Abstract
A prosthesis for the replacement of multiple diseased or traumatized spinal facets comprises a portion that replaces at least a bony portion of the facets to be replaced and where the prosthesis attaches to the vertebra in a manner that does not require attachment to, or abutment against, the lamina. Multiple configurations of the prosthesis provide for replacement of the two inferior facets, the two superior facets, a superior and inferior facet, or all four facets. A method of installing the prosthesis is provided that is comprised of the steps of resecting at least a portion of the facets that carry the diseased or traumatized spinal facets and attaching the prosthesis in a manner that does not require attachment or abutment against the lamina.
Claims
1. A surgical method comprising: inserting a left inferior facet prosthetic component into a left inferior facet via a fastener; inserting a right inferior facet prosthetic component into a right inferior facet via a fastener; inserting a left superior facet prosthetic component into a left superior facet via a fastener; and inserting a right superior facet prosthetic component into a right superior facet via a fastener.
2. The surgical method of claim 1, wherein the left inferior facet prosthetic component and the right inferior facet prosthetic component are operably connected via a bridge.
3. The surgical method of claim 2, wherein the bridge is curved.
4. The surgical method of claim 1, wherein the left inferior facet prosthetic component does not contact a lamina.
5. The surgical method of claim 1, wherein the right inferior facet prosthetic component does not contact a lamina.
6. The surgical method of claim 1, wherein the left inferior facet prosthetic component and the right inferior prosthetic component are part of a single body.
7. The surgical method of claim 1, wherein the left superior facet prosthetic component and the right superior facet prosthetic component are operably connected via a bridge.
8. The surgical method of claim 1, wherein left superior facet prosthetic component and the right superior facet prosthetic component are part of a single body.
9. The surgical method of claim 8, wherein the single body comprises a pair of flanges.
10. The surgical method of claim 9, wherein each of the flanges abuts against a pedicle of a vertebra.
11. A surgical method comprising: inserting a left inferior facet prosthetic component into a left inferior facet via a fastener; and inserting a right inferior facet prosthetic component into a right inferior facet via a fastener, wherein the left inferior facet prosthetic component and the right inferior facet prosthetic component are connected to one another via a bridge.
12. The surgical method of claim 11, wherein the left inferior facet prosthetic component and the right inferior prosthetic component are part of a single body.
13. The surgical method of claim 11, wherein the bridge is curved.
14. The surgical method of claim 11, wherein neither the left inferior facet prosthetic component nor the right inferior facet prosthetic component contacts a lamina.
15. The surgical method of claim 11, wherein the bridge does not contact any portion of a vertebra.
16. A surgical method comprising: inserting a left superior facet prosthetic component into a left superior facet via a fastener; and inserting a right superior facet prosthetic component into a right superior facet via a fastener, wherein the left superior facet prosthetic component and the right superior facet prosthetic component are connected to one another via a bridge.
17. The surgical method of claim 16, wherein the left superior facet prosthetic component and the right superior prosthetic component are part of a single body.
18. The surgical method of claim 16, wherein the bridge is curved.
19. The surgical method of claim 16, wherein the left superior facet prosthetic component and the right superior facet prosthetic component are connected to a pedicle.
20. The surgical method of claim 16, wherein the bridge does not contact any portion of a vertebra.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0023] FIG. 1 is a perspective view of a spine motion segment;
[0024] FIG. 2 is a dorsal view of a bilateral facet joint reconstructed in accordance with the present invention;
[0025] FIG. 3 is a lateral view of the bilateral facet joint prosthesis shown in FIG. 2;
[0026] FIG. 4 is a dorsal view of the implanted inferior bilateral facet prosthesis shown in FIGS. 2 and 3;
[0027] FIG. 5 is an inferior view of the implanted inferior bilateral facet prosthesis shown in FIGS. 2 and 3;
[0028] FIG. 6 is a ventral view of the inferior bilateral facet prosthesis shown in FIGS. 4 and 5;
[0029] FIG. 7 is a dorsal view of the implanted superior bilateral facet prosthesis shown in FIGS. 2 and 3;
[0030] FIG. 8 is a superior view of the implanted superior bilateral facet prosthesis shown in FIGS. 2 and 3;
[0031] FIG. 9 is a ventral view of the superior bilateral facet prosthesis shown in FIGS. 7 and 8;
[0032] FIG. 10 is a perspective view of an alternative embodiment of the superior bilateral facet prosthesis shown in FIGS. 7 and 8;
[0033] FIG. 11 is a dorsal view of a two level facet joint replacement;
[0034] FIG. 12 is a lateral view of the two level facet joint replacement of FIG. 11;
[0035] FIG. 13 is a dorsal view of the implanted four facet prosthesis shown in FIGS. 11 and 12;
[0036] FIG. 14 is a perspective view of the four facet prosthesis shown in FIG. 13;
[0037] FIG. 15 is a perspective view of an alternative form of inferior bilateral facet prosthesis;
[0038] FIG. 16 is a perspective view of an implanted superior and inferior unilateral facet prosthesis; and
[0039] FIG. 17 is a perspective view of the unilateral facet prosthesis shown in FIG. 16.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0040] Referring first to FIG. 1, there is shown a superior vertebra 5 and an inferior vertebra 10, with an intervertebral disc 15 located in between. Vertebra 5 has superior facets 20, inferior facets 25, a lamina (also sometimes referred to as a posterior arch) 30, a spinous process 35, and pedicles 40. Vertebra 10 has superior facets 45, inferior facets 50, a posterior arch 55, a spinous process 60, and pedicles 65 (only one of which is seen in FIG. 1).
[0041] Referring now to FIG. 2, the left and right inferior facets 25 of vertebra 5 have been resected at 70 and a bilateral inferior facet prosthesis 75 has been attached to vertebra 5 using screw fasteners 80. Similarly, the left and right superior facets 45 of vertebra 10 have been resected at 82 (FIG. 7) and a bilateral superior facet prosthesis 85 has been attached to vertebra 10 using screw fasteners 90.
[0042] In FIG. 3 it can be appreciated that bilateral inferior facet prosthesis 75 replicates the natural anatomy when compared to the intact inferior facet 25 of vertebra 5. Furthermore, bilateral facet prosthesis 75 extends from its attachment point in a manner that does not require contact with, or mating to, the complex geometry of the lamina (or posterior arch) 30. Resection surfaces 70 provide adequate clearance for bilateral inferior facet prosthesis 75 and provide complete removal of the diseased or traumatized natural inferior facets 25.
[0043] FIGS. 4 and 5 illustrate how the geometry of the bridge 95 of bilateral inferior facet prosthesis 75 matches that of the posterior arch 30 of vertebra 5 in order to provide adequate clearance for the central foramen 100. Articular surfaces 105 articulate with the opposing superior facets 45 (or their prosthetic replacements) of the vertebra 10.
[0044] FIG. 6 illustrates the bilateral inferior facet prosthesis 75 with flanges 110 that abut against the pedicles 40 of vertebra 5. Bridge 95 connects the articular surfaces 105. Holes 115 allow the attachment of bilateral inferior facet prosthesis 75 to vertebra 5 by means of screw fasteners 80. Alternatively, screw fasteners 80 could be replaced with staples, pins, tacks, anchors, modular fixation posts, or the like. These alternative fasteners could further include porous coatings to further enhance bony fixation, and could also include osteoconductive or osteoinductive substances.
[0045] In FIG. 7 it can be appreciated that bilateral superior facet prosthesis 85 replicates the natural anatomy when compared to the intact superior facets 45 of vertebra 10. Furthermore, bilateral facet prosthesis 85 extends from its attachment point in a manner that does not require contact with, or mating to, the complex geometry of the lamina (or posterior arch) 55. Resection surfaces 82 provide adequate clearance for bilateral superior facet prosthesis 85 and provide complete removal of the diseased or traumatized natural superior facets 45.
[0046] FIG. 8 illustrates how the geometry of the bridge 120 of bilateral superior facet prosthesis 85 matches that of the posterior arch 55 of vertebra 10 in order to provide adequate clearance for the central foramen 125. Articular surfaces 130 articulate with the opposing inferior facets of the vertebra 5.
[0047] FIG. 9 illustrates the bilateral superior facet prosthesis 85 with flanges 135 that abut against the pedicles 65 of vertebra 10. Bridge 120 connects the articular surfaces 130 (seen in FIG. 8 but not seen in FIG. 9). Holes 140 allow the attachment of bilateral superior facet prosthesis 85 to vertebra 10 by means of screw fasteners 90.
[0048] FIG. 10 illustrates an alternative superior facet prosthesis 85A with a bearing surface 130A that mounts to substrate 131A. The bearing surface 130A is preferably a biocompatible polymeric material, such as ultra high molecular weight polyethylene. Alternately, the bearing surface 130A can be ceramic, such as zirconia or alumina. The substrate 131A is preferably a biocompatible metal alloy, such as an alloy of titanium, cobalt, or iron.
[0049] FIG. 11 illustrates a superior vertebra 145, a middle vertebra 150, and an inferior vertebra 155. Superior facet prosthesis 85 articulates with quad-facet prosthesis 160 to recreate the natural biomechanics of the replaced facet joints. Inferior facet prosthesis 75 articulates with quad-facet prosthesis 160 to recreate the natural biomechanics of the replaced facet joints at the next upper level. Thus, FIG. 11 illustrates a two level reconstruction of facet joints. Superior facet prosthesis 85, quad-facet prosthesis 160, and inferior facet prosthesis 75 are each attached to bone by means of screw fasteners 165.
[0050] In the lateral view of FIG. 12, it can be appreciated that superior facet prosthesis 85, quad-facet prosthesis 160, and inferior facet prosthesis 75 do not encroach into the intervertebral foraminal spaces 167 where nerve roots extend laterally from the spinal cord.
[0051] Referring next to FIG. 13, it should be appreciated that superior bridge 170 and inferior bridge 175 of quad-facet prosthesis 160 do not contact any portion of vertebra 150. Mounting holes 180 (shown in FIG. 14) are used to secure the flanges 185 against the pedicles of vertebra 150.
[0052] In FIG. 15, an alternative inferior bilateral facet prosthesis 190 is presented. To further stabilize the implant and to counter moments that act upon the two points of fixation into the pedicles, a set of parallel flanges 195 extend posteriorly such that the two flanges straddle the spinous process 35. A bolt 200 is used to fasten the parallel flanges to the spinous process. Alternatively, other adjunctive structural features could be added to further stabilize the prosthesis. For example, a strut that extends, and attaches, to the transverse process could be used to further stabilize the prosthesis.
[0053] Looking next at FIGS. 16 and 17, there is shown a superior and inferior unilateral facet prosthesis 300. Unilateral facet prosthesis 300 comprises a body 305 and a stem 310 extending out of body 305. A superior element 315 extends vertically upward from body 305, and an inferior element 310 extends vertically downward from body 305. Unilateral facet prosthesis 300 is configured so that when its stem 310 extends into the pedicle of vertebra 325, superior element 315 will replace a resected superior facet, and inferior element 320 will replace a resected inferior facet. If desired, stem 310 could be replaced with a screw extending through a hole in body 305 and into the pedicle.
[0054] Having described preferred embodiments of the invention with reference to the accompanying drawings, it is to be understood that the embodiments shown herein are by way of example and not limitation, and that various changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the invention as defined in the following claims.
