate retention of the implant 700
in the joint 701. The teeth 760 can face in a direction
substantially opposite the direction of insertion, for retention of
the implant 700. As above, the joint insert or spacer 710 can be
wedge-shaped or substantially even in thickness, depending upon the
desired distraction. Because the implant distracts and is retained
without fusion, facet joint mobility is retained.
[0088] FIG. 11 depicts a further embodiment 800 of the implant of
the invention. In this embodiment 800, the joint insert or spacer
810 is continuous with a posterior sheath 820 having a bore 830 for
accepting a fixation device 840, as described above. The fixation
device 840 can be a screw which fits into a threaded bore 830;
alternatively, the fixation device 830 can be any other compatible
and appropriate device. This embodiment 800 further combines at
least one tooth 860 on an underside of the joint insert or spacer
810 with the posterior sheath 820, bore 830 and fixation device 840
to address fixation of the implant 800 in a cervical facet joint
801. It will be recognized by one of ordinary skill in the art that
the implant 800 can have a plurality of teeth 860 on the underside
of the joint insert or spacer 810.
[0089] FIG. 12 shows yet another embodiment 900 of an implant of
the present invention. In this embodiment 900, the joint inserts or
spacers 910 of two implants 900 are positioned in a cervical facet
joint 901. As described above, the joint inserts or spacers 910 can
be wedge-shaped as needed to restore anatomical curvature of the
cervical spine and to distract, or the joint inserts or spacers 910
can be of substantially uniform thickness. The implants 900 each
comprise a joint insert or spacer 910 with an outer surface 970
that interacts with the bone of the cervical facet joint 901. On
the upper implant 900, the surface 970 that interacts with the bone
is the upper surface 970 and on the lower implant 900, the surface
970 that interacts with the bone is the lower surface 970. Each
surface 970 can comprise a bone ingrowth surface 980 to create a
porous surface and thereby promote bone ingrowth and fixation. One
such treatment can be with plasma spray titanium, and another, with
a coating of sintered beads. Alternatively, the implant 900 can
have casted porous surfaces 970, where the porous surface is
integral to the implant 900. As a further alternative, the surfaces
970 can be roughened in order to promote bone ingrowth into these
defined surfaces of the implants 900. In other embodiments, the
surfaces 970 can be coated with materials that promote bone growth
such as for example bone morphogenic protein ("BMP"), or structural
materials such as hyaluronic acid ("HA"), or other substances which
promote growth of bone on other external surfaces 970 of the
implant 900. These measures facilitate fixation of the implants 900
in the facet joint, but do not result in fusion of the joint,
thereby retaining facet joint mobility, while also accomplishing
distraction of the joint.
[0090] FIG. 13 depicts yet another embodiment 1000 of the implant
of the present invention. In this embodiment 1000, the joint
inserts or spacers 1010 of two implants 1000 are positioned in a
cervical facet joint 1001. As described above, the joint inserts or
spacers 1010 can be wedge-shaped as needed to restore anatomical
curvature of the cervical spine and to distract, or the joint
inserts or spacers 1010 can be of substantially uniform thickness.
The implants 1000 each comprise a joint insert or spacer 1010 with
an outer surface 1070 that interacts with the bone of the cervical
facet joint 1001. On the upper implant 1000, the surface 1070 that
interacts with the bone is the upper surface and on the lower
implant 1000, the surface 1070 that interacts with the bone is the
lower surface. As set forth above, each outer surface 1070 can
comprise a bone ingrowth surface 1080 to create a porous surface
and thereby promote bone ingrowth and fixation, without facet joint
fusion and loss of mobility. In one preferred embodiment, the bone
ingrowth surface 1080 can be created with plasma spray titanium,
and/or with a coating of sintered beads. In an alternative
preferred embodiment, the implant 1000 can have casted porous
surfaces 1070, where the porous surface is integral to the implant
1000. In a further alternative preferred embodiment, the surfaces
1070 can be roughened in order to promote bone ingrowth into these
defined surfaces of the implants 1000. In other preferred
embodiments, the surfaces 1070 can be coated with materials that
promote bone growth such as for example BMP, or structural
materials such as HA, or other substances which promote growth of
bone on other external surfaces 1070 of the implant 1000.
[0091] The implant 1000 can have a posterior alignment guide 1090.
The posterior alignment guides 1090 of each implant 1000 can be
continuous with the joint inserts or spacers 1010. The posterior
alignment guides substantially conform to the bone of the vertebrae
when the joint inserts or spacers 1010 are inserted into the
cervical facet joint 1001. The posterior alignment guides 1090 are
used to align the implants 1000 so that the joint inserts or
spacers 1010 contact each other and not the bones of the cervical
facet joint 1001 when the joint inserts or spacers 1010 are
positioned in the cervical facet joint 1001.
[0092] FIG. 14 depicts a further embodiment 1100 of the implant of
the present invention. In this embodiment 1100, the joint inserts
or spacers 1110 of two implants 1100 are inserted into the cervical
facet joint 1101. Each of the joint inserts or spacers 1110 is
continuous with a cervical facet joint extender or facet-extending
surface 1192. The bone contacting surfaces 1170 of the joint
inserts or spacers 1110 are continuous with, and at an angle to,
the bone contacting surfaces 1193 of the cervical facet joint
extenders 1192, so that the cervical facet joint extenders 1192
conform to the bones of the vertebrae exterior to the cervical
facet joint 1101. The conformity of the cervical facet joint
extenders 1192 is achieved for example by forming the cervical
facet joint extenders 1192 so that when the join inserts 1110 are
positioned, the cervical facet joint extenders 1192 curve around
the bone outsider the cervical facet joint 1101.
[0093] The cervical facet joint extenders have a second surface
1184 that is continuous with the joint articular surfaces 1182 of
the joint inserts or spacers 1110. The second surfaces 1184 extend
the implant 1100 posteriorly to expand the joint articular surfaces
1182 and thereby to increase contact and stability of the spine at
least in the region of the implants 1100. It is to be understood
that such facet joint extenders 1192 can be added to the other
embodiments of the invention described and depicted herein.
[0094] The embodiment depicted in FIG. 15 shows two implants 1200
positioned in a cervical facet joint 1201, having bony ingrowth
surfaces as one preferred method of fixation, and using screws as
another preferred method of fixation. In this embodiment, each of
two implants 1200 has a joint insert or spacer 1210 positioned in a
cervical facet joint 1201. As described above, the joint inserts or
spacers 1210 can be wedge-shaped as needed to restore anatomical
curvature of the cervical spine and to distract, or the joint
inserts or spacers 1210 can be of substantially uniform thickness.
The implants 1200 each comprise a joint insert or spacer 1210 with
an outer surface 1270 that interacts with the bone of the cervical
facet joint 1001. On the upper implant 1200, the surface 1270 that
interacts with the bone is the upper surface and on the lower
implant 1200, the surface 1270 that interacts with the bone is the
lower surface. As set forth above, each outer surface 1270 can
comprise a bone ingrowth surface 1280 to create a porous surface
and thereby promote bone ingrowth and fixation. In one preferred
embodiment, the bone ingrowth surface 1280 can be created with
plasma spray titanium, and/or with a coating of sintered beads. In
an alternative preferred embodiment, the implant 1200 can have
casted porous surfaces 1270, where the porous surface is integral
to the implant 1200. In a further alternative embodiment, the
surfaces 1270 can be roughened in order to promote bone ingrowth
into these defined surfaces of the implants 1200. In other
preferred embodiments, the surfaces 1270 can be coated with
materials that promote bone growth such as for example BMP, or
structural materials such as HA, or other substances which promote
growth of bone on other external surfaces 1270 of the implant
1200.
[0095] Screw fixation or other appropriate fixation also can be
used with implants 1200 for fixation in the cervical facet joint
1201. The joint insert or spacer 1210 is continuous with a
posterior sheath 1220 bent at an angle from the joint insert or
spacer 1210 to align substantially parallel with the bone,
preferably the lateral mass or lamina. The posterior sheath 1220
can have a bore 1230 which can accept a bone screw 1240, preferably
into the lateral mass or lamina. Alternatively, the bore 1230 can
accept any other appropriate and/or equivalent fixation means for
fixing the embodiment 1200 to the spine.
[0096] FIG. 16 depicts a further preferred embodiment of the
present invention. In this embodiment 1300, two joint inserts or
spacers 1310 are positioned in the cervical facet joint 1301. The
joint inserts or spacers each have outer surfaces 1370 that
interact with the bone of the vertebrae forming the cervical facet
joint. These outer surfaces 1370 of the embodiment 1300 can be
treated to become bone ingrowth surfaces 1380, which bone ingrowth
surfaces 1380 contribute to stabilizing the two joint inserts or
spacers 1310 of the implant 1300. In one preferred embodiment, the
bone ingrowth surface 1380 can be created with plasma spray
titanium, and/or with a coating of sintered beads. In an
alternative preferred embodiment, the implant 1300 can have casted
porous surfaces 1370, where the porous surface is integral to the
implant 1300. In a further alternative embodiment, the surfaces
1370 can be roughened in order to promote bone ingrowth into these
defined surfaces of the implants 1300. In other preferred
embodiments, the surfaces 1370 can be coated with materials that
promote bone growth such as for example BMP, or structural
materials such as HA, or other substances which promote growth of
bone on other external surfaces 1370 of the implant 1300. This
fixation stabilizes the implant 1300 in the facet joint without
fusing the joint, and thus the implant preserves joint mobility,
while accomplishing distraction and increasing foraminal
dimension.
[0097] Also shown in FIG. 16 are articular inner surfaces 1382 of
the implants 1300. These surfaces can be formed from a metal and
polyethylene, the material allowing flexibility and providing for
forward bending/flexion and backward extension of the cervical
spine. The embodiment 1300 of FIG. 16 can be made in at least two
configurations. The first configuration includes a flexible spacer
1382 made, by way of example, using polyethylene or other suitable,
flexible implant material. The flexible spacer 1382 can be
permanently affixed to the upper and lower joint insert or spacer
1310. The spacer 1382 can be flat or wedge-shaped or have any other
shape that would correct the curvature of the spine. In other
configurations, the spacer 1382 can be affixed to only the upper
insert 1310 or to only the lower insert 1310. Alternatively, a
spacer 1382 can be affixed to each of an upper insert 1310 and a
lower insert 1310 with the upper insert 1310 and the lower insert
1310 being separate units.
[0098] FIG. 17 shows a further preferred embodiment of the implant
of the present invention. In this embodiment 1400, the implant has
a roller 1496 mounted on a joint insert or spacer 1410, the roller
being a further means of preserving joint mobility while
accomplishing distraction. Both the roller 1496 and the joint
insert or spacer 1410 are positioned in the cervical facet joint
1401. The joint insert or spacer 1410 as in other embodiments has a
bone-facing surface 1470 and joint articular surface 1482. The
bone-facing surface 1470 can interact with the lower bone of the
cervical facet joint 1401. Alternatively, the bone-facing surface
can interact with the upper bone of the cervical facet joint 1401.
Between the bone-facing surface 1470 and the joint articular
surface 1482 is an axis about which the roller 1496 can rotate. The
roller 1496 rotates in a cavity in the joint insert or spacer 1410,
and interacts with the top bone of the cervical facet joint 1401.
Alternatively, where the bone-facing surface 1470 of the joint
insert or spacer 1410 interacts with the top bone of the cervical
facet joint 1401, the roller 1496 rotates in a cavity in the joint
insert or spacer 1410 and interacts with the lower bone of the
cervical facet joint 1401. The rotation of the roller 1496 allows
flexion and extension of the cervical spine. Alternatively, a
roller such as roller 1496 can be secured to an upper and a lower
insert such as inserts 410 in FIG. 7. As depicted in FIG. 18, a
plurality of rollers 1496 also is possible.
[0099] FIG. 19 depicts a further embodiment of the implant of the
present invention. In this embodiment, two implants 1500 are
implanted in the cervical facet joint 1501. Screw fixation or other
appropriate fixation is used with implants 1500 for fixation in the
cervical facet joint 1501. The joint insert or spacer 1510 is
continuous with a posterior sheath 1520 bent at an angle from the
joint insert or spacer 1510 to align substantially parallel with
the bone, preferably the lateral mass or lamina. The posterior
sheath 1520 of each implant 1500 can have a bore 1530 which can
accept a bone screw 1540, preferably into the lateral mass or
lamina. Alternatively, the bore 1530 can accept any other
appropriate and/or equivalent fixation means for fixing the
embodiment 1500 to the spine. The head of the screw 1540 in each
posterior sheath 1520 of each implant 1500 has a groove 1598 or
other mechanism for retaining an elastic band 1597. The elastic
band 1597 is looped around each of the two screws 1540 to restrain
movement of the cervical spine without eliminating facet joint
mobility. The band 1597 preferably can restrain flexion and lateral
movement. The elastic band 1597 can be made of a biocompatible,
flexible material.
[0100] FIG. 20 shows an alternative to use of an elastic band as in
FIG. 19. In the embodiment in FIG. 20, the elastic band is replaced
with a spring restraint 1699, which extends between the heads of
two screws 1640, one screw fixing each of two implants 1600 in the
cervical facet joint 1601.
[0101] FIG. 21 shows another alternative to using an elastic band
and/or a spring as in FIGS. 19 or 20. In FIG. 21, magnets 1795 is
used for restraint between the two screws 1740. The magnet 1795 can
either be comprised of two opposing magnetic fields or two of the
same magnetic fields to operate to restrain movement. The head of
one of the two screws 1740 is magnetized, and the head of the other
screw 1740 is magnetized with either the same or opposite field. If
the magnets 1795 have the same polarity, the magnets 1795 repel
each other and thus limit extension. If the magnets 1795 have
opposite polarities, the magnets 1795 attract each other and thus
limit flexion and lateral movement.
[0102] FIGS. 22A-24B, depict a further embodiment 1800 of the
implant of the present invention. In this embodiment, a natural or
artificial facet joint spacer (or insert) or inter-facet spacer (or
insert) 1810 is connected with a lateral mass plate (also referred
to herein as an anchoring plate) 1820 with a hinge 1822. The hinge
1822 allows the lateral mass plate 1820 to bend at a wide range of
angles relative to the artificial facet joint and preferably at an
angle of more than 90 degrees, and this flexibility facilitates
positioning and insertion of the facet joint spacer (or insert)
1810 into a patient's facet joint, the anatomy of which can be
highly variable among individuals. This characteristic also applies
to embodiments described below, which have a hinge or which are
otherwise enabled to bend by some equivalent structure or material
property. The hinge 1822 further facilitates customizing the
anchoring of the implant, i.e., the positioning of a fixation
device. The hinge enables positioning of the lateral mass plate
1820 to conform to a patient's cervical spinal anatomy, and the
lateral mass plate 1820 accepts a fixation device to penetrate the
bone. The facet joint spacer (or insert) 1810 can be curved or
rounded at a distal end 1812 (FIG. 23A), and convex or dome-shaped
on a superior surface 1813 to approximate the shape of the bone
inside the facet joint. The inferior surface 1815 can be flat or
planar. Alternatively, the inferior surface 1815 can be concave. As
another alternative, the inferior surface 1815 can be convex.
[0103] The lateral mass plate 1820, when implanted in the spine, is
positioned outside the facet joint, preferably against the lateral
mass or against the lamina. The lateral mass plate 1820 has a bore
1830 therethrough. The bore 1830 can accept a bone screw 1840, also
referred to as a lateral mass screw, to secure the lateral mass
plate 1820 preferably to the lateral mass or alternatively to
another part of the spine, and thus to anchor the implant. The
lateral mass screw 1840 preferably has a hexagonal head to accept
an appropriately-shaped wrench. As described below, the head
accepts a compatible probe 1826 from a locking plate 1824.
[0104] The locking plate 1824 includes a keel 1828 with a wedge
shaped distal end to anchor the implant, preferably in the lateral
mass or in the lamina, outside the facet joint and to prevent
rotation of the lateral mass plate 1820 and the locking plate 1824.
The keel 1828 aligns with a groove 1823 through an edge of the
lateral mass plate 1820 to guide and align the keel 1828 as the
keel 1828 cuts into a vertebra.
[0105] As noted above, the locking plate 1824 includes a probe 1826
that fits against the head of the lateral mass screw 1840. The
locking plate further includes a bore 1831 that can accept a
machine screw (not shown) which passes through to an aligned bore
1829 in the lateral mass plate 1820 to hold the locking plate 1824
and the lateral mass plate 1820 together without rotational
displacement relative to each other. The locking plate 1824 thus
serves at least two functions: (1) maintaining the position of the
lateral mass screw 1840 with the probe 1826, so that the screw 1840
does not back out; and (2) preventing rotation of the implant with
the keel 1828 and machine screw relative to the cervical vertebra
or other vertebrae.
[0106] It is to be understood that other mechanisms can be used to
lock the locking plate 1824 to the lateral mass plate 1820. For
example, the locking plate can include a probe with barbs that can
be inserted into a port in the lateral mass plate. The barbs can
become engaged in ribs that define the side walls of the port in
the lateral mass plate
[0107] In the preferred embodiment depicted in FIGS. 25A, 25B, the
lateral mass plate 1920 includes a recessed area 1922 for receiving
the locking plate 1924 so that the locking plate 1924 is flush with
the upper surface 1925 of the lateral mass plate 1920 when the
probe 1926 is urged against the lateral mass screw 1940 and the
keel 1928 is inserted into the lateral mass or the lamina of the
vertebra. In the preferred embodiment depicted in FIGS. 25A, 25B,
the shape and contours of the facet joint spacer (or insert) 1910
can facilitate insertion of the facet joint spacer 1910 into the
cervical facet joint. In this embodiment, the facet joint spacer
1910 has a rounded distal end 1912. The distal end 1912 is tapered
in thickness to facilitate insertion. The tapered distal end 1912
meets and is continuous with a proximal mid-section 1916 which, in
this preferred embodiment, has a uniform thickness, and is
connected flexibly, preferably with a hinge 1922, to the lateral
mass plate 1920, as described above. The facet joint spacer 1910,
with its proximal mid-section 1916 and tapered distal end 1912, is
curved downward, causing a superior surface 1913 of the facet joint
spacer 1910 to be curved. The curve can cause the superior surface
1913 to be convex, and the convexity can vary among different
implants 1900 to suit the anatomical structure of the cervical
facet joint(s) of a patient. An inferior surface 1915 accordingly
can be preferably concave, flat, or convex. The curved shape of the
implant can fit the shape of a cervical facet joint, which is
comprised of an inferior facet of an upper vertebra and a superior
facet of a lower adjacent vertebra. The convex shape of the
superior surface 1913 of the facet joint spacer 1910 fits with a
concave shape of the inferior facet of the upper cervical
vertebrae. The concave shape of the inferior surface 1915 of the
facet joint spacer 1910 fits with the convex shape of the superior
facet of the cervical vertebrae. The degree of convexity and
concavity of the facet joint spacer inferior and superior surfaces
can be varied to fit a patient's anatomy and the particular pairing
of adjacent cervical vertebrae to be treated. For example, a
less-curved facet joint spacer 1910 can be used where the patient's
cervical spinal anatomy is sized (as described below) and found to
have less convexity and concavity of the articular facets.
Generally for the same level the input for the right and left facet
joint will be similarly shaped. It is expected that the similarity
of shape of the facet joint spacer and the smooth, flush surfaces
will allow distraction of the facet joint without loss of mobility
or damage to the bones of the cervical spine. Further, and
preferably, the width of the mid-section 1916 is from 1.5 mm to 2.5
mm.
[0108] In still other embodiments, some other structure can be
employed to resist movement of the seated bone screw within the
first bore. Referring to FIGS. 26A and 26B, in some embodiments a
cam 3824 can be rotatably associated with the lateral mass plate
3820 so that the first bore 3830 can be selectably obstructed or
unobstructed, thereby allowing a bone screw 3840 to be received
within the first bore 3830, or resisting movement of the bone screw
3840 seated within the first bore 3830. As shown in FIG. 26A, the
cam 3824 can have a shape such that at a first position the surface
3828 of the cam is approximately flush with the first bore 3830,
thereby allowing a bone screw 3840 to pass through the first bore
3830. Rotated to a second position (FIG. 26B), a protruding portion
3826 of the surface of the cam 3824 can extend across at least a
portion of the first bore 3830, thereby blocking a bone screw 3840
seated within the first bore 3830 and preventing the bone screw
3840 from backing out of the first bore 3830. The cam 3824 can
include features 3831 (e.g., indentations) that can allow the cam
to be grasped with a tool (not shown), and thus rotated to the
desired position. As shown, the cam 3824 is positioned within a
slot of the lateral mass plate 3820 so that the cam does not
protrude undesirably from the surface of the lateral mass plate
3820.
[0109] Except as otherwise noted above, the embodiment shown in
FIGS. 22A-24B is similar to the embodiment shown in FIGS. 25A-26B.
Accordingly the remaining elements on the 1900 series of element
numbers is preferably substantially similar to the described
elements in the 1800 series of element numbers, as set forth above.
Thus, by way of example, elements 1923, 1928, 1929 and 1930 are
similar, respective elements 1823, 1828, 1829 and 1830.
[0110] FIG. 30 is a flow chart of the method of insertion of an
implant of the invention. The embodiment 1800 or 1900 of the
present invention preferably is inserted in the following manner
(only elements of the embodiment 1800 will be set forth herein, for
purposes of the written description of a method of the invention).
First the facet joint is accessed. A sizing tool 2200 (see FIGS.
29A-C) can be inserted to select the appropriate size of an implant
of the invention for positioning in the cervical facet joint. This
step may be repeated as necessary with, if desired, different sizes
of the tool 2200 until the appropriate size is determined. This
sizing step also distracts the facet joint and surrounding tissue
in order to facilitate insertion of the implant. Then, the facet
joint spacer (or insert) 1810 is urged between the facets into the
facet joint. The facet itself is somewhat shaped like a ball and
socket joint. Accordingly, in order to accommodate this shape, the
artificial joint 1810 can have a rounded leading edge shaped like a
wedge or tissue expander to cause distraction of the facet joint as
the facet joint spacer is urged into the facet joint of the spine.
The facet joint spacer 1810 also includes the convex surface 1813
in order to more fully accommodate the shape of the facet joint of
the spine. However, as set forth above and as depicted in FIG. 25B,
it is possible in the alternative to have a curve-shaped facet
joint spacer (or insert) 1910 with a convex superior surface 1913
and a concave inferior surface 1915, the distal end 1912 tapering
to facilitate insertion, while the remainder of the facet joint
spacer 1910, (i.e., the proximal section 1916) has a uniform
thickness.
[0111] Once the artificial joint 1810 is positioned, the lateral
mass plate 1820 is pivoted downward about the hinge 1822 adjacent
to the vertebrae and preferably to the lateral mass or to the
lamina. Thus the lateral mass plate 1820 may be disposed at an
angle relative to the facet joint spacer 1810 for a representative
spine configuration. It is to be understood that as this embodiment
is hinged the final position of the lateral mass plate 1820
relative to the facet joint spacer 1800 will depend on the actual
spine configuration. It is to be understood that embodiments of the
invention can be made without a hinge, as long as the connection
between the facet joint spacer and the lateral mass plate is
flexible enough to allow the lateral mass plate to be bent relative
to the facet joint spacer in order to fit the anatomy of the
patient. Once the lateral mass plate 1820 is positioned, or prior
to the positioning of the lateral mass plate 1820, a bore can be
drilled in the bone to accommodate the bone screw 1824.
Alternatively the screw 1824 can be self-tapping. The screw is then
placed through the bore 1830 and secured to the bone, preferably
the lateral mass or the lamina, thereby holding the facet joint
spacer 1800 in place. In order to lock the bone screw 1824 in place
and to lock the position of the facet joint spacer 1800 and the
lateral mass plate 1820 in place, the locking plate 1824 is
positioned over the lateral mass plate 1820. So positioned, the
probe 1826 is positioned through the bore 1830 and against the head
of the bone screw to keep the bone screw from moving. The keel
1828, having a sharp chisel-shaped end, preferably can self-cut a
groove in the bone so that the keel 1828 is locked into the bone as
the keel 1828 is aligned by, and received in, a groove 1831 of the
lateral mass plate 1820. Alternatively, a groove can be pre-cut in
the bone to receive the keel 1828. As this occurs the bore 1829 of
the locking plate 1824 aligns with the threaded bore 1831 of the
lateral mass plate 1820 and a machine screw can be inserted to lock
the locking plate relative to the lateral mass plate. This locking
prevents the lateral mass plate 1820 and the facet joint spacer
1810 from rotating and, as previously indicated, prevents the bone
screw 1840 from backing out from the vertebra. Preferably the
implant is between the C5 and C6 vertebrae level, or the C6 and C7
vertebrae level. It is noted that two implants preferably will be
implanted at each level between vertebrae. That is, an implant 1800
will be placed in a right facet joint and also in a left facet
joint when viewed from a posterior view point. This procedure can
be used to increase or distract the foraminal area or dimension of
the spine in an extension or in neutral position (without having a
deleterious effect on cervical lordosis) and reduce the pressure on
the nerves and blood vessels. At the same time this procedure
preserves mobility of the facet joint.
[0112] FIGS. 27A-27D show a further embodiment of the implant of
the invention, with the embodiment 2000 implanted in the cervical
spine as depicted in FIGS. 27C and 27D. The implant 2000 comprises
a first facet joint spacer (or insert) 2010 and a second facet
joint spacer 2010. Each facet joint spacer can have a distal end
2012 that is tapered or wedge-shaped in a way that facilitates
insertion into the cervical facet joints on both sides of two
adjacent cervical vertebrae at the same level. The facet joint
spacers further can be dome-shaped, or convex on a superior surface
2013, to approximate the shape of the cervical facets of the
cervical facet joints.
[0113] The first and second facet joint spacers 2010 are bridged
together by a collar 2015. The collar 2015 passes between the
spinous processes of the adjacent cervical vertebrae. As can be
seen in FIG. 27B, the implant can preferably be "V" shaped or
"boomerang" shaped. The entire implant 2000 or the collar 2015 of
the implant can be made of a flexible material such as titanium, so
that it is possible to bend the collar 2015 so that it conforms
preferably to the shape of the lateral mass or the lamina of the
cervical vertebrae of the patient and thereby holds the implant in
place with the facet joint spacers (or inserts) 2010 inserted in
the cervical facet joints. Bores 2029 are preferably are provided
through implant 2000 adjacent to the facet joint spacer 2010
respectively. These bores 2029 can receive bone screws to position
the implant 2000 against the lateral mass or the lamina as shown in
FIGS. 27C, 27D. The description of the embodiment 2100, in FIGS.
28A, 28B provide further details concerning the method of affixing
the implant 2000 to the vertebrae. The implant 2100 also can be
made of PEEK or other materials as described herein. Embodiment
2000 (the "boomerang" shape depicted in FIG. 27D) further can have
a locking plate as, for example, the locking plate 1824 in FIG.
22A. The locking plate for embodiment 2000 (not shown) can have the
same features as locking plate 1824, that is: (1) a probe 1826 that
interacts with the bone screws to prevent the bone screws from
backing out of the bone, the likely consequence of which would be
displacement of the implant 2000; and (2) a keel 1828 with a chisel
end to embed in the bone and thus to prevent rotational
displacement of the implant. However, given the collar 2015
configuration of embodiment 2000, a chisel may not serve the same
purpose as with the embodiments set forth above, which lack a
collar stabilized by two bone screws. Therefore, a locking plate on
embodiment 2000 can be provided without a keel.
[0114] FIGS. 28A and 28B depict a further embodiment of the implant
of the invention 2100. In this embodiment 2100, the collar 2115 can
be made of a flexible material such as titanium, of a substantially
inflexible material, or of other materials described herein.
Substantial flexibility can also be derived from connecting a first
facet joint spacer (or insert) 2110 with the collar 2115 using a
first hinge 2117, and connecting a second facet joint spacer 2110
with the collar 2115 using a second hinge 2117. Using the first
hinge 2117 and the second hinge 2117, the collar 2115 can be
pivoted downward to conform to a particular patient's cervical
spinal anatomy. In other words, the degree of pivoting will vary
among different patients, and the first hinge 2117 and second hinge
2117 allow the implant 2100 to accommodate the variance.
[0115] In the hinged embodiment 2100, and similar to the embodiment
2000, the collar 2115 can have a first bore 2129 inferior to the
first hinge 2117, and a second bore 2129 inferior to the second
hinge 2117. A first bone screw penetrates the first bore 2130 and
into the lateral mass or the lamina, and the second bone screw
penetrates the second bore 2130 and into the lateral mass or the
lamina, the first and second bone screws serving to anchor the
implant. A bore, preferably in the lateral mass, can be drilled for
the first bone screw and for the second bone screw. Alternatively,
the bone screws can be self-tapping. A first locking plate similar
to the plate 1924 (FIG. 25A) can be secured about the head of the
first bone screw and a second locking plate can be secured about
the head of the second bone screw to prevent displacement of the
first and second bone screws 2140. The first locking plate can
block the first bone screw with a probe and the second locking
plate can block to the second bone screw with a probe.
[0116] It should be noted that embodiments 2000 and 2100 also can
be configured for accommodating treatment of cervical spinal
stenosis and other cervical spine ailments where only a single
cervical facet joint between adjacent vertebrae requires an
implant, i.e., where treatment is limited to one lateral facet
joint. In that case, the collar 2015, 2115 extends medially without
extending further to join a second facet joint spacer 2010,2110.
For the hinged embodiment 2100, the implant comprises a single
hinge 2117, and the collar 2115 has only one bore 2129 to accept
one bone screw to secure the implant 2100.
[0117] FIGS. 29A-E, depict a sizing and distracting tool 2200 of
the invention. Sizing tool 2200 has a handle 2203 and a distal head
2210 that is shaped as a facet joint spacer (e.g., 1810) of an
implant of the invention. That is, the head 2210 preferably will
have essentially the same features as the facet joint spacer 1810,
but the dimensions of the head 2210 will vary from one tool 2200 to
the next, in order to be able to use different versions of the
sizing tool 2200 to determine the dimensions of the cervical facet
joint that is to be treated and then to select an
appropriately-sized implant. The head 2210 preferably can be used
to distract the facet joint prior to the step of implanting the
implant in the facet joint. In this regard, the head 2210 is
rounded at the most distal point 2212, and can be a tapered to
facilitate insertion into a cervical facet joint. The head 2210
also can have a slightly convex superior surface 2213, the degree
of convexity varying among different sizing tools 2200 in order to
determine the desired degree of convexity of an implant to be
implanted in the cervical facet joint. The head 2210 may have a
uniform thickness along a proximal mid-section 2216. Accordingly,
the inferior surface 2215 preferably can be concave. Alternatively,
the proximal mid-section 2212 may be convex on the superior surface
1813 without being uniform in thickness. Thus, the inferior surface
2215 can be flat or planar. The head also can be curved.
[0118] The head 2210 has a stop 2218 to prevent over-insertion of
the head 2210 of the sizing tool 2200 into the facet joint. The
stop 2218 can be a ridge that separates the head 2210 from the
handle 2203. Alternatively, the stop 2218 can be any structure that
prevents insertion beyond the stop 2218, including pegs, teeth, and
the like.
[0119] Different sizing tools 2200 covering a range of dimensions
of the head 2210 can be inserted successively into a cervical facet
joint to select the appropriate size of an implant to position in
the cervical spine, with the appropriate convexity and concavity of
facet joint spacer. Each preferably larger head also can be used to
distract the facet joint.
[0120] FIG. 31A depicts a posterior view of a further embodiment
2300 of the implant of the invention. Embodiment 2300, as well as
all of the embodiments herein, can benefit from some or all of the
advantages described herein with regard to the other embodiments
described herein. Further, FIG. 31A, embodiment 2300 has a facet
joint spacer (or insert) 2310 that can have a tapered or thinned
distal end 2312 so that the distal end 2312 facilitates insertion
of the facet joint spacer 2310 into a cervical facet joint. The
distal end 2312 can be rounded, as seen in the plan view of FIG.
31A, in order to conform to the roundness of the facet joint. The
facet joint spacer 2310 further can be curved so that a superior
surface 2313 of the facet joint spacer 2310 is convex, and an
inferior surface 2315 is concave, to approximate the natural shape
of the cervical facet joint that is to receive the implant 2300.
The curve can have a uniform thickness, or it can have a varied
thickness. Further, the lateral edges of the facet joint spacer
2310 are curved or rounded, for distribution of load-bearing
stress. As with other embodiments described herein, the facet joint
spacer 2310 also can be made of a flexible, biocompatible material,
such as PEEK, to maintain joint mobility and flexibility.
[0121] The facet joint spacer 2310 is connected flexibly with a
lateral mass plate 2320, the flexible connection preferably being a
hinge 2322. As seen in the plan view of FIG. 31A, the implant 2300
is substantially hour-glass shaped. This shape, as well as the
shape of FIG. 32, will be discussed further below. The hinge 2322
is narrower than the facet joint spacer (or insert) 2310, with the
hinge 2322 sitting at substantially the isthmus 2317 between facet
joint spacer 2310 and the lateral mass plate 2320. The curved
edges, or fillets, about the hinge 2322 serve to distribute more
evenly the load-bearing stress on the implant 2300, and thus
prevent concentrating the stress about the edges.
[0122] The hinge 2322 allows the implant 2300 to bend at the hinge
2322, bringing a lateral mass plate 2320 adjacent to the lateral
mass and/or lamina of the patient's spine, and to conform to a
particular patient's anatomy. The lateral mass plate 2320 is made
of a biocompatible flexible material, preferably titanium or any
other biocompatible flexible material as described herein, for
example PEEK, that will support the use of bone screws and other
hardware, as described below. The lateral mass plate 2320 bends
downward at the hinge 2322 over a wide range of angles relative to
the facet joint spacer 2310, and preferably at an angle of more
than 90 degrees, and this flexibility facilitates positioning and
insertion of the facet joint spacer. This flexibility of the
lateral mass plate 2320 relative to the facet joint spacer 2310
further facilitates positioning of the lateral mass plate relative
to the lateral mass and/or the lamina of the patient's spine. Once
the lateral mass plate 2320 is positioned adjacent to the bone,
preferably the lateral mass of a cervical vertebra, a first bone
screw, such as bone screw 1840, can be inserted through a first
bore 2330 through the lateral mass plate 2320 and embedded into the
bone of the lateral mass of the cervical vertebra.
[0123] The lateral mass plate 2320 further comprises a second bore
2329 which is preferably positioned medially, relative to the first
bore 2330. Thus, viewing the implant from a posterior perspective
as in FIG. 31A, the second bore 2329 in the lateral mass plate 2320
can be positioned either to the left or to the right of the first
bore 2330. The position of the second bore 2329 will depend upon
whether the implant 2300 is intended to be inserted into a cervical
facet joint on the left or right side of a patient. Specifically,
an implant 2300 to be inserted into a right-side cervical facet
joint (i.e., the patient's rights side) will have a second bore
2329 positioned to the left of the first bore 2330 as in FIG. 31A,
when implant 2300 is viewed from a posterior perspective, while an
implant 2300 to be inserted into a left-side cervical facet joint
will have a second bore 2329 positioned to the right of the first
bore 2330, when implant 2300 is viewed from a posterior
perspective.
[0124] The second bore 2329 through the lateral mass plate 2320 is
adapted to accept a second screw 2390 (FIG. 31B), which preferably
is a locking screw with a chisel point 2391. The locking screw 2390
is received by the second bore 2329 and the chisel point 2391
self-cuts a bore into the bone. The locking screw 2390 preferably
is inserted through the second bore 2329 and embedded in the bone,
after the bone screw is embedded in the bone through the first bore
2330. The position of the second bore 2329, i.e., medial to the
first bore 2330, positions the locking screw 2390 so that it embeds
in stronger bone tissue than if the second bore 2329 were located
more laterally. The locking screw, in combination with the bone
screw, prevents rotational and/or backward displacement of the
implant 2300. As the locking screw 2390 is received by the second
bore 2329, the head 2392 of the locking screw 2390 aligns with the
head of the first bone screw in the first bore 2330, blocking the
head of the first bone screw to prevent the first bone screw from
backing out of the bone of the vertebra and the first bore
2330.
[0125] FIG. 32 depicts a further embodiment 2400 of the implant of
the invention, from a posterior view. Embodiment 2400 is adapted to
be implanted in a manner that preserves the anatomy of the cervical
facet joint, in particular, the soft tissues around the cervical
facet joint, including the joint capsule.
[0126] Implant 2400, like implant 2300 and other implants disclosed
above, has a facet joint spacer 2410, flexibly connected,
preferably by a hinge 2422, to a lateral mass plate 2420. As can be
seen in FIG. 32, the implant 2400 including the facet joint spacer
(or insert) 2410 and the hinge 2422 is substantially "P"shaped. As
explained below, its "P" shape assists in the insertion of the
implant 2400 into the facet joint with most of the facet capsule
and facet capsule ligament and other soft tissue associated with
the facet joint still left intact. The facet joint spacer, as above
for implant 2300 and the other implants disclosed above, can have a
superior surface 2413 of the facet joint spacer 2410 that is
convex, and an inferior surface 2415 that is concave, or any
appropriate shaping to approximate the natural shape of the
cervical facet joint that is to receive the implant 2400. The
thickness of the facet joint spacer 2410 can be uniform, or varied.
The facet joint spacer 2410 also can be made of a flexible,
biocompatible material, such as PEEK, to maintain joint mobility
and flexibility. The hinge 2422 can have smooth, rounded edges, for
distribution of load stress, as disclosed above. Other features and
advantages of the other embodiments can be, if desired,
incorporated into the design of the embodiment of FIG. 32. For
example, the facet joint spacer 2410 further can have a tapered or
thinned edge 2412 so that the edge 2412 facilitates insertion of
the facet joint spacer 2410 into a cervical facet joint. The edge
2412 can be curved. In this embodiment 2400, however, the thinned
edge 2412 of the facet joint spacer 2410 preferably is not at the
distal end of the facet joint spacer 2400 as is the thinned edge
2312 of the facet joint spacer 2300; rather, the thinned edge 2412
preferably is positioned laterally, toward the hinge 2422 of the
implant 2400. The thinned edge 2412 coincides substantially with a
lateral curvature 2440 of the facet joint spacer 2410, which is
pronounced relative to the curvature on the medial side of the
implant 2400, i.e., a "P"shape. In other words, the curved part of
the head of the "P" 2440 corresponds to the thinned edge 2412, and
serves as the leading edge of the implant 2400 to begin insertion
of the facet joint spacer 2410 into a cervical facet joint,
preferably through an incision in the soft tissue of the facet
joint. The "P" shape narrows at isthmus 2417 where the facet joint
spacer 2410 that is joined by the hinge 2422 with the lateral mass
plate 2420. The smooth or rounded edges or fillets serve to
distribute stresses on the implant 2400. The above described
"P"shape of implant 2400 allows the implant 2400 to be pivoted into
place into a facet joint as described below. The thinned edge 2412
and leading lateral curvature 2440 of the facet joint spacer 2410
are adapted to facilitate urging implant 2400 into the cervical
facet joint, through the incision in the joint capsule. The implant
2400 then is pivoted into position so that the lateral mass plate
2420 can be bent downward, relative to the facet joint spacer 2410,
to align with and lie adjacent to the lateral mass and/or the
lamina. The lateral mass plate 2420 is then fastened to the
bone.
[0127] The lateral mass plate 2420 of implant 2400, like the
lateral mass plate for implant 2300, is flexibly connected,
preferably by the smooth-edged hinge 2422, to the facet joint
spacer 2410 at the narrow lower part of the facet joint spacer. The
lateral mass plate 2420 is made of a biocompatible flexible
material, preferably titanium or any other biocompatible flexible
material such as PEEK that will support the use of bone screws and
other hardware, as described below.
[0128] The lateral mass plate 2420 bends downward at a wide range
of angles relative to the facet joint spacer 2410, and preferably
at an angle of more than 90 degrees. The flexibility of the lateral
mass plate 2420 relative to the facet joint spacer 2410 further
facilitates positioning of the lateral mass plate 2420 relative to
the lateral mass and/or the lamina of the patient's spine.
[0129] Like embodiment 2300, described above, the lateral mass
plate 2420 has first bore 2430, which is adapted to receive a bone
screw 2440, to help anchor implant 2400 in position. The lateral
mass plate 2420 further includes a second bore 2429 adapted to be
positioned medially, relative to the first bore 2430, as disclosed
above for implant 2300. The position of the second bore 2429, when
viewing implant 2400 from a posterior perspective (FIG. 32), will
depend upon whether implant 2400 is intended to be implanted into a
left-side or right-side cervical facet joint of a patient. Thus,
implant 2400 with the second bore 2429 positioned to the left of
the first bore 2430 is intended to be implanted in a right-side
cervical facet joint of a patient, as depicted in FIG. 32, while an
implant 2400 with a second bore 2429 positioned to the right of the
first bore 2430 is intended to be implanted in a left-side cervical
facet joint of a patient.
[0130] The second bore 2429 through the lateral mass plate 2420 is
adapted to receive a second screw 2490 with head 2492, which
preferably is a locking screw with a chisel point, such as screw
2390. The function and purpose of the bone screw disposed through
bore 2430 and the locking screw disposed through bore 2429 are as
described above with respect to the implant 2300.
[0131] The present invention further includes a method of
implanting the implant 2400 (FIGS. 33A, 33B). To insert the facet
joint spacer (or insert) 2410, a facet joint is accessed and an
incision or a pair of incisions is made in the capsular ligament,
the joint capsule, and the synovial membrane so that the thinned
edge 2412 of the implant 2400 can be urged into the cervical facet
joint through these tissues. The capsular ligament and the joint
capsule and other soft tissues around the cervical facet joint are
allowed to remain substantially intact, except for the small
incision, and will be sutured and allowed to heal around the
implant 2400. If desired, the cervical facet joint can be
distracted prior to urging the curved section 2440 with the thinned
edge 2412 of the facet joint spacer 2410 into the cervical facet
joint. Once the curved section 2440 of the facet joint spacer 2410
with the thinned edge 2412 is urged into the cervical facet joint,
implant 2400 is pivoted, preferably about 90 degrees, so that the
second bore 2429 is placed medially relative to the first bore
2430. This allows the facet joint spacer 2410 to be positioned in
the facet joint. It is noted that the overall size, including the
isthmus 2417, of the artificial fact joint 2410, as that of 2310,
can be somewhat smaller than in prior embodiments to allow the
facet joint spacer to be positioned within the edges of the facet
joint with the joint capsule substantially intact. The lateral mass
plate 2420 then can be bent downward about the hinge 2422 into
position adjacent the lateral mass or lamina of the spine of the
patient, which position will depend upon the anatomy of an
individual patient's cervical spine.
[0132] Once the lateral mass plate 2420 is positioned adjacent to
the bone, preferably the lateral mass of a cervical vertebra, a
first bone screw can be inserted through the first bore 2430
through the lateral mass plate 2420 and become embedded into the
bone of the lateral mass of the cervical vertebra to anchor the
implant 2400. After the bone screw is embedded, a locking screw is
inserted through the second bore 2429 of the lateral mass plate
2420, the second bore 2429 medial to the first bore 2430. The
locking screw has a chisel end that allows the locking screw to dig
into the bone without use of a tool to pre-cut a bore.
Alternatively, a bore can be pre-cut and a locking screw without a
chisel end can be used. As the locking screw is embedded in the
bone, the locking head of the locking screw is brought into
proximity with the head of the bone screw to block its backward
movement so that the implant 2400 remains anchored with the bone
screw, i.e., so that the bone screw cannot back out of the bone.
The embedded locking screw also serves to prevent rotational
displacement of implant 2400, while blocking backward displacement
of the first bone screw.
[0133] Referring to FIGS. 34A through 36B, a still further
embodiment of an implant 2500 in accordance with the present
invention can include a facet joint spacer (or insert) 2510
connected with a lateral mass plate (also referred to herein as an
anchoring plate) 2520 by a spheroidal joint arrangement 2538 or
otherwise shaped multiple direction articulation joint arrangement.
The facet joint spacer 2510 has a load bearing structure sized and
shaped to distribute, as desired, a load applied by opposing
surfaces of superior and inferior facets to one another. As shown,
the load bearing structure has a saucer shape, but as described in
further detail below (and as described in previous embodiments
above), in other embodiments the load bearing structure can have
some other shape so long as a desired load distribution and
separation between superior and inferior facets is achieved. The
facet joint spacer 2510 includes a handle-like structure connected
with the load bearing surface, the handle-like structure necking at
an isthmus 2517 and terminating at a pivot end 2526. In an
embodiment, the pivot end 2526 is substantially spherical, ovoidal,
or similarly rounded in shape. As further described below, the
facet joint spacer 2510 can comprise a flexible material, for
example a biocompatible polymer such as PEEK, or a more rigid
material, for example a biocompatible metal such as titanium. As
shown, the lateral mass plate 2520 has a generally square shape
with rounded corners; however, in other embodiments the lateral
mass plate 2520 can have any number of shapes so long as the
lateral mass plate 2520 provides sufficient support for anchoring
the implant 2500 in position and so long as the lateral mass plate
2520 allows a desired range of motion for the facet joint spacer
2510. The lateral mass plate 2520 includes a cavity 2527 within
which the pivot end 2526 is held. The spheroidal joint arrangement
2538 comprises the pivot end 2526 and the cavity 2527 and as
described below allows the facet joint spacer 2510 to tilt and
swivel relative to the lateral mass plate 2520.
[0134] FIG. 34A is a posterior view showing a posterior face 2532
of the lateral mass plate 2520, while FIG. 34B is an anterior view
showing an anterior face 2534 of the lateral mass plate 2520. The
lateral mass plate 2520 includes an anterior notch 2524 (see FIG.
35) or other indentation formed along the edge of the anterior face
2534 and a posterior notch 2522 or other indentation formed along
the posterior face 2532. The posterior and anterior notches 2522,
2524 are generally aligned with one another along the edge of the
lateral mass plate 2520 and are connected with the cavity 2527. The
notches 2522, 2524 confine movement of the facet joint spacer 2510
in the anterior and posterior directions relative to the lateral
mass plate 2520, allowing the facet joint spacer 2510 to tilt at
varying degrees of angle in an anterior and posterior direction.
Referring to FIG. 35, the anterior notch 2524 can have a narrower
width than the posterior notch 2522 which is sized to provide the
pivot end 2526 of the facet joint spacer (or insert) 2510 with
access to the cavity 2527 so that the pivot end 2526 can be
inserted into the cavity 2527. Once the pivot end 2526 is
positioned within the cavity 2527 a plug 2528 can be mated with the
lateral mass plate 2520 to lock the pivot end 2526 in place within
the cavity 2527 and to further limit freedom of movement of the
facet joint spacer 2510, particularly limiting tilting of the facet
joint spacer 2510 in a posterior direction. The plug 2528 can be
press fit to the posterior notch 2522 and further welded or
otherwise fixedly fastened with the lateral mass plate 2520. A
physician can select an appropriate and/or desired facet joint
spacer 2510, lateral mass plate 2520, and plug 2528 according to
the motion segment targeted for implantation and/or the particular
anatomy of the patient. Once an appropriate combination of
components is identified, the facet joint spacer 2510 and the
lateral mass plate 2520 can be mated, and the facet joint spacer
2510 can be locked in place by the plug 2528.
[0135] As can further be seen in FIGS. 34A through 35 the lateral
mass plate 2520 has a first bore 2530 therethrough. The first bore
2530 can accept a bone screw 2540 (also referred to herein as a
lateral mass screw) to secure the lateral mass plate 2520
preferably to the lateral mass, lamina, or alternatively to another
part of the spine, and thus to anchor the implant 2500. The lateral
mass screw 2540 preferably has a head 2542 that can accept a tool
chosen for the surgical procedure whether a wrench, screwdriver, or
other tool. The lateral mass plate 2520 further has a second bore
2529 which is preferably positioned medially, relative to the first
bore 2530. Referring to FIG. 34A, the second bore 2529 in the
lateral mass plate 2520 can be positioned either to the left or to
the right of the first bore 2530. The position of the second bore
2529 will depend upon whether the implant 2500 is intended to be
inserted into a cervical facet joint on the left or right side of a
patient. Specifically, an implant 2500 to be inserted into a
right-side cervical facet joint (i.e., the patient's rights side)
will have a second bore 2529 positioned to the left of the first
bore 2530 as in FIG. 34A, when implant 2500 is viewed from a
posterior perspective, while an implant 2500 to be inserted into a
left-side cervical facet joint will have a second bore 2529
positioned to the right of the first bore 2530, when implant 2500
is viewed from a posterior perspective.
[0136] The second bore 2529 through the lateral mass plate 2520 is
adapted to accept a second screw 2590 which preferably is a locking
screw having a chisel point 2591. The locking screw 2590 is
received by the second bore 2529 and the chisel point 2591
self-cuts a bore into the bone. The locking screw 2590 is
preferably inserted through the second bore 2529 and embedded in
the bone after the bone screw 2540 is embedded in the bone through
the first bore 2530. The medial position of the second bore 2529
relative to the first bore 2530 positions the locking screw 2590 so
that it embeds in stronger bone tissue than if the second bore 2529
were located more laterally. The locking screw 2590, in combination
with the bone screw 2540, prevents rotational and/or backward
displacement of the lateral mass plate 2520. As the locking screw
2590 is received by the second bore 2529, the head 2592 of the
locking screw 2590 aligns with the head 2542 of the first bone
screw 2540 in the first bore 2530, blocking the head 2542 of the
first bone screw 2540 to prevent the first bone screw 2540 from
backing out of the bone of the vertebra and the first bore 2530.
The posterior face 2532 can include a recessed portion 2539, and/or
the second bore 2529 can be countersunk, so that the locking screw
2590 does not protrude farther from the posterior face 2532 than
desired.
[0137] In a preferred embodiment (as shown in FIGS. 34A-37), the
spheroidal joint arrangement 2538 includes a spherical pivot end
2526 and a cavity 2527 having a shape approximately conforming to
the spherical pivot end 2526 so that the spheroidal joint
arrangement 2538 is a ball-in-socket arrangement. The
ball-in-socket arrangement 2538 allows the facet joint spacer (or
insert) 2510 to move freely relative to the lateral mass plate 2520
where the facet joint spacer 2510 is unobstructed by the lateral
mass plate 2520. For example, as shown in FIG. 36A the facet joint
spacer 2510 can tilt in an anterior direction (to position 1, for
example) and can tilt in a posterior direction (to position 2, for
example). As the facet joint spacer 2510 tilts in an anterior
direction, the isthmus 2517 moves within the anterior notch 2524 so
that the facet joint spacer 2510 can continue tilting without
obstruction. Conversely, as the facet joint spacer 2510 tilts in a
posterior direction (to position 2, for example), the isthmus 2517
contacts the plug 2528, limiting the amount of tilt of the facet
joint spacer 2510 in a posterior direction.
[0138] Referring to FIG. 36B, the ball-and-socket arrangement
allows the facet joint spacer (or insert) 2510 to swivel (to
position 3, for example) relative to the lateral mass plate 2520,
potentially providing a more conformal arrangement of the facet
joint spacer 2510 with the surfaces of the superior and inferior
facets. Further, the ability of the facet joint spacer 2510 to
swivel can increase options for lateral mass plate 2520 anchor
positions. A physician can anchor the lateral mass plate 2520 in a
more conformal or advantageous orientation and/or position along
the lateral mass, for example, by altering the arrangement of the
lateral mass plate 2520 relative to the facet joint spacer 2510.
The amount of swiveling accommodated (and the degree of freedom of
movement accommodated in general) depends on the geometries of the
components. For example, where the isthmus 2517 is sufficiently
narrow and long in length, a greater degree of swiveling in
combination with tilt can be achieved, or for example where the
plug 2528 extends over a portion of the facet joint spacer 2510, as
shown in FIGS. 36A and 36B, the amount of tilt possible in the
posterior direction can be limited. One of ordinary skill in the
art will appreciate that the freedom of movement of the facet joint
spacer 2510 relative to the lateral mass plate 2520 is limited
substantially or wholly by the geometries of the components, and
therefore can be substantially altered to achieve a desired range
of movement. The ball-and-socket arrangement need not include a
ball that extends from the facet joint spacer and a socket that is
formed in the lateral mass plate. For example, the ball of such a
joint can extend from a locking or anchoring plate and the socket
can be included in the facet joint spacer. Further, while the
preferred embodiment has been described as a ball-and-socket
arrangement, other arrangements can be employed with varied
results. It should not be inferred that embodiments in accordance
with the present invention need include a spheroidal shaped end
mated with a rounded cavity. The scope of the present invention is
not intended to be limited to ball-and-socket arrangements, but
rather is intended to encompass all such arrangements that provide
a plurality of degrees of freedom of movement and substitutability
of components.
[0139] Referring again to FIGS. 36A and 36B, the load bearing
structure of the facet joint spacer 2510 includes a superior
surface 2513 having a generally convex shape and an inferior
surface 2514 having a slightly concave shape. The shape of the load
bearing structure is intended to approximate a shape of opposing
surfaces of the superior and inferior facets. The shape of the
superior and inferior surfaces 2513, 2514 can vary between motion
segments and between patients. For example, as shown in FIG. 37,
where the cervical vertebra includes an inferior facet having a
substantially convex natural surface, a physician may select a
facet joint spacer 2610 including a load bearing structure with an
inferior surface 2614 having a more concave shape combined with a
lateral mass plate 2620 having a bone screw 2640 more appropriately
sized for the particular lateral mass to which it will be fixed.
(As shown the bone screw 2640 has a shorter length and wider
diameter.) A physician can be provided with facet joint spacers
having a multiplicity of load bearing structure shapes. As
mentioned above, the ability to match different facet joint spacers
with different lateral mass plates can improve a physician's
ability to provide appropriate treatment for a patient, and can
further provide the physician flexibility to reconfigure an implant
once a surgical site has been exposed and the physician makes a
determination that a different combination of components is
appropriate.
[0140] In yet another embodiment, the spheroidal joint arrangement
2538 of FIGS. 34A-37 can be applied to collar structures, for
example as shown in FIGS. 26A-27B so that the facet joint spacers
at each end of the collar structure include an increased range of
motion to improve surface matching between the facet joint spacers
and the surfaces of the superior and inferior facets (i.e.,
increasing the amount of facet surface area contacting the facet
joint spacers).
[0141] A further embodiment of an implant 2600 in accordance with
the present invention is shown in FIGS. 38A-38G. The implant 2600
resembles implants as shown in FIGS. 22A-25A in that the facet
joint spacer (or insert) 2610 has limited freedom of movement
relative to the lateral mass plate 2620. As can be seen, a hinge
connects the facet joint spacer 2610 with the lateral mass plate
2620, allowing the facet joint spacer to pivot up and down relative
to a plane of the lateral mass plate 2620. However, in other
embodiments the facet joint spacer 2610 can be connected with the
lateral mass plate 2620 by way of a spheroidal joint arrangement
(as described above) or by way of some other structure. An inferior
surface 2615 of the facet joint spacer 2610 includes a plurality of
cleats (also referred to herein as protrusions) 2686 extending from
the inferior surface 2615. The plurality of cleats 2686 can
penetrate or grip a superior facet of the targeted facet joint,
thereby reducing slippage of the facet joint spacer 2610 relative
to the superior facet. The cleats 2686 do not directly restrict the
inferior facet of the targeted facet joint from moving along the
superior surface 2613 of the facet joint spacer 2610. The cleats
2686 can further promote bone growth by roughing the surface, which
can provide beneficial results where an increase in surface contact
resulting in a reduction of slippage is desired. In a preferred
embodiment the facet joint spacer 2610 can include a inferior
surface 2615 connected with the hinge 2622 and formed of a
light-weight, bio-compatible material having a desired strength,
such as titanium, titanium alloys, aluminum, aluminum alloys,
medical grade stainless steel, etc. Such a structure is also
referred to herein as an inferior shim 2680. As shown, a
substantial portion of the facet joint spacer 2610 including the
superior surface 2613 can be formed of a biocompatible polymer,
such as described below. Such a substantial portion is also
referred to herein as a superior shim 2682. Such a material is
radiolucent, and can have a desired smoothness and reduced
compressive strength relative to the inferior surface 2615 such
that the superior surface 2613 of the facet joint spacer 2610
allows for a desired slippage relative to the inferior facet of the
facet joint. A superior surface 2613 having a reduced compressive
strength and an increased elasticity can reduce damage to a bony
structure. The superior shim 2682 can be molded onto the inferior
shim 2680 to form the facet joint spacer 2610, or the superior shim
2682 can be adhesively fastened to the inferior shim 2680,
interference with optional protuberances of the inferior shim 2680,
etc. One of ordinary skill in the art will appreciate the different
techniques for fixedly connecting a superior shim 2682 with the
inferior shim 2680.
[0142] In a preferred embodiment, the cleats 2686 of the implant
2600 can extend from the inferior surface 2615 to have a sawtooth
shape and arrangement to resist movement in a generally posterior
direction away from the facet joint (i.e., toward the lateral mass
plate 2620 as shown) and further to resist movement in a lateral
direction relative to the facet joint. However, the cleats 2686
need not necessarily be sawtooth in shape and arrangement. For
example, the cleats 2686 can have a conical shape, a pyramid shape,
a curved shape, etc. Further, as shown particularly in FIG. 38C
four cleats 2686 extend from the inferior surface 2615. In other
embodiments, any number of cleats 2686 can be provided, the cleats
2686 being similarly sized and shaped, or varying in size and
shape. In reflection on the teachings contained herein, one of
ordinary skill in the art will appreciate the myriad different
shapes with which the cleats 2686 can be formed. The cleats 2686
can vary in performance and technique for implantation with shape
and number; however, the present invention is meant to encompass
all such variations.
[0143] The implant 2600 can further optionally include plate cleats
2688 extending from a surface of the lateral mass plate 2620
substantially contacting the bony structures of the spine (e.g.,
the lateral mass). The plate cleats 2688 can help anchor the
lateral mass plate 2620 in position either to assist in resisting
shifting as a bone screw 2640 is associated with the bony
structure, or as an adjunct to the bone screw 2640. Surface
roughening caused by the plate cleats 2688 can further promote bone
growth near and/or integrally with the lateral mass plate 2620. As
shown particularly in FIG. 38C there are four plate cleats 2688,
each plate cleat 2688 having a conical structure. However, as above
the plate cleats 2688 can vary in size, number and shape. For
example, the plate cleats 2688 can have a saw-tooth shape, a
pyramid shape, a curved shape, etc.
[0144] Referring to FIGS. 38D through 38G, a bone screw 2640 of the
implant 2600 can be arranged in a bore 2630 so that the bone screw
2640 and bore 2630 permit a relative degree of freedom of movement
resembling a ball-in-socket joint. Such an arrangement can allow
for flexibility in fastening the implant 2600 to a bony structure,
thereby allowing a surgeon to avoid diseased or fragile bony
structures, fastening the implant 2600 to more durable, healthy
bony structures. The bone screw 2640 can swivel within the bore
2630 toward or away from the facet joint spacer 2610 and/or from
side-to-side relative to the facet joint spacer (or insert) 2610.
When the bone screw 2640 is arranged as desired a retaining plate
2624 can be attached to the lateral mass plate 2620 to resist
backing out of the bone screw 2640, similar to the functioning of
features as shown in previous embodiments.
[0145] Referring to FIG. 39, in still further embodiments, implants
in accordance with the present invention can have both an inferior
surface 2715 and a superior surface 2713 having cleats 2786
extending therefore. Such embodiments can be employed, for example,
to fuse the facet joint. The cleats 2786 can resist relative
movement of the inferior and superior facets, and can further
promote bone growth through roughening of the facet surface,
thereby promoting fusion of the facet joint. The facet joint spacer
(or insert) 2710 can be formed from a light-weight, high strength,
biocompatible material such as titanium, titanium alloys, aluminum,
aluminum alloys, medical grade stainless steel, etc. Alternatively,
the facet joint spacer 2710 can be formed from a biocompatible
polymer, as described below, or the facet joint spacer 2710 can
comprise inferior and superior shims (not shown) fixedly connected
and formed of the same or different materials. Upon reflection of
the teachings herein, one of ordinary skill in the art will
appreciate the different ways in which the facet joint spacer 2710
can be formed.
[0146] As described above in reference to FIGS. 38A-G, the cleats
2786 are saw-tooth in shape and arrangement, but alternatively can
have some other shape and/or arrangement. For example, the cleats
2786 can have a pyramidal shape, a curved shape, a conical shape,
etc. Further, the shape, size and arrangement for cleats 2786 of
the inferior surface 2715 can be different or the same from cleats
2786 of the superior surface 2713. The shape, size, and arrangement
of the cleats 2786 can be chosen based on the location of
implantation, the preferences of the surgeon, the physical
condition of the target facet joint, etc.
[0147] FIG. 40 is a flow chart of an embodiment of a method in
accordance with the present invention for implanting an implant as
described in FIGS. 34A through 39. An incision must first be made
to expose the surgical site and access the targeted facet joint
(Step 2500). Once the facet joint is made accessible, the facet
joint can be sized and distracted (Step 2502). A sizing tool 2200
(for example, see FIGS. 29A-C) can be inserted to select the
appropriate size of an implant 2500 of the invention for
positioning in the cervical facet joint. This step may be repeated
as necessary with, if desired, different sizes of the tool 2200
until the appropriate size is determined. This sizing step also
distracts the facet joint and surrounding tissue in order to
facilitate insertion of the implant 2500. Once the appropriate size
is determine, the physician can select an appropriate facet joint
spacer (or insert) 2510 with the lateral mass plate 2520 (Step
2504). The facet joint spacer 2510 can then be urged between the
facets into the facet joint (Step 2510). The facet itself is
somewhat shaped like a ball and socket joint. Accordingly, in order
to accommodate this shape, the artificial joint 2510 can have a
rounded leading edge shaped like a wedge or tissue expander to
cause distraction of the facet joint as the facet joint spacer is
urged into the facet joint of the spine. The facet joint spacer
2510 also includes the convex superior surface 2513 in order to
more fully accommodate the shape of the facet joint of the spine.
However, as set forth above and as depicted in FIG. 37, it is
possible in the alternative to have a curve-shaped facet joint
spacer 2610 with a convex superior surface 2613 and a concave
inferior surface 2614, the distal end of the facet joint spacer
2610 tapering to facilitate insertion, while the remainder of the
facet joint spacer 2610 has a uniform thickness.
[0148] Once the facet joint spacer 2510 is positioned, the lateral
mass plate 2520 is tilted and/or swiveled so that the lateral mass
plate 2520 is adjacent to the vertebrae and preferably to the
lateral mass or to the lamina (Step 2512). Thus the lateral mass
plate 2520 may be disposed at an angle relative to the facet joint
spacer 2510 for a representative spine configuration. It is to be
understood that the final position of the lateral mass plate 2520
relative to the facet joint spacer 2510 will depend on the actual
spine configuration. Once the lateral mass plate 2520 is
positioned, or prior to the positioning of the lateral mass plate
2520, a bore can be drilled in the bone to accommodate the bone
screw 2540. Alternatively the screw 2540 can be self-tapping. The
screw 2540 is then placed through the first bore 2530 and secured
to the bone, preferably the lateral mass or the lamina, thereby
holding the facet joint spacer 2510 in place (Step 2514). In order
to lock the bone screw 2540 in place and to lock the position of
the facet joint spacer 2510 and the lateral mass plate 2520 in
place, a self-tapping locking screw 2590 is positioned within a
second bore 2529 of the lateral mass plate 2520 and secured to the
bone, thereby resisting undesirable movement of the lateral mass
plate 2520 (Step 2516). A head 2592 of the locking screw 2590 can
further block movement of the bone screw 2540 by trapping the bone
screw head 2542 between the locking screw head 2592 and the first
bore 2530. The locking screw 2590 therefore prevents the lateral
mass plate 2520 and the facet joint spacer 2510 from rotating and,
as previously indicated, prevents the bone screw 2540 from backing
out from the vertebra. Preferably the implant is between the C5 and
C6 vertebrae level, or the C6 and C7 vertebrae level. It is noted
that two implants preferably will be implanted at each level
between vertebrae. That is, an implant will be placed in a right
facet joint and also in a left facet joint when viewed from a
posterior view point. This procedure can be used to increase or
distract the foraminal area or dimension of the spine in an
extension or in neutral position (without having a deleterious
effect on cervical lordosis) and reduce the pressure on the nerves
and blood vessels. At the same time this procedure preserves
mobility of the facet joint.
[0149] Although implants as described above in FIGS. 1-40 provide
the feature of permitting (as desired) relative movement between a
superior and inferior facet joint, it can be desired that the facet
joint be fixed or restricted in movement (e.g., fused). In such
circumstances, it may be desired that an implant having similar
techniques of implantation be employed. An embodiment of an implant
2700 in accordance with the present invention is shown in FIGS. 41A
and 41B having a generally similar structure to implants as
described above, while further restricting relative movement
between lateral masses associated with the inferior and superior
facets. The implant 2700 resembles implants as shown in FIGS.
22A-25A in that the facet joint spacer (or insert) 2710 has limited
freedom of movement relative to a superior lateral mass plate (also
referred to herein as a first lateral mass plate) 2720 arranged
over a surface of a lateral mass (or related structure) associated
with a superior facet and optionally fixed to the lateral mass be a
cleat 2788. A superior hinge (also referred to herein as a first
hinge) 2722 connects the facet joint spacer 2710 with the superior
lateral mass plate 2720 and permits one degree of freedom (i.e.,
swiveling clockwise or counter-clockwise about the hinge). Further,
an inferior hinge (also referred to herein as a second hinge) 2752
connects the facet joint spacer 2710 with an inferior lateral mass
plate (also referred to herein as a second lateral mass plate) 2750
arranged over a surface of an inferior facet, the inferior hinge
2752 also permitting one degree of freedom. The facet joint spacer
2710 includes a flange 2711 extending from a load supporting
portion of the facet joint spacer 2710 disposed within the facet
joint. The flange 2711 provides a structure with which the superior
hinge 2722 and inferior hinge 2752 can be attached. As shown, the
flange 2711 protrudes at an obtuse angle relative to the load
supporting portion so that the inferior hinge 2752 is disposed
slightly more posteriorly of the spine than the superior hinge 2722
when implanted. However, it should be noted that the flange 2711
shown in FIGS. 41A and 41B is merely exemplary and in practice can
vary in shape. The flange 2711 should be shaped to satisfactorily
accommodate the physiology of the patient, so that the superior
lateral mass plate 2720 and the inferior lateral mass plate 2750
can be fixedly associated with a respective lateral mass (or
associated structures) within the range of freedom of movement of
the lateral mass plates. In the exemplary physiology illustrated in
FIG. 41B, the flange 2711 appropriately extends in both a cranial
and posterior direction relative to the spine so that an anterior
surface (also referred to herein as a contact surface) of the
inferior lateral mass plate 2750 approximately conforms with a
posterior surface of the inferior lateral mass. However, the flange
2711 can vary in structure with the physiology of a patient and
with a motion segment targeted. The shape of neighboring motion
segments can vary significantly, for example as between cervical
segment C3-C4 and C4-C5, therefore it should be understood that the
flange 2711 as well as other structures of the implant (e.g.,
posterior surfaces of the superior and inferior lateral mass plates
and the facet joint spacer) can vary significantly. Further, a
patient's physiology can alternatively be accommodated by a shape
of the lateral mass plate 2750 itself rather than by a shape or
arrangement of the flange 2711. Still further, the flange 2711 can
have a single attachment point such that the superior lateral mass
plate 2720 and the inferior lateral mass plate 2750 are pivotably
associated with a common hinge, although such an arrangement may or
may not be disadvantageous to positioning the implant and fixing
the implant in place.
[0150] As shown in the perspective view of FIG. 41A and the side
view of FIG. 41B, the facet joint spacer 2710 can include detents
2709 at the contact surfaces of the facet joint spacer 2710 for
receiving boney ingrowth. Boney ingrowth can provide additional
rigidity to restrict movement of adjacent spinal structures at the
facet joint. In such embodiments, the facet joint spacer 2710 can
include a rasp at an insertion edge or the facet joint spacer 2710
can include a textured surface to roughen the contact surfaces of
the superior and facet joint spacers, thereby stimulating bone
growth. Alternatively, the contact surfaces of the superior and
facet joint spacers can be roughened using a tool prior to
implantation of the facet joint spacer 2710 between the superior
and inferior facets. Referring to FIG. 41C, in alternative
embodiments an implant 2800 in accordance with the present
invention can includes protrusions 2807, such as cleat or spikes,
extending from the contact surfaces of the facet joint spacer that
can be forced into the bone of the superior and inferior facets,
thereby resisting slippage of the facet joint spacer from an
implanted position. As shown, the implant 2800 can also optionally
include cleats 2888,2889 protruding from the contact surface of the
respective lateral mass plate 2820,2850 to fixedly associate the
lateral mass plate with the lateral mass. In still other
embodiments, an implant in accordance with the present invention
can include a combination of protrusions and detents. One of
ordinary skill in the art, upon reflecting on the figures and
detailed description, will appreciate the myriad different
variations in the shapes and features of the contact surface of the
facet joint spacer and how performance is affected by such
variations.
[0151] Referring to FIGS. 41A-41E, in some embodiments an anterior
surface (also referred to herein as a contact surface) 2931, 2951
of one or both of the superior lateral mass plate and the inferior
lateral mass plate can include protrusions 2935, 2955 such as
spikes or cleats extending from the anterior surface 2931, 2951.
The protrusions can help restrict or limit movement of the superior
lateral mass plate 2930 and inferior mass plate 2950 during seating
of the bone screws 2940, 2941 and/or the protrusions can provide
additional resistance to prevent undesired movement of the lateral
mass plates after the bones screws are seated and arranged as
desired.
[0152] The superior lateral mass plate 2720 can include a first
bore 2730 disposed through the superior lateral mass plate 2720.
Likewise, the inferior lateral mass plate 2750 can include a first
bore 2760 disposed through the inferior lateral mass plate 2750.
The first bore 2730, 2760 of the superior and inferior lateral mass
plates 2720,2750 are adapted to accept a respective bone screw
2740,2770 so that the bone screw 2740,2770 can be fixedly attached
to the lateral mass associated with the respective facet. The first
bores 2730,2760 of the superior and inferior lateral mass plates
2720,2750 can vary in size and shape from each other to accommodate
the associated structures with which the lateral mass plates
2720,2750 are attached. Likewise, the bone screws 2740,2770 of the
superior and inferior lateral mass plates 2720,2750 can vary in
size and shape from each other. The first bores 2730,2760 can be
formed such that the bone screw 2740,2770 can be inserted and
mounted at an angle relative to a plane of the superior and
inferior lateral mass plates 2720,2750 so that the bone screws
2740,2770 can be satisfactorily secured to the respective lateral
masses. As can be seen in FIG. 41B, mounting a bone screw 2740 at
an angle relative to the superior lateral mass plate 2720
(generally parallel to the facet joint spacer 2710 as shown) allows
the bone screw 2740 to be seated with a desirable clearance from
the outer surface of the lateral mass allowing the thread of the
screw 2740 to securely grip the bone of the lateral mass. The first
bore 2760 of the inferior lateral mass plate 2750 can be formed
such that a bone screw 2770 can be inserted and mounted to a
lateral mass associated with the inferior facet in a roughly
similar manner.
[0153] The superior lateral mass plate 2720 can further include a
second bore 2729 disposed partially or wholly through the superior
lateral mass plate 2720. Likewise, the inferior lateral mass plate
2750 can include a second bore 2759 disposed partially or wholly
through the inferior lateral mass plate 2750. The second bore
2729,2759 of the superior and inferior lateral mass plates
2720,2750 are adapted to accept a locking screw (not shown) for
fixing the bone screw 2740, 2770 in position. In a preferred
embodiment, the locking screw includes a chisel point so that when
the locking screw is received by the second bore 2729,2759 the
chisel point self-cuts into the bone (as described in detail in
FIGS. 24A-25B). The locking screw preferably is inserted through
the second bore 2729,2759 after the bone screw 2740,2770 is
embedded in the bone through the first bore 2730,2760. Where the
locking screw includes a chisel point, the position of the second
bore 2729,2759, i.e., medial to the first bore 2730,2760, positions
the locking screw so that it embeds in stronger bone tissue than if
the second bore 2729,2759 were located more laterally. The locking
screw, in combination with the bone screw 2740,2770 can resist
rotational and/or backward displacement of the implant 2700. As the
locking screw is received by the second bore 2729, the head of the
locking screw aligns with the head of the first bone screw
2740,2770 in the first bore 2730,2760, blocking the head of the
first bone screw 2740,2770 to prevent the first bone screw
2740,2770 from backing out of the bone of the vertebra and the
first bore 2730,2760.
[0154] In still other embodiments, some other structure can be
employed to resist movement of the seated bone screw within the
first bore. Referring to the perspective views of FIGS. 41D and
41E, in some embodiments a cam 2924,2954 can be rotatably
associated with one or both of the superior lateral mass plate 2920
and the inferior lateral mass plate 2950 so that the first bore
2930,2960 can be selectably obstructed or unobstructed, thereby
allowing a bone screw 2940,2970 to be received within the first
bore 2930,2960, or resisting movement of the bone screw 2940,2970
seated within the first bore 2930,2960. As shown in FIG. 41D, the
cam 2924,2954 can have a shape such that at a first position the
surface 2928,2958 of the cam is approximately flush with the first
bore 2930,2960, thereby allowing a bone screw 2940,2970 to pass
through the first bore 2930,2960. Rotated to a second position
(FIG. 41E), a protruding portion 2928,2958 of the surface of the
cam 2924,2954 can extend across at least a portion of the bore
2930,2960, thereby blocking a bone screw 2940,2970 seated within
the first bore 2930,2960 and preventing the bone screw 2940,2970
from backing out of the first bore 2930,2960. The cam 2924,2954 can
include features 2931,2961 (e.g., indentations) that can allow the
cam 2924,2954 to be grasped with a tool (not shown), and thus
rotated to the desired position. As shown, the cam 2924,2954 is
positioned within a slot of the lateral mass plate 2920,2950 so
that the cam 2924,2954 does not protrude undesirably from the
surface of the lateral mass plate 2920,2950.
[0155] Implants as shown in FIGS. 41A-41E include a facet joint
spacer having a flange extending therefrom; however, alternative
embodiment of implants in accordance with the present invention can
include some other structure for movably connecting the facet joint
spacer and the superior and inferior lateral mass plates. For
example, as shown in FIG. 41F, in some embodiments the facet joint
spacer 3010 can be pivotably connected with a hub structure 3011,
to which both the superior and inferior lateral mass plates
3030,3050 are likewise pivotably connected. In such embodiments,
the hub structure 3011 can be shaped so that the implant structures
are appropriately positioned during implantation to provide desired
contact between the implant structures and the targeted motion
segment. In still other embodiments, as shown in FIG. 41G, one of
the superior and inferior lateral mass plates (as shown, the
superior lateral mass plate 3130) can include a flange 3111
extending therefrom, with the facet joint spacer 3110 and the other
of the superior and inferior lateral mass plates (as shown the
inferior lateral mass plate 3150) being pivotably connected with
flange 3111.
[0156] Further, in still other embodiments, the implant structures
can be connected so that more than one degree of freedom exists
between two or more of the implant structures. As shown in FIGS.
41A-41G, at least two of the implant structures are connected with
a hinge to allow pivoting in a clockwise direction about the hinge,
or a counter-clockwise direction about the hinge. However, in other
embodiments the implant structures can be connected using some
other arrangement. For example, the facet joint spacer can be
connected with one or both of the superior and inferior lateral
mass plate by way of a spheroidal joint arrangement (as described
above in reference to FIGS. 34A-37).
[0157] FIG. 42 is a flow chart of an embodiment of a method in
accordance with the present invention for implanting an implant as
described in FIGS. 41A through 41G. An incision must first be made
to expose the surgical site and access the targeted facet joint
(Step 2700). Once the facet joint is made accessible, the facet
joint can be sized and distracted (Step 2702). A sizing tool 2200
(for example, see FIGS. 29A-C) can be inserted to select the
appropriate size of an implant 2700 of the invention for
positioning in the cervical facet joint. This step may be repeated
as necessary with, if desired, different sizes of the tool 2200
until the appropriate size is determined. This sizing step also
distracts the facet joint and surrounding tissue in order to
facilitate insertion of the implant 2700. Once the appropriate size
is determine, the physician can select an appropriate facet joint
spacer 2710 with the lateral mass plate 2720 (Step 2704). The facet
joint spacer 2710 can then be urged between the facets into the
facet joint (Step 2710). The facet itself is somewhat shaped like a
ball and socket joint. Accordingly, in order to accommodate this
shape, the artificial joint 2710 can have a rounded leading edge
shaped like a wedge or tissue expander to cause distraction of the
facet joint as the facet joint spacer is urged into the facet joint
of the spine. The facet joint spacer 2710 also includes the convex
superior surface 2713 in order to more fully accommodate the shape
of the facet joint of the spine. However, as set forth above and as
depicted in FIG. 37, it is possible in the alternative to have a
curve-shaped facet joint spacer 2610 with a convex superior surface
2613 and a concave inferior surface 2614, the distal end of the
facet joint spacer 2610 tapering to facilitate insertion, while the
remainder of the facet joint spacer 2610 has a uniform
thickness.
[0158] Once the artificial joint 2710 is positioned, a first
lateral mass plate (for purposes of illustration the superior
lateral mass plate 2720, although in other embodiments the inferior
lateral mass plate 2750 can be positioned and fixed first) is
tilted and/or swiveled so that the lateral mass plate 2720 is
adjacent to the vertebrae and preferably to the lateral mass or to
the lamina (Step 2712). Thus the lateral mass plate 2720 may be
disposed at an angle relative to the facet joint spacer 2710 for a
representative spine configuration. It is to be understood that the
final position of the lateral mass plate 2720 relative to the facet
joint spacer 2710 will depend on the actual spine configuration.
Once the lateral mass plate 2720 is positioned, or prior to the
positioning of the lateral mass plate 2720, a bore can be drilled
in the bone to accommodate the bone screw 2740. Alternatively the
screw 2740 can be self-tapping. The screw 2740 is then placed
through the first bore 2730 and secured to the bone, preferably the
lateral mass or the lamina, thereby holding the facet joint spacer
2710 in place (Step 2714). In order to lock the bone screw 2740 in
place and to lock the position of the facet joint spacer 2710 and
the lateral mass plate 2720 in place, a self-tapping locking screw
2790 is positioned within a second bore 2729 of the lateral mass
plate 2720 and secured to the bone, thereby resisting undesirable
movement of the lateral mass plate 2720 (Step 2716). A head 2792 of
the locking screw 2790 can further block movement of the bone screw
2740 by trapping the bone screw head 2742 between the locking screw
head 2792 and the first bore 2730. The locking screw 2790 therefore
prevents the lateral mass plate 2720 and the facet joint spacer
2710 from rotating and, as previously indicated, prevents the bone
screw 2740 from backing out from the vertebra.
[0159] Once the first lateral mass plate 2720 is positioned and
fixed, the second lateral mass plate in this illustration the
inferior lateral mass plate 2750) is tilted and/or swiveled so that
the second lateral mass plate 2750 is adjacent to the inferior
vertebrae and preferably to the lateral mass or to the inferior
lamina (Step 2718). Thus the inferior lateral mass plate 2750 may
be disposed at an angle relative to the facet joint spacer 2710 for
a representative spine configuration. It is to be understood that
the final position of the lateral mass plate 2750 relative to the
facet joint spacer 2710 will depend on the actual spine
configuration. Once the lateral mass plate 2750 is positioned, or
prior to the positioning of the lateral mass plate 2750, a bore can
be drilled in the bone to accommodate the bone screw 2770.
Alternatively the screw 2770 can be self-tapping. The screw 2770 is
then placed through the first bore 2760 and secured to the bone,
preferably the lateral mass or the lamina, thereby holding the
facet joint spacer 2710 in place (Step 2720). In order to lock the
bone screw 2770 in place and to lock the position of the facet
joint spacer 2710 and the lateral mass plate 2750 in place, a
self-tapping locking screw 2791 is positioned within a second bore
2759 of the lateral mass plate 2750 and secured to the bone,
thereby resisting undesirable movement of the lateral mass plate
2750 (Step 2722). A head 2793 of the locking screw 2791 can further
block movement of the bone screw 2770 by trapping the bone screw
head 2772 between the locking screw head 2793 and the first bore
2760. The locking screw 2791 therefore prevents the lateral mass
plate 2750 and the facet joint spacer 2710 from rotating and, as
previously indicated, prevents the bone screw 2770 from backing out
from the vertebra.
[0160] Preferably the implant is between the C5 and C6 vertebrae
level, or the C6 and C7 vertebrae level. It is noted that two
implants preferably will be implanted at each level between
vertebrae. That is, an implant will be placed in a right facet
joint and also in a left facet joint when viewed from a posterior
view point. This procedure can be used to increase or distract the
foraminal area or dimension of the spine in an extension or in
neutral position (without having a deleterious effect on cervical
lordosis) and reduce the pressure on the nerves and blood vessels.
At the same time this procedure preserves mobility of the facet
joint.
Materials for Use in Implants of the Present Invention
[0161] As alluded to above, and as described in further detail as
follows, in some embodiments, the implant, and components of the
implant (i.e., a lateral mass plate, a bone screw, a locking screw,
etc.) can be fabricated from medical grade metals such as titanium,
stainless steel, cobalt chrome, and alloys thereof, or other
suitable implant material having similar high strength and
biocompatible properties. Additionally, the implant can be at least
partially fabricated from a shape memory metal, for example
Nitinol, which is a combination of titanium and nickel. Such
materials are typically radiopaque, and appear during x-ray
imaging, and other types of imaging. Implants in accordance with
the present invention, and/or portions thereof (in particular a
facet joint spacer) can also be fabricated from somewhat flexible
and/or deflectable material. In these embodiments, the implant
and/or portions thereof can be fabricated in whole or in part from
medical grade biocompatible polymers, copolymers, blends, and
composites of polymers. A copolymer is a polymer derived from more
than one species of monomer. A polymer composite is a heterogeneous
combination of two or more materials, wherein the constituents are
not miscible, and therefore exhibit an interface between one
another. A polymer blend is a macroscopically homogeneous mixture
of two or more different species of polymer. Many polymers,
copolymers, blends, and composites of polymers are radiolucent and
do not appear during x-ray or other types of imaging. Implants
comprising such materials can provide a physician with a less
obstructed view of the spine under imaging, than with an implant
comprising radiopaque materials entirely. However, the implant need
not comprise any radiolucent materials.
[0162] One group of biocompatible polymers is the
polyaryletherketone group which has several members including
polyetheretherketone (PEEK), and polyetherketoneketone (PEKK). PEEK
is proven as a durable material for implants, and meets the
criterion of biocompatibility. Medical grade PEEK is available from
Victrex Corporation of Lancashire, Great Britain under the product
name PEEK-OPTIMA. Medical grade PEKK is available from Oxford
Performance Materials under the name OXPEKK, and also from CoorsTek
under the name BioPEKK. These medical grade materials are also
available as reinforced polymer resins, such reinforced resins
displaying even greater material strength. In an embodiment, the
implant can be fabricated from PEEK 450G, which is an unfilled PEEK
approved for medical implantation available from Victrex. Other
sources of this material include Gharda located in Panoli, India.
PEEK 450G has the following approximate properties: TABLE-US-00001
Property Value Density 1.3 g/cc Rockwell M 99 Rockwell R 126
Tensile Strength 97 MPa Modulus of Elasticity 3.5 GPa Flexural
Modulus 4.1 GPa
PEEK 450G has appropriate physical and mechanical properties and is
suitable for carrying and spreading a physical load between the
adjacent spinous processes. The implant and/or portions thereof can
be formed by extrusion, injection, compression molding and/or
machining techniques.
[0163] It should be noted that the material selected can also be
filled. Fillers can be added to a polymer, copolymer, polymer
blend, or polymer composite to reinforce a polymeric material.
Fillers are added to modify properties such as mechanical, optical,
and thermal properties. For example, carbon fibers can be added to
reinforce polymers mechanically to enhance strength for certain
uses, such as for load bearing devices. In some embodiments, other
grades of PEEK are available and contemplated for use in implants
in accordance with the present invention, such as 30% glass-filled
or 30% carbon-filled grades, provided such materials are cleared
for use in implantable devices by the FDA, or other regulatory
body. Glass-filled PEEK reduces the expansion rate and increases
the flexural modulus of PEEK relative to unfilled PEEK. The
resulting product is known to be ideal for improved strength,
stiffness, or stability. Carbon-filled PEEK is known to have
enhanced compressive strength and stiffness, and a lower expansion
rate relative to unfilled PEEK. Carbon-filled PEEK also offers wear
resistance and load carrying capability.
[0164] As will be appreciated, other suitable similarly
biocompatible thermoplastic or thermoplastic polycondensate
materials that resist fatigue, have good memory, are flexible,
and/or deflectable, have very low moisture absorption, and good
wear and/or abrasion resistance, can be used without departing from
the scope of the invention. As mentioned, the implant can be
comprised of polyetherketoneketone (PEKK). Other material that can
be used include polyetherketone (PEK),
polyetherketoneetherketoneketone (PEKEKK),
polyetheretherketoneketone (PEEKK), and generally a
polyaryletheretherketone. Further, other polyketones can be used as
well as other thermoplastics. Reference to appropriate polymers
that can be used in the implant can be made to the following
documents, all of which are incorporated herein by reference. These
documents include: PCT Publication WO 02/02158 A1, dated Jan. 10,
2002, entitled "Bio-Compatible Polymeric Materials;" PCT
Publication WO 02/00275 A1, dated Jan. 3, 2002, entitled
"Bio-Compatible Polymeric Materials;" and, PCT Publication WO
02/00270 A1, dated Jan. 3, 2002, entitled "Bio-Compatible Polymeric
Materials." Other materials such as Bionate.RTM., polycarbonate
urethane, available from the Polymer Technology Group, Berkeley,
Calif., may also be appropriate because of the good oxidative
stability, biocompatibility, mechanical strength and abrasion
resistance. Other thermoplastic materials and other high molecular
weight polymers can be used.
[0165] The foregoing description of the present invention has been
presented for purposes of illustration and description. It is not
intended to be exhaustive or to limit the invention to the precise
forms disclosed. Many modifications and variations will be apparent
to practitioners skilled in this art. The embodiments were chosen
and described in order to explain the principles of the invention
and its practical application, thereby enabling others skilled in
the art to understand the invention for various embodiments and
with various modifications as are suited to the particular use
contemplated. It is intended that the scope of the invention be
defined by the following claims and their equivalents.
* * * * *