Conically shaped anterior fusion cage and method of implantation

• US 5,906,616 A
• Filed: 01/15/1997
• Issued: 05/25/1999
• Est. Priority Date: 09/15/1994
• Status: Expired due to Term

• Current Assignee: Howmedica Osteonics Corp. (Stryker Corporation)
• Original Assignee: Surgical Dynamics Incorporated (Medtronic Plc)
• Inventors: Klyce, Henry A., Winslow, Charles J., Pavlov, Paul W., Jayne, Kirk
• Primary Examiner(s): Tucker, Guy V.
• Application Number:
  US08/783,790
• Time in Patent Office: 860 Days
• Field of Search: 606/61, 606/60, 606/72, 606/73, 606/76, 606/77, 606/65, 606/66, 606/90, 606/104, 623/16, 623/17
• US Class Current: 606/247
• CPC Class Codes: A61B 17/862 at the periphery of the screw head
• CPC Class Codes: A61B 17/8883 the driver bit acting on the periphery of the screw head
• CPC Class Codes: A61F 2/30744 End caps, e.g. for closing an endoprosthetic cavity
• CPC Class Codes: A61F 2/442 Intervertebral or spinal discs, e.g. resilient non-disc-shaped intervertebral inflatable pockets A61F2/441; non-disc-shaped intervertebral fusion implants A61F2/4455
• CPC Class Codes: A61F 2/446 having a circular or elliptical cross-section substantially parallel to the axis of the spine, e.g. cylinders or frustocones
• CPC Class Codes: A61F 2/4601 for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• CPC Class Codes: A61F 2/4603 for insertion or extraction of endoprosthetic joints or of accessories thereof
• CPC Class Codes: A61F 2/4611 of spinal prostheses
• CPC Class Codes: A61F 2/4637 for connecting or disconnecting two parts of a prosthesis
• CPC Class Codes: A61F 2002/2835 Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30121 with lobes
• CPC Class Codes: A61F 2002/30143 hexagonal
• CPC Class Codes: A61F 2002/30154 square
• CPC Class Codes: A61F 2002/3021 frustoconical
• CPC Class Codes: A61F 2002/30217 hollow cones, e.g. tubular-like cones
• CPC Class Codes: A61F 2002/30235 tubular, e.g. sleeves
• CPC Class Codes: A61F 2002/30327 differing in diameter
• CPC Class Codes: A61F 2002/30331 made by longitudinally pushing a protrusion into a complementarily-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2002/30405 made by screwing complementary threads machined on the parts themselves
• CPC Class Codes: A61F 2002/30593 hollow
• CPC Class Codes: A61F 2002/30617 : Visible markings for adjusting, locating or measuring
• CPC Class Codes: A61F 2002/30774 : internally-threaded
• CPC Class Codes: A61F 2002/30777 : Oblong apertures
• CPC Class Codes: A61F 2002/30785 : parallel
• CPC Class Codes: A61F 2002/30787 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30797 : internally-threaded
• CPC Class Codes: A61F 2002/30813 : Stepped or enlarged blind bores, e.g. having discrete diameter changes
• CPC Class Codes: A61F 2002/3082 : Grooves
• CPC Class Codes: A61F 2002/3085 : with a threaded, e.g. self-tapping, bone-engaging surface, e.g. external surface
• CPC Class Codes: A61F 2002/30863 : the entry end surface having flutes, relief grooves, starter notches or bevelled indentations
• CPC Class Codes: A61F 2002/30873 : Threadings machined on non-cylindrical external surfaces
• CPC Class Codes: A61F 2002/30968 : Sintering
• CPC Class Codes: A61F 2002/448 : comprising multiple adjacent spinal implants within the same intervertebral space or within the same vertebra, e.g. comprising two adjacent spinal implants
• CPC Class Codes: A61F 2002/4627 : with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0033 : made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2230/0006 : circular
• CPC Class Codes: A61F 2230/0017 : Angular shapes
• CPC Class Codes: A61F 2230/0021 : square
• CPC Class Codes: A61F 2230/0067 : conical
• CPC Class Codes: A61F 2230/0069 : cylindrical
• CPC Class Codes: A61F 2250/0039 : differing in diameter
• CPC Class Codes: A61F 2250/0097 : Visible markings, e.g. indicia
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys

Abstract

A fusion cage for vertebral body fusion is conically-shaped. A thread is formed as part of the external conical surface of the fusion cage. Apertures are defined through the fusion cage in order to provide for contact between the engaged vertebral bone structures and bone growth inducing substances packed within the fusion cage. The fusion cage is introduced and maintains or increases the lordosis between adjacent vertebral bone structures.

Claims

1. A fusion cage for promoting fusion with one or more bone structures, which comprises:

a cage body having a proximal end and a distal end, and defining an internal cavity and a longitudinal axis, said proximal end having a diameter which is smaller than a diameter of said distal end, said cage body having an outer surface and a thread formed into said outer surface, and a plurality of radial apertures extending through said outer surface in communication with said internal cavity, said apertures increasing in size from said distal end toward said proximal end;

and said distal end being rounded to facilitate insertion relative to one or more bone structures.

2. An apparatus for promoting fusion with one or more bone structures, comprising an implant member having proximal and distal end portions and defining a longitudinal axis, the implant member including at least a longitudinal portion extending along at least a major portion of the length of the implant member, the longitudinal portion having an arcuate cross-sectional dimension transverse to the longitudinal axis and defining a generally tapered configuration whereby the cross-sectional dimension of the longitudinal portion gradually decreases from distal to proximal, the distal end portion defining an entry end surface, the entry end surface being closed to facilitate insertion relative to one or more bone structures.

3. The apparatus according to claim 2 wherein the entry end surface of the implant member is generally rounded.

4. The apparatus according to claim 2 wherein the longitudinal portion defines a frusto-conical configuration.

5. The apparatus according to claim 4 wherein the implant member includes an exterior surface portion having discontinuities to permit bone ingrowth.

6. The apparatus according to claim 5 wherein the external surface portion includes a threaded portion to facilitate positioning adjacent the one or more bony structures.

7. The apparatus according to claim 4 wherein the implant member includes a hollow interior cavity dimensioned to accommodate bone growth inducing substances.

8. The apparatus according to claim 2 wherein the implant member includes a second longitudinal portion, the second longitudinal portion defining a cylindrical configuration having a cross-sectional dimension which remains constant throughout the length of the second longitudinal portion.

9. An apparatus for promoting fusion with one or more bone structures, comprising an implant member having proximal and distal end portions and defining a longitudinal axis the implant member including at least a longitudinal portion extending along at least a major portion of the length of the implant member, the longitudinal portion having an arcuate cross-sectional dimension transverse to the longitudinal axis and defining a generally frusto-conical configuration whereby the cross-sectional dimension of the longitudinal portion gradually decreases from distal to proximal, the implant member having a hollow interior cavity dimensioned to accommodate bone growth inducing substances and a plurality of apertures extending through an external wall portion thereof in communication with the interior cavity to thereby permit bone ingrowth to facilitate fusion of one or more bone structures, the distal end portion defining an entry end surface, the entry end surface being closed to facilitate insertion relative to one or more bone structures.

10. The apparatus according to claim 9 wherein the external wall portion includes at least one flute formed in the threaded portion.

11. The apparatus according to claim 10 wherein the one flute extends to the entry end surface.

12. The apparatus according to claim 10 including a plurality of flutes formed in the threaded portion.

13. The apparatus according to claim 9 wherein the apertures are configured and dimensioned to provide immediate contact between the one or more bone structures and bone growth inducing substances disposed in the interior cavity upon positioning of the implant member adjacent the one or more bone structures.

14. An apparatus for promoting fusion with one or more bone structures, comprising an implant member having proximal and distal end portions and defining a longitudinal axis, the implant member including at least a longitudinal portion extending along at least a major portion of the length of the implant member, the longitudinal portion defining a generally frusto-conical configuration whereby the cross-sectional dimension of the longitudinal portion gradually decreases from distal to proximal, the implant member including a hollow interior cavity dimensioned to accommodate bone growth inducing substances and having a plurality of apertures extending through an exterior wall portion thereof in communication with the interior cavity the exterior wall portion having a threaded portion to facilitate positioning adjacent the one or more bone structures, and at least one flute defined in the threaded portion and extending through the exterior wall portion in communication with the interior cavity.

15. An apparatus for promoting fusion with one or more bone structures, comprising an implant member having proximal and distal end portions and defining a longitudinal axis, the implant member including at least a longitudinal portion extending along at least a major portion of the length of the implant member, the longitudinal portion defining a generally tapered configuration whereby the cross-sectional dimension of the longitudinal portion gradually decreases from distal to proximal, the implant member further including a second longitudinal portion disposed proximal of the first mentioned longitudinal portion, the second longitudinal portion defining a cylindrical configuration having a cross-sectional dimension which remains constant throughout the length of the second longitudinal portion.

16. An apparatus for facilitating fusion of adjacent vertebrae comprising an elongated implant member configured and dimensioned for insertion within an intervertebral space defined between adjacent vertebrae, the implant member having proximal and distal end portions and defining a longitudinal axis, the implant member including at least a longitudinal section extending along at least a major section of the length thereof, the longitudinal section defining a generally frusto-conical configuration whereby the cross-sectional dimension of the longitudinal section decreases from distal to proximal, the implant member including an internal cavity for accommodating bone growth inducing substances and having a plurality of apertures extending through an external wall portion thereof in communication with the internal cavity, the distal end portion having a closed entry end surface to prevent access to the internal cavity through the entry end surface.

17. The apparatus according to claim 16 wherein the implant member includes an external threaded portion for facilitating insertion within the intervertebral space.

18. The apparatus according to claim 17 wherein the implant member includes at least one flute, the one flute being formed in the threaded portion.

19. The apparatus according to claim 18 including at least one flute formed in the entry end surface.

20. The apparatus according to claim 19 further including an end cap mountable to the proximal end portion of the implant member to enclose the internal cavity.

21. The apparatus according to claim 16 wherein the apertures are configured and dimensioned to provide immediate contact between the one or more bone structures and bone growth inducing substances disposed in the interior cavity upon positioning of the implant member adjacent the one or more bone structures.

22. A fusion cage (1) for promoting fusion between two spaced apart vertebral bone structures which have posterior sections and anterior sections with a posterior interspace defined between the posterior sections and an anterior interspace defined between the anterior sections, and (2) for achieving a desired lordosis as the fusion cage is implanted by urging the fusion cage from the posterior sections toward the anterior sections using an posterior approach, the fusion cage comprising a cage body having a proximal end portion and a distal end portion, the cage body defining a generally frusto-conical configuration whereby the cross-sectional dimension of the cage body gradually decreases from the distal end portion to the proximal end portion, the distal end portion positionable in the posterior interspace between the posterior sections of the vertebral bone structures and with the proximal end portion positionable in the anterior interspace between the anterior sections of the vertebral bone structures as the cage body is urged using a posterior approach from an initial position where the distal end portion is positioned adjacent to the posterior sections to a final position where the distal end portion is positioned in the anterior interspace and the proximal end portion is positioned in the posterior interspace, the distal end portion defining a closed entry end surface.

23. The fusion cage of claim 22 wherein the cage body includes an external surface portion having a threaded portion to facilitate positioning between the vertebral bone structure.

24. The fusion cage of claim 22 wherein the cage body includes an internal cavity dimensioned to accommodate bone growth inducing structures.

25. The fusion cage of claim 24 wherein the cage body includes an external wall portion having a plurality of apertures extending therethrough in communication with the internal cavity.

26. The fusion cage of claim 25 wherein the proximal end portion of the cage body includes a trailing end, the trailing end having an opening in communication with the interior cavity.

27. The fusion cage of claim 26 including an end cap releasably mounted to the trailing end of the cage body to enclose the interior cavity.

28. A fusion cage (1) for promoting fusion between two spaced apart vertebral bone structures which have posterior sections and anterior sections with a posterior interspace defined between the posterior sections and an anterior interspace defined between the anterior sections, and (2) for achieving a desired lordosis as the fusion cage is implanted by urging the fusion cage from the posterior sections toward the anterior sections using an posterior approach, the fusion cage comprising a cage body having a proximal end portion and a distal end portion, the cage body defining a generally frusto-conical configuration whereby the cross-sectional dimension of the cage body gradually decreases from the distal end portion to the proximal end portion, the distal end portion positionable in the posterior interspace between the posterior sections of the vertebral bone structures and with the proximal end portion positionable in the anterior interspace between the anterior sections of the vertebral bone structures as the cage body is urged using a posterior approach from an initial position where the distal end portion is positioned adjacent to the posterior sections to a final position where the distal end portion is positioned in the anterior interspace and the proximal end portion is positioned in the posterior interspace the distal end portion defining a closed rounded entry end surface to facilitate insertion between the vertebral bone structures.

29. In combination:

an implant member for promoting fusion of one or more bone structures, the implant member having proximal and distal end portions and defining a longitudinal axis, the implant member including at least a longitudinal section defining a generally tapered configuration whereby the cross-sectional dimension of the longitudinal section decreases from distal to proximal, the implant member including an internal cavity for accommodating bone growth inducing substances and having a plurality of apertures extending through an external wall portion thereof in communication with the internal cavity, and an end cap mountable to the proximal end portion of the implant member to enclose the internal cavity; and

an insertion tool to facilitate insertion of the implant member, the insertion tool including an elongated member having a remote end, the remote end including a tang to be received in a corresponding indentation of the implant member and a threaded shaft to be accommodated in a threaded bore of the end cap.

30. A method for fusion of adjacent vertebrae having posterior and anterior section comprising the steps:

providing a fusion implant member including proximal and distal ends and defining a longitudinal axis, the implant member including at least a longitudinal section defining a generally tapered configuration whereby the cross-sectional dimension of the longitudinal section decreases from distal to proximal;

accessing the intervertebral space defined between adjacent vertebrae from a posterior location;

inserting the distal end of the implant member within the intervertebral space from the posterior location and advancing the implant member such that the distal end and the proximal end of the implant member are adjacent respective anterior and posterior sections of the adjacent vertebrae; and

permitting bone growth into contacting surfaces of the implant member to facilitate fusion of the adjacent vertebrae.

31. The method according to claim 30 including the step of introducing bone growth inducing substances within an internal cavity defined within the implant member whereby the adjacent vertebrae communicates with the bone growth inducing substances to form a solid fusion.

32. The method of claim 31 wherein the implant member includes an exterior wall portion having apertures extending therethrough wherein the step of permitting bone ingrowth includes permitting bony tissue of the adjacent vertebrae to grow through the apertures to communicate with the bone growth inducing substances.

33. The method of claim 32 wherein the implant member includes an external threaded portion, wherein the step of inserting includes rotating the implant member about the longitudinal axis such that the threaded portion engages the adjacent vertebrae to facilitate advancement of the implant member within the intervertebral space.

34. The method of claim 33 wherein the external threaded portion of the implant body includes a cutting thread wherein the step of inserting includes rotating the implant member whereby the cutting thread deburs bone tissue to self-tap the implant member within the intervertebral space.

35. The method of claim 30 wherein the implant member includes a second longitudinal section disposed proximal of the first-mentioned longitudinal section, the second longitudinal section defining a general cylindrical configuration having a cross-sectional dimension remaining substantially constant throughout the length of the second longitudinal section, and wherein the step of inserting includes advancing the implant member such that the second longitudinal portion is adjacent the posterior sections of the vertebrae.

36. An apparatus for facilitating fusion of adjacent vertebrae comprising an elongated implant member configured and dimensioned for insertion within an intervertebral space defined between adjacent vertebrae, the implant member having proximal and distal ends and defining a longitudinal axis, the implant member including at least a longitudinal section defining a generally tapered configuration whereby the cross-sectional dimension of the longitudinal section decreases from distal to proximal, the implant member including an internal cavity for accommodating bone growth inducing substances and having a plurality of apertures extending through an external wall portion thereof in communication with the internal cavity, the proximal end having an opening to permit access to the internal cavity to facilitate loading of the bone growth inducing substances therewithin, and an end cap releasably mounted to the proximal end.

37. The apparatus according to claim 36 wherein the longitudinal section is dimensioned to extend along a major portion of the length of the implant member.

38. The apparatus according to claim 37 wherein the longitudinal section defines a generally frusto-conical configuration.

39. The apparatus according to claim 36 wherein the end cap is dimensioned to substantially close the opening in the proximal end of the implant member.

40. The apparatus according to claim 36 wherein the distal end defines a closed entry end surface.