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1. US20180344360 - DEVICE FOR RECONSTRUCTING A SPINOUS PROCESS AND SPINAL FIXING EQUIPMENT COMPRISING SAID DEVICE

Note: Text based on automatic Optical Character Recognition processes. Please use the PDF version for legal matters
      The present invention relates to a device for reconstructing a spinous process and a spinal fixing equipment comprising said device. Therefore, the present invention finds particular application in the biomedical field and, especially, in the manufacturing of fastening and reconstruction systems for spinal surgery.
      As known, the fastening devices are used in orthopaedic surgery to stabilize bones such as those of the spine, providing support in the event of damage to the spine itself.
      In case of fractures or bone resections, it may be necessary to restore the correct bone anatomy not only for aesthetic reasons but mainly to restore the correct functioning of essential elements, such as ligaments.
      In the specific case of bone resection, reduction or repositioning of the spinous process, it may be necessary to replace the bone and the ligament attachment points. By reconstructing the spinous process, the natural bone appearance is restored, as well as the correct behaviour of the ligaments.
      Currently, in case of fractures of the spinous process, the same is reconstructed through fusion devices of the spinous process which distract and/or immobilize the spinous processes of adjacent vertebrae, as described in patent US2015164656.
      In this way, the spine is excessively immobilized, fusing together parts that may instead be left more movable.
      The Applicant has found that the known devices present drawbacks related to excessive limitation of mobility of the vertebrae, even of those not directly involved.
      Therefore, the Applicant has assessed that it would be much more beneficial to be able to reconstruct the spinous process without tightening two adjacent vertebrae together, in order to reduce patient discomfort.
      Therefore, the object of the present invention is to provide a device for reconstructing a spinous process, capable of overcoming the above mentioned drawbacks of the prior art.
      More precisely, the object of the present invention is to provide a device for reconstructing a spinous process of simple positioning and effective use.
      In addition, it is an object of the present invention to make available a reconstruction device of a spinous process which allows to restore both the appearance and, above all, the functionality of the spinous process, especially referring to the correct functionality of the ligaments.
      Lastly, it is an object of the present invention to provide a reconstruction device of a spinous process that is minimally invasive and which does not produce undue discomfort to the patient.
      These and other objects are substantially achieved by a device for reconstructing a spinous process as described in one or more of the appended claims. The dependent claims correspond to some possible embodiments of the invention.
      In any case, these and further features, as well as their technical advantages, will become more apparent from the following exemplifying, and not limiting, description of a preferred, and therefore not exclusive, embodiment of a device for reconstructing a spinous process.
      This description is provided with reference to the accompanying figures, provided only as an example and not as a limitation, in which:
       FIG. 1 is a prospective view of a device for reconstructing a spinous process according to the present invention;
       FIG. 1is a detail of the device illustrated in FIG. 1;
       FIGS. 2 and 2 a are respectively a perspective view and a top view of a spinal fastening equipment comprising the device shown in FIG. 1;
       FIGS. 3 and 4 are perspective views of a detail of the spinal fastening equipment illustrated in FIGS. 1and 2.
      With reference to the attached figures, number 1 generally identifies a device for reconstructing a spinous process.
      The device 1 for reconstructing a spinous process comprises a main portion 2 having an enlarged area 2 a and a narrow area 2 b. Preferably, the enlarged area 2 a degrades continuously in the narrow area 2 b conferring to the main portion 2 a substantially tapered shape.
      At least one first coupling hole 3, for the insertion of a fixing bar 4, and at least one through-seat 5, for the insertion of ligaments to be reconstructed, are provided in the main portion 2. The fixing bar 4 is an integral part of the reconstruction device 1 and preferably presents a slightly curved configuration, specifically bow-shaped.
      The fixing bar 4 is insertable transversely inside said engaging hole 3 of the main portion 2.
      The engaging hole 3 is advantageously obtained in the enlarged area 2 a of the main portion 2 and preferably presents a polygonal geometry which is compatible and which is matchable with a coupling portion 4 c of the mentioned fixing bar 4. The coupling portion 4 c preferably presents a polygonal geometry complementarily shaped to the engaging hole 3. The polygonal, preferably hexagonal, geometry prevents the relative rotation between the main portion 2 and the fixing bar 4.
      Advantageously, the coupling portion 4 c is arranged centrally with respect to the longitudinal extension of the fixing bar 4, in such a way that the main portion 2 is centred along the fixing bar 4.
      A fastening pin 7, inserted in a respective seat 8 formed in the main portion, in correspondence of the enlarged area 2 a, blocks the main portion 2 in a defined position along the axis of the transverse fixing bar 4 to prevent medio-lateral movements.
      Ligaments are linked to the distal part of the main portion 2, in correspondence of the through-seat 5, preferably placed at the ends of the narrow area 2 b. Advantageously, there are two or more through-seats 5 for the attachment of ligaments.
      The shape of the main portion 2 artificially defines the structure of the patient's missing spinous process and is therefore designed to be used as a replacement for the missing bone.
      The main portion 2 can be provided in different sizes to fit the anatomy of the patient in the best possible way.
      Advantageously, the main portion 2 presents a plurality of lightening holes 6 which reduce the weight of the main portion creating a lightweight device.
      In order to firmly arrange the main portion 2 in the correct position at the missing spinous process, a spinal fixing equipment 10 is needed.
      In particular, the spinal fixing equipment 10 also comprises, in addition to the reconstruction device 1 described above, a pair of longitudinal bars 11 to which the reconstruction device 1 is fixed.
      The longitudinal side bars 11 are able to be arranged in a sagittal direction Y alongside the real spinous processes 9 of the cervical and/or spinal vertebrae and are fixed to the vertebrae by means of polyaxial screws of known type.
      The connection between each of these longitudinal bars 11 and the transverse fixing bar 4 of the reconstruction device 1 takes place via a respective transverse connection element 12.
      The connection element 12 comprises a main body 13 which presents at least a first 13 a and a second 13 b housing seat, respectively for one of the two longitudinal bars 11 and for the transverse fixing bar 4.
      Advantageously, the first 13 a and second 13 b housing seats provided in the main body 13 are arranged on parallel planes and extend along transversely reciprocal axial directions, following the spatial arrangement of the bars 11 and 4.
      Preferably, the first seat 13 a is partially open and is defined by a groove formed on a side surface of the main body 13.
      In this way, the insertion of the bar within it can also be achieved laterally.
      The second seat 13 b, instead, is defined by a through-hole inside the main body 13.
      The development axis 13 a′ of the first seat 13 a is preferably orthogonal to the axis of development 13 b′ of the second seat 13 b. The two seats 13 a and 13 b, preferably presenting a substantially cylindrical shape, are communicating with each other.
      The connecting element 12 also comprises tightening means 14 for blocking any roto-translational movement of the longitudinal bar 11 and of the transverse bar 4: in particular, the tightening means 14 securing the bars 11 and 4 in an operative position with respect to the main body 13 and prevent relative movements between the two bars.
      Preferably, the tightening means 14 comprise a fastening screw.
      Advantageously, the tightening means 14 are arranged inside a respective housing 15 formed inside the main body 13.
      Preferably, the housing 15 is a cylindrical cavity whose axis 15 a extends along a direction orthogonal to the direction of development axes 13 a′ and 13 b′ of the first 13 a and second 13 b seats.
      Moreover, the housing 15 is in communication with the second seat 13 b and, consequently, with the first seat 13 a.
      By acting on the tightening means 14, bars 11 and 4 are blocked in their respective seats 13 a and 13 b.
      Before fixing the bars in their final position, it is necessary to make precise and accurate adjustments.
      In this regard, it is preferable that at least one of the two bars is prevented from sliding freely inside its seat.
      For this purpose, inside the connection element 12, in particular inside the main body 13, there are specific interference means 16 adapted to restrain the sliding of at least the transverse fixing bar 4 within the respective housing seat 13 b.
      Advantageously, said interference means 16 are arranged inside a respective housing 17 which is in communication with the second seat 13 b.
      The interference means 16 face the interior of the second housing seat 13 b, reducing the passage opening of the bar and interfering with it by friction.
      The embodiment illustrated in the attached drawings shows the housing 17 of the interference means 16 developing along a direction orthogonal to the direction of development axes 13 a′ and 13 b′ of the first 13 a and second 13 b seats. Other positions and orientations of the housing 17 are validly possible, provided there is an interference with one of the two bars.
      The interference means 16 can be done in different ways and advantageously comprise an elastic element adapted to exert a pressure force against the transverse fixing bar 4.
      Still more preferably, the elastic element is a wire spring.
      A first assembly method requires that, after having positioned and fixed the two longitudinal bars 11 to the vertebrae, a connection element 12 is applied on each longitudinal bar 11, by inserting the latter inside the first seat 13 a.
      Subsequently the transverse fixing bar 4 is inserted within the second seat 13 b.
      Alternatively, a second assembly procedure requires positioning and fixing the two longitudinal bars 11 to the vertebrae, separately assembling the system comprising the two connection elements 12 and the reconstruction device 1 interposed between them, and then placing this system first on a bar longitudinal 11 and, subsequently, on the other.
      Before completely blocking the system with the tightening means 14, the connection element is adjusted by correcting the position along the respective longitudinal bar 11 and by setting the position of the transverse fixing bar 4 so as to improve its fitting to the spinal fixing system. It is also possible to rotate the connection element 12 by a few degrees around the longitudinal bar 11, compatibly with the elasticity and the interference produced by the transverse fixing bar 4.
      The transverse fixing bar 4, inserted inside the second seat 13 b, reaches the interference means 16 having a retentive effect on it, preventing it from slipping off the respective seat 13 a before the action of the tightening means 14 intervenes.
      By acting on the tightening means 14, the screw is pushed further down within its housing 15, until it protrudes into the second seat 13 b in which the transverse fixing bar 4 is inserted.
      The transverse fixing bar 4 insists and rests partially on both longitudinal bars 11 housed inside the respective groove or first seat 13 a.
      The action of pressure exerted by the fixing screw 14 on the transverse fixing bar 4 is discharged on each longitudinal bar 11 that is counteracted by the bottom of the first seat 13 a.
      In this way, each longitudinal bar 11 is fixed to the transverse fixing bar 4 within the respective seats 13 a and 13 b, preventing relative movement both between the bars and of each bar with respect to the connection element 12 itself.
      The invention achieves the intended objects and achieves important advantages.
      The device for reconstructing a spinous process allows to recreate the missing natural spinous process due to breakage or bone resections, fills the space between the missing vertebrae, and restores bone appearance.
      Moreover, it provides anchoring points for ligaments, giving the opportunity to attach ligaments, thus restoring their natural functionality and the original anatomical pattern. The transverse connection achieved by the transverse fixing bar improves the torsional functionality of the system.
      The main purpose of this device for reconstructing a spinous process is to act as a bridge between adjacent vertebrae, when the natural spinous process is absent.
      The spinal fixing equipment allows to place and secure in the correct position the device for reconstructing the spinous process.