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    • 专利摘要:
    The present invention relates to an intervertebral implant comprising a body (20) extending longitudinally along a primary axis (X), between a proximal end and a distal end, characterized in that it comprises: - a base (6) at the 'proximal end, - a plurality of arms (2a, 2b, 2c, 2d) elongated along the primary axis (X) and each comprising at least one surface (4a, 4b, 4c, 4d) of vertebral support, the arms ( 2a, 2b, 2c, 2d) being articulated at least on the base (6) so that the implant comprises, on the one hand, a folded position in which the arms (2a, 2b, 2c, 2d) are close from each other, and on the other hand, an extended position in which the arms (2a, 2b, 2c, 2d) are moved away from each other along at least one secondary axis (Y) and / or at least one tertiary axis (Z), the primary (X), secondary (Y) and tertiary (Z) axes being substantially orthogonal to each other; - Expansion means (3, 8, 21, 21a, 21b, 22, 25, 66, 67, 151) of the implant between the folded and deployed positions, comprising at least two branches (151) mounted to pivot the one relative to the other and connected to the elongated arms (2a, 2b, 2c, 2d) by at least guide means (66, 67) so that a translation of the expansion means (3, 8, 21 , 21a, 21b, 22, 25, 66, 67, 151) parallel to the primary axis (X) causes the branches (151) to pivot with respect to each other and separate the arms (2a, 2b, 2c, 2d) from each other, along the secondary axis (Y) and / or the tertiary axis (Z).
    公开号:FR3058042A1
    申请号:FR1660472
    申请日:2016-10-27
    公开日:2018-05-04
    发明作者:Pierre Bernard；Herve Chataignier；Craig CHEBUHAR；Alexander Kirgis；Ross Sherban；Samuel Lequette；Emmanuel BOUGERE；Aymeric FRESNEAU；Nicolas ROCHE
    申请人:LDR Medical SAS；
    IPC主号:
    专利说明:

    TECHNICAL FIELD OF THE INVENTION
    The present invention relates to the field of vertebral implants and in general to the field of implants intended to be implanted between two vertebrae in order to at least partially supplant an intervertebral disc. The present invention relates more particularly to an expandable intervertebral implant, of the corporectomy cage or intersomatic cage type.
    TECHNOLOGICAL BACKGROUND OF THE INVENTION
    Intervertebral implants are implanted between two adjacent vertebrae to allow the insertion and growth of bone tissue (or substitute) grafts in the disc space in order to obtain arthrodesis (fusion of two vertebrae). The intervertebral space, after the placement of the cage, is generally filled with autologous cancellous bone or suitable bone substitutes.
    Various arthrodesis techniques are known from the prior art, based on various types of implants, such as, for example, corporectomy cages or interbody cages inserted in place of a disc to promote bone growth (or arthrodesis). and join together at least two vertebrae. Such devices are for example illustrated in patent application FR1651637 which describes intersomatic cages making it possible to supplant an intervertebral disc. Other examples of implants are described, for example, in the following published patents or patent applications: US6447546, US7291170, US7594931, US8241359,
    US8343219, US8409288, US8617245, US9039774, US9044337,
    US9173745, US20150045893A1, US20150127107A1, US20150209089A1 and US20150320568A1.
    A frequent problem in the field of vertebral implants and in particular of corporectomy cages or intervertebral cages relates to the capacity to maximize the stability of such implants so as to cover a volume which is as close as possible to the volume occupied by the injured vertebral disc. Implants of the prior art therefore generally have a very large volume making their implantations very invasive for the patient.
    îo One solution used to reduce the size of the implants during their implantation, was the use of expandable cages as described for example in patent application EP1699389. Such cages, once implanted, are deployed by the surgeon to cover a volume approaching the volume of an intervertebral disc, while having a profile allowing to follow the lordosis of the spine, thus improving comfort for the patient and the stability of the cage. However, this type of expandable cage has a number of drawbacks. In particular, during their expansion, the surgeon must exert excessive pressure on the implant since its expansion takes place simultaneously on two axes orthogonal to each other. In addition, the implants of the prior art are complex, deploy only in one direction (in height or in lordosis or on the surface) and without intrinsic stabilizing elements of said implants. This imposes a difficulty for the surgeon to respect a specific lordosis. Indeed, this type of cage does not allow a large amplitude of deployment and the expansion in height may therefore be insufficient to effectively restore the desired height and intervertebral lordosis. The surface expansion may not be sufficient to allow the implant to rest on the peripheral areas of the vertebral plateau, generally more solid because the implant will remain positioned on more central areas, causing a risk of collapse of the implant in the larger vertebral body. While generally a distribution of the support points over a wider surface allows better stabilization of the vertebral bodies relative to one another.
    In this context, it is interesting to propose an easily implantable, reliable and non-invasive expandable implant solution, adaptable to different lordoses and limiting the risks of weakening the adjacent vertebral structures.
    GENERAL DESCRIPTION OF THE INVENTION
    The object of the present invention is to propose an intervertebral implant making it possible to overcome at least part of the drawbacks of the prior art, by proposing an intervertebral implant whose invasiveness is limited, while having increased stability and reliability, an expansion easier for the surgeon and possibly allowing to impose a lordosis.
    To this end, the invention relates to an intervertebral implant comprising a body extending longitudinally along a primary axis, between a proximal end and a distal end, the intervertebral implant comprises:
    a base at the proximal end, a plurality of arms elongated along the primary axis and each comprising at least one vertebral support surface, the arms being articulated at least on the base so that the implant comprises, firstly, a folded position in which the arms are close to each other, and secondly, a deployed position in which the arms are distant from each other along at least one secondary axis and / or at least one tertiary axis, the primary, secondary and tertiary axes being substantially orthogonal to each other;
    means for expanding the implant between the folded and deployed positions, comprising at least two arms pivotally mounted relative to each other and connected to the elongated arms by at least guide means so that a translation expansion means parallel to the primary axis causes the branches to pivot relative to one another and separates the arms from each other, along the secondary axis and / or the tertiary axis.
    According to another particular feature, the expansion means comprise at least one insert screwable through the base to cause the translation of the expansion means relative to the body of the implant during the deployment of the elongated arms.
    According to another particular feature, the pivoting of the branches relative to each other occurs around at least one pivot axis oriented parallel to the secondary axis to separate the arms extended along this axis and allow the expansion of the width of the implant.
    According to another particular feature, the means for expanding the implant also include means for expanding the height of the implant, along an axis parallel to the tertiary axis, thanks to the guide means comprising inner surfaces of the arms which are not parallel to each other and divergent towards the distal end, so that the arms are spaced from each other along the tertiary axis during the translation of the expansion means along the primary axis.
    According to another particularity, the pivoting of the branches with respect to each other occurs around at least one pivot axis oriented parallel to the tertiary axis to spread the arms extended along this axis and allow the expansion of the height of the implant.
    According to another particular feature, the means for expanding the implant also include means for expanding the width of the implant, along an axis parallel to the secondary axis.
    According to another particularity, the means for expanding the width of the implant comprise flexible blades integral with the distal end of the arms of the implant and mounted slidingly with respect to the rest of the arms, but connected to the means of expansion in height, so that actuation of the translation causes the flexible blades to slide and deform, inducing the expansion of the width covered by the implant.
    According to another particularity, the means for expanding the width of the implant comprise pivot arms mounted pivotally on a pivot axis and with respect to the body between the folded position in which the pivot arms are substantially parallel to the pivot axis and run along the body, and the deployed position in which the arms are distant from the body and not parallel to the pivot axis in order to deploy said implant along the secondary axis.
    In another feature, the base includes a joint capable of joining the arms together on the proximal end of the body, the joint forming a ring segment.
    According to another particular feature, the implant comprises articulations 15 hinging the base and the arms extended between the folded position and the deployed position.
    According to another particular feature, the joints form reciprocal coupling means between the base and at least one of the elongated arms.
    According to another particular feature, the joints comprise at least 20 a plate articulated both on the base and on the proximal end of at least one elongated arm.
    According to another particularity, the joints form reciprocal coupling means, on the one hand, between the plate and the base, and on the other hand, between the plate and the proximal end of at least one of the elongated arms.
    According to another particular feature, the guide means comprise at least one projection disposed on the expansion means, and at least one groove disposed on at least one of the elongated arms, so that the groove guides the projection along the body during deployment of the extended arms.
    According to another particularity, the expansion means comprise at least one attachment means with at least one instrumentation and connected to the branches so as to cause the translation of the expansion means relative to the body of the implant during deployment elongated arms.
    According to another particular feature, the insert is configured to dissociate into at least two fragments, forming said branches, to cause said translation of the expansion means relative to the body of the implant during the deployment of the elongated arms.
    According to another particular feature, the branches are arranged on the distal end of the body of the implant and comprise at least one projecting part allowing the anchoring of said implant on at least one vertebra.
    According to another particularity, the implant comprises at least one anchoring device able to pass through a passage passing through at least a portion of said implant between a periphery of the implant and at least one vertebra, and fix said implant on said vertebra.
    In another feature, the base includes at least one guide groove adapted to at least partially guide the anchoring device.
    According to another particular feature, the base comprises at least one orifice 20 adapted to at least partially accommodate an anchoring guide for the anchoring device.
    Another object of the present invention is to propose implantation instrumentation making it possible to overcome at least part of the drawbacks of the prior art, by proposing instruments configured for the implantation of at least one intervertebral implant according to one of the characteristics. of the invention. To this end, according to certain features, the instrumentation makes it possible to facilitate and accelerate the implantation of an intervertebral implant, while improving, on the one hand, stability; and the reliability of the implantation, and on the other hand, by reducing the invasiveness of the implantation and the cost of necessary instruments.
    To this end, the invention relates to instrumentation for the implantation of at least one intervertebral implant according to one of the features of the present invention, between at least two vertebrae. The instrumentation includes at least the following instruments:
    an implant holder tube adapted to be fixed on the implant base and to guide it towards the intervertebral space, a spreader adapted to be inserted in the implant holder tube and comprising a connection rod adapted to allow actuation of the means of expansion.
    According to another particular feature, the actuation is carried out by fixing the connection rod to the attachment means of the implant.
    According to another particularity, the instrumentation comprises at least one charger capable of receiving at least one anchoring device and / or a graft, and at least one impactor, the impactor being able to impact anchoring devices or to deliver from the graft through the feeder.
    According to another particularity, the instrumentation further comprises an implantation gun comprising a handle capable of connecting to the implant holder tube through a connection means so as to implant at least one implant, an anchoring device and / or a graft to the vertebra.
    According to another particular feature, the instruments, such as the deployer, the loader or the impactor, can be successively coupled and decoupled on the gun during an implantation.
    According to another particular feature, the gun can be coupled and decoupled with or without the presence of instruments, such as the spreader, the magazine or the impactor, in the tube of the implant holder.
    DESCRIPTION OF ILLUSTRATIVE FIGURES
    Other features and advantages of the present invention will appear more clearly on reading the description below, given with reference to the appended drawings, in which:
    - Figures 1A and 1B show views, respectively, in section along the plane 1A-1A of Figure 1B, and in profile of an intervertebral implant after deployment of the elongated arms according to one embodiment, and Figure 1C shows a view in perspective of the same implant placed on a vertebra;
    - Figures 2A and 2B show perspective views of an intervertebral implant according to one embodiment, respectively, before and after the lateral deployment of the lateral expansion means and the deployment of the elongated arms; Figures 2D and 2E show sectional views, respectively, along the 2D-2D plane of Figure 2A and along the 2E-2E plane of Figure 2B; and Figure 2C shows a sectional view along the plane 2C-2C of Figure 2E;
    FIG. 3A represents a perspective view of an intervertebral implant according to an embodiment before the lateral deployment of the lateral expansion means: FIGS. 3B and 3C represent perspective views of an intervertebral implant after the lateral deployment of the lateral expansion means and comprising elongated arms, respectively, in the folded position and in the deployed position; Figures 3D and 3E show sectional views, respectively, along the 3D-3D plane of Figure 3B, and along the 3E-3E plane of Figure 3D;
    - Figure 4A shows a perspective view of an intervertebral implant according to one embodiment before the lateral deployment of the lateral expansion means; Figures 4B and 4C show perspective views of an intervertebral implant according to one embodiment after the lateral deployment of the lateral expansion means and comprising elongated arms, respectively, in the folded position and in the deployed position; and FIG. 4D represents a perspective view of the expansion means when the elongated arms of the implant are deployed;
    - Figures 5A, 5B and 5C show perspective views of an intervertebral implant according to one embodiment, respectively, before, during and after insertion of an insert and the deployment of the elongated arms; FIG. 5E represents a perspective view of the insert and of the means for expanding the implant; FIGS. 5D and 5F represent views, respectively, of the front / distal face and in section along the plane 5F-5F of FIG. 5C;
    îo - Figures 6A, 6B and 6C show perspective views of an intervertebral implant according to one embodiment, respectively, before, during and after insertion of an insert and deployment of the elongated arms; FIG. 6E represents a perspective view of the insert and of the means for expanding the implant; Figure 6D shows a sectional view along the plane 6D-6D of Figure 6C;
    - Figures 7A, 7B and 7C show perspective views of an intervertebral implant according to one embodiment, respectively, before, during and after insertion of an insert and the deployment of the elongated arms; FIG. 7E represents a perspective view of the insert and of the means for expanding the implant; FIGS. 7D and 7F show views, respectively, of the front / distal face and in section along the plane 7F-7F of FIG. 7C;
    - Figure 8A shows a perspective view of an intervertebral implant according to one embodiment before the lateral deployment of the lateral expansion means: Figures 8B and 8C represent perspective views of an intervertebral implant after the lateral deployment of the lateral expansion means and comprising elongated arms, respectively, in the folded position and in the deployed position; Figures 8D and 8E show sectional views, respectively, along the plane 8D-8D of Figure 8C and along the plane 8E-8E of Figure 8D
    - Figures 9A, 9B and 9C show perspective views of a vertebral implant according to one embodiment, respectively, before, during and after insertion of an insert and the deployment of the elongated arms; and FIG. 9D represents a perspective view of the deployed insert;
    - Figures 10A, 10B and 10C show perspective views of an intervertebral implant according to one embodiment, respectively, before, during and after deployment of the expansion means and elongated arms using instrumentation; FIG. 10D represents a perspective view of the implant comprising the extended extended arms; Figures 10E and 10F show sectional views, respectively, along the plane 10E-10E of Figure 10D and along the plane 10F-1 OF of Figure 10C;
    îo - Figures 11A and 11B show perspective views of an intervertebral implant according to an embodiment comprising elongated arms, respectively, in the folded position and in the deployed position; FIG. 11C represents a perspective view of the same deployed implant placed on a vertebra; and Figure 11D shows a top view of Figure 11B;
    - Figures 12A and 12B show perspective views of an intervertebral implant according to one embodiment, respectively, before and during the deployment of the expansion means and elongated arms using instrumentation; and Figure 12C shows a sectional view along the plane 12C-12C of Figure 12B;
    - Figure 13A shows a perspective view of an intervertebral implant according to one embodiment after deployment of the elongated arms using instrumentation; and Figures 13B and 13C show perspective views of the implant, respectively, before and after loading and deployment of two anchoring devices through the implant using instrumentation;
    - Figures 14A and 14C show perspective views of the expansion means according to one embodiment, respectively, before and after assembly of said means; FIGS. 14B and 14D represent perspective views of a base of a vertebral implant according to an embodiment, respectively, before and after deployment of two anchoring devices; and Figure 14E shows a perspective view of the anchoring devices deployed through the implant;
    - Figures 15A and 15B show perspective views of an intervertebral implant according to one embodiment, respectively, before and during the deployment of the expansion means and elongated arms using instrumentation; and Figure 15C shows a sectional view along the plane 15C-15C of Figure 15B;
    - Figures 16A and 16B show partial perspective views of an intervertebral implant according to one embodiment after deployment of the elongated arms, respectively, before and after loading of the graft using instrumentation (in which a tube carries instrumentation implant is shown in section); and FIGS. 16C and 16D represent sectional views along the plane 16C-16C and 16D-16D of FIG. 16B, respectively, before and during impaction of the graft in the implant;
    - Figures 17A and 17B show perspective views of a vertebral implant according to an embodiment after deployment of the elongated arms, respectively, before and after deployment of two anchoring devices through the implant using instrumentation (in the figure
    16A includes an instrumentation implant holder tube which is shown in section); FIG. 17C represents a perspective view of the anchoring devices deployed through the implant;
    - Figures 18A and 18B show perspective views of the expansion means according to one embodiment, respectively, after and before assembly of said means;
    - Figures 19B and 19A show views, respectively, in perspective and a section along a median plane of Figure 19B of an implantation gun according to one embodiment;
    - Figures 20A and 20E show perspective views of the implantation gun, respectively, before and during the release of the instrumentation for implantation of an implant; Figures 20B, 20C and
    20D represent sectional views along a median plane of the gun, respectively, before and during the release of the instrumentation;
    - Figure 21A shows a perspective view of an alignment of the pistol, the instrumentation and the intervertebral implant to be implanted between two adjacent vertebrae.
    DESCRIPTION OF THE PREFERRED EMBODIMENTS OF THE INVENTION The present invention relates to a vertebral implant, suitable for use in the spine and intended to be implanted in general in a vertebral segment composed of at least two vertebrae. This implant is intended to be deployed horizontally, vertically and laterally thanks to various elements participating in said deployment or expansion of said implant.
    These various elements are different from each other, but they have the advantage of all participating in the horizontal, vertical and / or lateral expansion of the implant. Which makes it possible to group these elements by the term "means of expansion" and the different technical characteristics of each means of expansion will be detailed below. In particular, this implant may be an intervertebral type implant implanted between two adjacent vertebrae or a corporectomy type implant implanted on a segment which may extend beyond a single intervertebral space, or even over several bodies and / or space vertebral. Indeed, various embodiments relate to implants provided with elongated arms and expansion means facilitating a reliable, stable and non-invasive implantation, so as to provide an effective fusion (bone fusion) in various implantation sites (different lordoses) and the examples provided above should therefore not be considered as limiting. Thus, various embodiments may provide an implant which is not intended for the spine but configured (in particular in terms of three-dimensional shape) for another type of bone of the musculoskeletal system.
    On the other hand, the person skilled in the art may possibly be able to use the two other requests filed on the same day as the present request, by the present plaintiff, in order to assess any functional and / or structural characteristics which are not , or insufficiently, detailed in the present request. In other words, the entirety of these two other requests (description, claims and figures) can therefore be considered, if necessary (according to the law in force), as being incorporated into this request, by reference or by reference .
    io
    It will be noted that the designations of the “proximal” and “distal” ends of the implant (1) or of any other element are used in the present application with reference to the direction in which the implant (1) is inserted. Thus, the wall or the end designated as proximal of the body of the implant is that by which it is generally held to be implanted, whether this wall is really proximal to the implant or not during its implantation. In the case of the spinal implants described in the present application, this proximal end may or may not be effectively disposed towards the rear of the patient, in particular for implants which are essentially intended for implantation by the posterior or transforaminal route. Consequently, the terms “distal” and “proximal” are not intended to refer simply to the patient or to one of his anatomical characteristics, but to the direction of insertion of the anchor in the implant and / or of the implant. itself (whether this implant is itself implanted along an anteroposterior axis or not).
    On the other hand, we generally designate here by the terms "vertical" and "horizontal" without limitation, with reference to the axis of the spine when considering the patient standing and the implant positioned in the spine. On the other hand, the terms “width or lateral” and “length” designate dimensions along a plane perpendicular to the axis of the spine (a transverse plane), with the width generally being in the mediolateral direction while the length will be in the anteroposterior direction, without this conventional definition having the least limiting implication for the invention. Indeed, this conventional terminology is to simplify the description of various technical structures of the present invention and therefore cannot have a limited connotation compared to the actual orientation of one of the embodiments. According to certain embodiments, the terms "vertical or" height "can generally refer to directions or dimensions oriented substantially along the tertiary axis (Z). It will also be noted that the term “substantially” or “substantially” is regularly used in the present description, in particular concerning a characteristic such as an orientation or a direction, so as to indicate that the characteristic concerned may in fact be slightly different and not not be exactly as designated (for example, the expression "substantially perpendicular" must be interpreted as "at least approximately perpendicular" because it may be possible to choose an orientation which is not exactly perpendicular in order to nevertheless be able to fulfill substantially the same function or structural layout). In addition, terms such as the term "substantially" used in the present application can also be interpreted as defining that the technical characteristic can be "in general" ("generally"), and often "preferably", as indicated, but that other embodiments or configurations may be within the scope of the present invention.
    It will be noted that in the present application, in general the primary (X), secondary (Y) and tertiary (Z) axes are substantially orthogonal to one another, the primary axis (X) of which corresponds to the direction along which the implant will move during its implantation in the patient, as shown for example in FIG. 1C. Furthermore, in general, the references in the present application will consider that the primary axis (X) is a horizontal axis, the secondary axis (Y) is a lateral axis and the tertiary axis (Z) is a vertical axis. For example, in some embodiments, the intervertebral implant (1) includes a body (20) extending longitudinally along a primary axis (X), between a proximal end and a distal end. Generally, in the present application, the distal end may be the end by which the implant is introduced into the intervertebral space and the proximal end being the end by which the implant is held during its implantation.
    In some embodiments, the implant (1) comprises a base (6) disposed at the proximal end and by which the implant (1) is gripped by instrumentation adapted to be implanted in the intervertebral space. The base thus comprises on its proximal end, complementary fixing means, such as for example and without limitation a tapping, with instrumentation (for example an implant holder tube (PI)), as shown for example in FIGS. 1A , 2A to 2E, 3A to 3E, 4A to 4C, 8A to 8D, 14E, 15C, 16C, 16D and 17D, to facilitate handling when gripping the implant by instrumentation for implantation or removal said implant. In certain embodiments, said means for fixing the base are complementary with means for fixing (34) an insert (3) which may be, without limitation, threads, as shown for example in FIGS. 5A to 5F, 6A to 6E, 7A to 7C, 7E and 7F, allowing the insert to be easily guided in the deployment of the implant (1).
    The implant (1) further comprises a plurality of arms (2a, 2b, 2c, 2d) elongated along the primary axis (X) and each comprising at least one surface (4a, 4c) of vertebral support, the arms ( 2a, 2b, 2c, 2d) being articulated at least on the base (6) so that the implant comprises, on the one hand, a folded position in which the arms (2a, 2b, 2c, 2d) are close from each other, and on the other hand, a deployed position in which the arms (2a, 2b, 2c, 2d) are distant from each other along at least one secondary axis (Y) and / or at least one tertiary axis (Z). In particular, the implant (1) comprises at least two elongated arms (2a, 2b), as shown for example in FIGS. 1A to 1 C, 2A to 2E, 3A to 3E, 4A to 4D, 8A to 8E, 11A at
    11C, 12A to 12C, 13A to 13C, 14E, 15A to 15C, 16A to 16D and 17A to 17C, arranged one on the other and symmetrically along the body (20) so as to carry out a following translational movement the secondary axis (Y) and / or the tertiary axis (Z) between said folded position and said deployed position. According to another embodiment, the implant (1) comprises at least four elongated arms (2a, 2b, 2c, 2d), as shown for example in FIGS. 5A to 5F, 6A to 6E, 7A 7D, 7F, 9A to 9C and 10A to 10F, also arranged symmetrically along the body (20) of the implant (1) so as to carry out a translational movement along the secondary axis (Y) and / or the tertiary axis (Z) between said folded and deployed positions. Note that the primary (X), secondary (Y) and tertiary (Z) axes are substantially orthogonal to each other. Thus, the arms (2a, 2b, 2c, 2d) of the implant (1) according to the invention are able to deploy vertically and / or laterally so as to provide a larger surface to absorb all of the load distribution, better stability and increased resistance to sagging in the vertebrae. Generally, the implant (1) is implanted with the arms (2a, 2b, 2c, 2d) in the folded position in the intervertebral space so as to minimize the dimensions of the implant (1) and achieve implantation the minimally invasive to the patient. Then, the arms are deployed vertically or in height along the tertiary axis (Z) and / or laterally or in width along the secondary axis (Y) thanks to the expansion means (3, 8, 21, 21a, 21b, 22, 25, 66, 67, 69, 151) of the implant (1) to reinforce the stability of the implant and so that the implant occupies a larger space between the vertebrae so as to facilitate and improve bone fusion . It will be noted that, according to one of the embodiments, the expansion means can be or be produced by an insert (3), a hooking means (8), pivot arms (21, 21a, 21b), a pivot axis (25), guide means (66, 67), a spacer (69) and / or pivoting arms (151). It will be noted that, preferably, firstly the arms are deployed horizontally along the primary axis (X), then secondly, the arms are deployed vertically along the tertiary axis (Z) and / or laterally along the secondary axis (Y). This configuration has the advantage of limiting the force exerted on the vertebrae by the arms during their deployment in the intervertebral space.
    In certain embodiments, at least one of the upper and / or lower surfaces (4a, 4c) of the arms (2a, 2b, 2c, 2d) of the body (20) has notches, for example as illustrated in most of the figures (for example FIGS. 5A to 5C, 10A to 10D or 14E), to avoid displacement of the implant (1) between the vertebrae between which it is intended to be implanted before the bone fusion is sufficient. In addition, in various embodiments, the body (20) and / or the arms (2a, 2b, 2c, 2d) comprises at least one bevelled and / or chamfered part on at least one peripheral portion of at least one of its upper and lower surfaces îo of the distal end, so as to facilitate the insertion of the implant (1) between the vertebrae (V), for example as illustrated in most of the figures (for example Figures 2A to 2C , 5A to 5C, 11A to 11D or 17C).
    In addition, the implant (1) includes expansion means (3, 8, 25, 21,
    21a, 21b, 22, 66, 67, 69, 151) allowing the expansion of the arms (2a, 2b, 2c,
    2d) of the body (20) of said implant (1) between the folded and deployed positions. These expansion means comprise, on the one hand, height expansion means (3, 8, 25, 66, 67, 69, 151), and / or on the other hand, width expansion means (3, 21, 21a, 21b, 22, 151) allowing the deployment of the arms (2a, 2b, 2c, 2d) so that the implant occupies a larger space while allowing increased stability and reliability of the implantation between the intervertebral space.
    In certain embodiments, the height expansion means (3, 8, 25, 66, 67, 69, 151) comprise at least two branches (151) pivotally mounted relative to one another and connected to the arm (2a,
    2b, 2c, 2d) elongated by at least guide means (66, 67) so that a translation of the expansion means parallel to the primary axis (X) causes the branches (151) to pivot one relative to each other and spreads the arms (2a, 2b, 2c, 2d) from each other, along the secondary axis (Y) and / or the tertiary axis (Z). In certain embodiments, the pivoting of the branches (151) relative to each other occurs around a pivot axis (25) oriented substantially parallel to the tertiary axis (Z) to separate the elongated arms (2a, 2b, 2c, 2d) along this axis and allow the height expansion of the implant (1). Thus, one of the two branches (151) comprises, on the one hand, a first end (152) which is fixed to a distal end of at least one of the arms (2a, 2b, 2c, 2d), for example and without limitation by clipping (FIG. 14C), and on the other hand, a second end attaching to the other branch (151) via the pivot axis (25) by locking means (250), such as, without limitation, lugs (250) and / or complementary stops (251, 252) between said branches (FIGS. 18A and 18B). In certain embodiments, this configuration of the branches (151), as shown for example in FIGS. 14A, 14C, 18A and 18B, allows the branches (151) to be pivotally mounted relative to each other , thanks to the pivot axis (25), and fixed to the arms (2a, 2b, 2c, 2d) stably so that the translational movement of the branches leads to the deployment of the arms (2a, 2b, 2c, 2d ) along the secondary axis (Y) and / or the tertiary axis (Z). In certain embodiments, the branches (151) allowing the expansion in height and / or in width of the arms (2a, 2b, 2c, 2d) of the implant (1), are arranged at the distal end of the body (20) of the implant. Said branches comprise at least one projecting part (31) capable of anchoring in at least one vertebra (V) after deployment of the arms (2a, 2b, 2c, 2d) in the intervertebral space, such as for example teeth ( 31) or any other similar means allowing the arms deployed in the vertebrae to be anchored. For example, in the embodiment of FIG. 2E, the branches (151) include teeth (31) on their lower and upper ends, which facilitates the stable anchoring of the arms deployed in height and / or the width of the implant (1) in the vertebrae (V).
    In certain embodiments, the implant (1) comprises guide means (66, 67) comprising interior surfaces (67) of the arms (2a, 2b, 2c, 2d) which are not parallel to each other and divergent in direction from the distal end, so that the arms (2a, 2b, 2c, 2d) are separated from one another along the tertiary axis (Z) during the translation of the expansion means along the primary axis (X ). In particular, the guide means (66, 67) comprise at least one projection (66) disposed on at least one of the expansion means, for example and without limitation the insert (3) as shown for example in Figures 5E and 6E, and at least one groove (67) disposed on at least one of the arms (2a, 2b, 2c, 2d) elongated, so that the projection (66) cooperates with the groove (67) when said expansion means is moved along the body (20) during the deployment of the arms (2a, 2b, 2c, 2d) elongated. Thus, the displacement along the primary axis (X) of the projection (66) in the groove (67), as shown for example in Figures 5A to 5E, 6A to 6E, 7A to 7F and 10F, allows an expansion in height or vertical deployment of the elongated arms of the implant along the tertiary axis (Z).
    In certain embodiments, the implant (1) comprises at least one spacer element (69) disposed on at least one of the expansion means, for example and without limitation the insert (3) as shown for example on Figures 6D, 6E and 7F. Said spacer element (69) which may be a projecting part (69), as shown for example in FIG. 6D, or a hollow part (69) complementary to a curved surface of the legs (151), as represented by example in Figure 7F. For example in the embodiment of FIGS. 6A to 6E, said spacer element (69) disposed on the distal end of the insert (3) and having a projecting part (which may be spherical or non-spherical) makes it possible to spread the branches (151) to trigger the deployment of the arms (2a, 2b, 2c, 2d) elongated along the secondary (Y) and tertiary (Z) axes when the insert (3) moves longitudinally along the primary axis ( X). For example, in the embodiment of FIGS. 7A to 7F, the hollow part of said spacer element (69) of the insert (3) cooperates with the curved surface of the branches (151) to also allow the spacing of said branches and the deployment of the arms (2a, 2b, 2c, 2d) elongated along the secondary (Y) and tertiary (Z) axes, when the insert (3) moves longitudinally along the primary axis (X).
    In certain embodiments, the expansion means (3, 8,
    25, 21,21 a, 21 b, 22, 66, 67, 69, 151) of the implant also include expansion means (22, 21, 21a, 21b) in width of the implant, following at least a direction generally parallel to the secondary axis (Y). For example, in various embodiments, these expansion means (22, 21, 21a, 21b) in width of the implant comprise blades (21) integral with the distal end of the arms (2a, 2b) of the implant and mounted in rotation relative to the rest of the arms (2a, 2b). In certain embodiments, the blades (21) can be flexible or rigid and can be connected to the height expansion means, so that the translation of an actuator can cause the blades (21) to rotate, and associating the expansion of the width covered by the implant. As shown for example in FIG. 1A, the implant (1) can be implanted with the arms extended in the folded or closed position then the blades (21) are deployed laterally by an actuator using traction or pressure exerted by the surgeon of so as to cover as much surface as possible in the intervertebral space. For example in the embodiment of FIGS. 1A to 1 C, the actuator can be implemented in the form of a bar (5), which can deploy the blades (21) by translation of traction of the bar (5), but other similar embodiments can use the pressure translation of the bar (5) to deploy the blades (21).
    In various embodiments, the expansion means (22, 21,
    21a, 21b) in width of the implant include pivot arms (21a, 21b) pivotally mounted on a pivot axis (22) and with respect to the body (20) between the folded or closed position in which the arms pivots (21a, 21b) can run alongside the body (20), and the deployed position in which the arms (21a, 21b) are distant from the body (20) in an expansion configuration, for example, generally along the secondary axis (Y). In some embodiments, the pivot axis (22) and the pivot blades (21a, 21b) can be configured so that the pivot blades (21a, 21b) can be substantially parallel to the pivot axis (22) in the insertion configuration and not parallel to the pivot axis (22) in the deployed configuration. In certain embodiments, as shown for example in FIGS. 2A to 2E, 3A to 3C, 4A to 4C and 8A to 8C, the pivot arms (21a, 21b) make it possible to increase the final surface occupied by the implant between the intervertebral space. In certain embodiments, the pivot arms (21a, 21b) deployed laterally form cavities along the body (20) of the implant (1) which will facilitate and reinforce bone fusion through said cavities and can provide space for bone (or substitute) grafts.
    In certain embodiments, the pivoting of the branches (151) relative to each other, which occurs around the pivot axis (25) oriented substantially parallel to the tertiary axis (Z) to separate the elongated arms (2a, 2b, 2c, 2d) along the secondary (Y) and tertiary (Z) axes, allowing the implant to expand in width. For example, as shown in FIGS. 5A to 5C, 6A to 6C or 7A to 7C, the lateral deployment of the arms (2a, 2b, 2c, 2d) is achieved by moving the insert (3) along the body ( 20) of the implant (1).
    In some embodiments, a portion of the distal end (210) of the arm (21) slides along the body when the implant is in the deployed position (i.e., the final position of use). The arm (21) then deploys along a secondary axis (Y) substantially perpendicular to the body, so as to become arched. Thus, the deployment of the arm (21) allows the implant to occupy a larger space, while allowing increased stability and reliability since the surface, in contact with the bone of the vertebrae, in particular the cortical bone, is bigger. In other words, the implant gained in volume due to the sliding of a portion of the distal end of the arm. It is not a redistribution of the initial volume of the implant, but rather an increase in it.
    In certain embodiments, means of expansion (3, 8, 25, 66, 67, 69, 151) in height may comprise an insert (3) having branches (151) pivoting around a pivot axis ( 25) and guide means (66, 67) comprising the guide surface (66) cooperating with grooves (67), which can have a constant depth or a variable depth. In certain embodiments, expansion means (3, 21, 21a, 21b, 22, 151) in width may comprise an insert (3) provided with branches (151) pivoting about a pivot axis (25) (for example illustrated in FIGS. 5A to 5E) and / or sliding in relation to a spacer (69) (for example illustrated in FIGS. 6A to 6E as spherical, but can be substituted by other convex shapes) , wherein the guide means (66, 67) may include a guide surface (66) cooperating with grooves (67) whose depth decreases towards the distal end of the body of the implant. In certain embodiments, in which the expansion means comprise a groove (67) having a depth which decreases towards the distal end of the body of the implant can carry out part or all of the extension in height of the arms (2a, 2b, 2c, 2d). It will be noted that, preferably, the arms are first deployed laterally along the secondary axis (Y) and then vertically along the tertiary axis (Z), for example as shown in FIGS. 5A to 5C, 6A to 6C or 8A to 8C.
    In certain embodiments, the expansion means therefore comprise at least one insert (3) which can be screwed through the base (6) to drive the translation of part or all of the expansion means (3, 8, 21, 21 a, 21 b, 22, 25, 66, 67, 69, 151) relative to the body (20) of the implant during the deployment of the elongated arms. For example, the displacement of the insert (3) along the primary axis (X) and along the body (20) of the implant can deploy the arms (2a, 2b, 2c, 2d) along the secondary axis (Y) and / or the tertiary axis (Z). In certain embodiments, the insert (3) can guide an expansion in height of the implant by a vertical displacement of the elongated arms (2a, 2b, 2c, 2d) along the tertiary axis (Z), as shown for example in Figures 5A to 5C, 6A to 6C or 7A to 7C. In certain embodiments, the insert (3) can guide an expansion in width of the implant by a lateral displacement of the elongated arms (2a, 2b, 2c,
    2d) along the secondary axis (Y), as shown for example in Figures 5A to 5C, 6A to 6C or 7A to 7C. In certain embodiments, the insert (3) can be provided with branches (151) which can be separated from each other by a spacer (69) to allow the translation of the expansion means relative to the body implant during deployment of the extended arms. In some embodiments, said spacer (69) disposed on the distal end of the insert (3) can be used to exert pressure on the branches (151) to separate them from each other , in order to obtain lateral expansion of said arms (2a, 2b, 2c, 2d) of the implant. For example, in the embodiment of FIGS. 9A to 9D, the insert (3) comprises lateral extensions (151) which deploy laterally when the insert moves along the body (20). In this configuration, the insert comprises two guide surfaces (51, 52) with at least one internal and lateral wall (26) of the body (20) of the implant (1) allowing the horizontal and lateral displacement of the insert (3) along the body (20), as shown for example in Figures 9A to 9C. Depending on the layout and shape of the insert following a particular layout, the structures as described above can allow either a successive expansion of the implant along the primary axis (X), the secondary axis (Y) and / or the tertiary axis (Z), ie an expansion of the implant simultaneously along one of the combinations of the three orthogonal axes (X, Y, Z). For example in FIGS. 9A to 9C, the simultaneous reduction of the guide surfaces along the secondary axis (Y) and the tertiary axis (Z) towards the distal end of the implant, simultaneously implements the expansion respectively along the axes. In certain embodiments, the insert (3) can be a cylindrical tube, as shown for example in FIGS. 5E or 6E, threaded and comprising cavities (30) to allow bone fusion through said cavities.
    In certain embodiments, the insert (3) can be screwed through the base to a hooking means (8) by instrumentation (for example a connecting rod (P3)), as shown for example in the figure 12C. In certain embodiments, the expansion means comprise at least one hooking means (8) with at least one instrumentation (PI, P3, D, D30, D31) which can be fixed to the branches (151) so as to drive the translation of the expansion means relative to the body (20) of the implant (1) during the deployment of the elongated arms (2a, 2b, 2c, 2d). In some embodiments, the insert (3) screwed by means of attachment (8) by the connection rod (P3) of the instrumentation can, on the one hand, the deployment of the arms (2a, 2b, 2c, 2d) of the implant (1) during its implantation in the intervertebral space, and on the other hand, the folding of the arms (2a, 2b, 2c, 2d) of said implant (1) during its removal from the intervertebral space.
    In certain embodiments, the elongated arms (2a, 2b, 2c, 2d) îo can be articulated at least partially on the base (6) between said folded or closed and deployed positions. For example, the base (6) may include a joint (64) capable of joining the arms (2a, 2b, 2c, 2d) together on the proximal end of the body (20). Indeed, as shown for example in Figures 9A, 11C and 12A, a joint (64) is disposed between the elongated arms (2a, 2b, 2c, 2d) and the base (6) and oriented parallel to the axis tertiary (Z) and / or secondary axis (Y) to separate said arms along this (or these) axis (s) and allow expansion in height and / or width of the implant (1). Therefore, as shown for example in Figures 9A to 9C, the joint (64) can form a ring segment allowing the implant (1) to achieve an expansion in height and width which can be simultaneous or sequential . In certain embodiments, the implant (1) comprises other articulations (61, 62, 63) able to articulate the base (6) and the arms (2a, 2b, 2c, 2d) elongated between the folded position and the deployed position. In fact, these joints (61, 62, 63) form reciprocal coupling means (62, 63) between the base (6) and at least one of the elongated arms (2a, 2b, 2c, 2d). As shown for example in FIGS. 1B, 2A, 2B, etc., the base (6) and the arms (2a, 2b, 2c, 2d) are interconnected by at least one coupling means (62) making it possible to articulate them between said folded and deployed positions and obtain an expansion in height of the implant. On the other hand, the joints (61, 62, 63) comprise at least one plate (61) capable of being fixed between the base (6) and the proximal end of at least one arm (2a, 2b, 2c , 2d) elongated so that the plate (61) is articulated both on the base (6) and on the proximal end of the arms (2a, 2b, 2c, 2d) Indeed, these joints (61, 62, 63) also form reciprocal coupling means (62, 63), on the one hand, between the plate (61) and the base (6), and on the other hand, between the plate (61) and the 'proximal end of at least one of the arms (2a, 2b, 2c, 2d) elongated. Thus, as shown for example in FIGS. 5C, 6C, 7C, 10C, etc., the plate (61) is joined with the base (6) by at least one coupling means (63) and with at least one of the arms (2a, 2b, 2c, 2d) by at least one coupling means (62), allowing articulation of the base with the arms between said folded and deployed positions and obtaining an expansion in height and / or in width of l 'implant (1). Said coupling means comprise, for example and without limitation, pins, hooks, rings or any other means making it possible to link the base to the elongated arms of the implant.
    On the other hand, the present application describes various embodiments of a bone anchoring for the implant, and therefore details various types of bone anchoring devices, generally called anchors in the present application, although it may be also act with a screw implanted by screwing (spiral rotation), or with a device planted in the bone following a rectilinear translation or following a curvilinear path, for example as illustrated in FIGS. 13C, 14E or 17C, or d 'a projecting part capable of anchoring in the bone after deployment of the implant between the intervertebral space, for example as shown in Figure 2E. The term anchor is therefore used here only with reference to its anchoring function and it does not imply any limitation in shape or structure, except that the anchor is preferably elongated along a longitudinal axis which is extends between a first end, designated here as "distal end" intended to penetrate a bone (a vertebra in general) and a second end, designated here as "proximal end" intended generally to remain in the implant to retain it and keep it in place. Thus, for the anchor (DA), the first end, called the distal end, is that intended to be inserted first and intended to penetrate a vertebra to fix an implant. Various types of anchors can of course be used in various combinations in any embodiment. In addition, various types of anchors can be deployed in one of the embodiments described or suggested in this application, even if it is not expressly noted as a component of such an embodiment.
    Thus, in certain embodiments, the implant (1) further comprises at least one anchoring device (DA) disposed through a passage (or a conduit or an opening) located on at least one peripheral wall of the implant (1) and passing through at least a portion of said implant (1) to penetrate into at least one vertebra (V) and fix said implant (1) on said vertebra (V). Indeed, in various embodiments, it is preferred to use interbody implants provided with bone anchors. However, because of the size, the anchoring will preferably be chosen from anchoring devices (DA) in the form of a curved anchor because it allows implantation of the anchor by an approach which is made substantially in the plane of the disc space, which can reduce the invasiveness of the surgical operation of the implantation on the patient. For these types of deployment, it is possible to use intervertebral implants intended to be implanted in the disc space between the vertebrae and comprising at least one peripheral wall with a posterior or proximal end, comprising an opening for at least one passage, which can be of rectilinear shape (or curved or of another shape), dimensions and orientation complementary to the shapes and dimensions of at least one anchoring device or anchor or screw (DA) comprising at least one body (DA10) elongated along an axis longitudinal extending between distal end and proximal end, said body (DA10) being inserted into said passage, substantially in the plane of (1), by sliding from said proximal part of the implant (1), said passage passing through the implant (1) from the periphery to an upper or lower surface so that the distal end of said body (DA10) penetrates into one of said adjacent vertebrae (V), while the proximal end remains in said passage or along the proximal surface and retains said implant (1) against said vertebra (V). In a preferred embodiment, the anchor will generally be rigid and pass through the passage without deformation, but other embodiments using flexible or deformable anchors can be used. Generally in this type of embodiment, said anchoring device (DA) is intended to be anchored in one of the vertebrae (V) so as to fix the implant (1) on / against this vertebra (V). In certain embodiments, said body (DA10) of the anchoring device (DA) may comprise at least one rib (DA11) or a second projection which will generally be arranged along the body (DA10). In certain embodiments, the rib or the projection can be adapted, that is to say cooperate with at least one groove formed in the passage of the implant (1) to receive the rib or the projection. In certain embodiments, the elongated arms (2a, 2b) of the implant (1) comprise at least one opening (12) capable of at least partially receiving the deployed anchoring device (DA), as shown for example on Figures 2A, 2B, 3B and 3C. In some embodiments, the passage may open along part or all of the passageway through the implant, but in most preferred embodiments, the passage will have at least a portion of the passage. passage forming a closed space open at its opposite ends.
    In certain embodiments, said rib (DA11) is preferably intended at least to limit (or even prevent) the transverse movement of the anchor (DA) (and therefore also of the implant) relative to the vertebra (V) . The rib can also be configured and deployed to stiffen the anchor (DA). For example, FIGS. 13C or 14E show anchoring devices (1) provided with at least one rib (16). In addition, as particularly visible for example in FIG. 13C, the distal end of the body (DA10) of the anchor (DA) has substantially the shape of a bevel or chamfer or point of shell (DA12) to optimize the penetration of the anchor (DA) into the vertebrae (V).
    In some embodiments, the anchoring devices (DA) can be easily implanted through the base (6) of the implant (1) in the vertebrae (V). Therefore, in certain embodiments, the base (6) participates in guiding the deployment of the anchors of the anchoring device (DA) and the base (6) may comprise at least one guide groove adapted to guide the at least partially the anchoring device (DA). In certain embodiments, the base (6) may include at least one orifice adapted to at least partially accommodate an anchoring guide (GA) of the anchoring device (DA). Indeed, the base (6) comprises, for example and without limitation, at least one opening whose walls are complementary to those of the anchor, for example by forming grooves intended to follow the contours of the anchor or anchors that the base is intended to receive. FIGS. 14B and 14D show examples of such guiding of the anchors by the base with an anchoring guide (DA) facilitating the guiding of the anchors in the base through an orifice and the anchoring guide participates in indexing the orientation of the anchors thanks to the complementary shape of the peripheral wall of the guide (DA) with the inner wall of the opening in the base (6). The complementarity between the guide (GA) and the base (6), with at least one rib in the peripheral wall of the guide (GA) which cooperates with at least one projection in the opening of the base (6) make it possible to index the orientation of the guide (GA) and anchors (DA) through the base (6). It will be noted that the term "guide" has a functional definition and that the examples of structures provided by way of example here should not be considered as limiting, but that the guide on the other hand necessarily has a particular shape to ensure its guiding function. .
    In various embodiments, anchor locking means are provided to assist in securing the anchors and securing the implantation of the implant in the bone tissue. After anchoring in the bone tissue, undesirable movements of the anchors, for example during movements of the patient, induce risks that these anchors do not move back and leave the bone, which can cause significant damage for the patient. It is therefore useful to provide at least one mechanism securing the bone anchoring, in particular by locking the anchors. Various types of locking means are possible, in particular for obtaining a mutual locking of the anchors with one another and / or a locking of at least one anchor with another element or the implant. For example, the anchoring device (DA) provides locking means, such as a tongue (DA13) and / or a stop (DAM), locking on a clip disposed on a proximal end of the base (6 ), for example as shown in FIGS. 14B and 14E. In certain embodiments, the proximal end of the body (20) of the implant comprises an extension (268) capable of being housed in a cavity (68) of the clip of the base (6) making it possible to stabilize the implant after deployment of said arms, as for example shown in Figure 14E. In certain embodiments, the base (6) comprises a profile (62) capable of being clipped into an opening (64) in the proximal end of the body (20) of the implant, so as to lock the base on the proximal end of the body of said implant after deployment of the arms, as for example shown in FIG. 14E.
    Various embodiments of the present application relate to instrumentation for the insertion of an intervertebral implant in a treatment area. Certain embodiments are described with reference to insertion into the spine and preferably for the fixation of this implant in the adjacent vertebral structures. Such instrumentation comprises at least one implant holder tube (P1) and a spreader (D) comprising a connection rod (P3). The implant holder tube (Pl) is able to be fixed on the base (6) of the implant (1) and to guide it towards the vertebra (V). This implant holder tube (Pl) comprises retaining means complementary to attachment means present on the base (6) of the implant (1). Various types of retaining means and attachment means are known from the prior art, such as for example rods of the implant holder, threaded or not, penetrating passages, threaded or not, of the implant, or arm of the implant holder cooperating with lateral edges and / or upper and / or lower faces of the implant, for example by inserting said arms into grooves of the implant (or for example hooks on an engagement structure hollowed out, or openings on another structure). For example, Figures 10A, 10F, 12A or 13A show examples of tapping capable of cooperating with a threaded end of the implant holder tube (Pl) of the instrumentation. In some embodiments, a spreader (D) is used in the implant holder tube (Pl) to guide the implant (1) and trigger the deployment or expansion of the arms of the implant in the intervertebral space. In certain embodiments, a distal end of the spreader (D) may comprise a system (D3, D31) for pre-expanding the implant (1) before actuating the spread, for example and not limitation by pushing manually, for the final expansion of the implant in the intervertebral space. In particular, the connecting rod (P3) contained in the deployer (D) attach to the attachment means (8) of the implant (1) so as to actuate the expansion means for deployment or expansion of the extended arms (2a, 2b, 2c, 2d). Like the implant holder tube and the base, the connection rod comprises retaining means complementary to the attachment means (8) of the means for expanding the implant. FIG. 10F shows an example of a tapping included in the attachment means (8) and able to cooperate with a threaded end of the connector (P3) of the instrumentation. In certain embodiments, the spreader (D) and the connection rod (P3) are arranged in the implant holder tube (Pl) to receive a thrust or a shock, for example by an impactor, so that the anterior end or implant (1) can penetrate the intervertebral space and / or deliver the graft (G) through the charger (CG) in the implant (1). In some embodiments, the loader (CG) can define the appropriate dose or volume of bone graft or substitute to be delivered relative to the volume of the implant. For example as shown in FIGS. 16B and 16C, the charger (CG) can be a tube comprising a conduit (CG12) for receiving, for example, a graft or a substitute, and can further comprise an end (CG10) having attachment means (CG11) complementary to the attachment means (8) of the implant (1), so as to immobilize the fixation of the charger in the implant and obtain a reliable impaction of the graft or of the substitute.
    In certain embodiments, the surgical instrumentation comprises at least one charger (CA, CG) capable of receiving anchoring devices (DA) and / or of the graft (G) and of sliding in the implant holder tube (Pl) . The charger is provided with a guide surface (CO) making it possible to receive an impactor (IG) for pushing said anchoring devices (DA) and / or said graft (G) through the implant holder tube (Pl) towards the vertebrae (V). This embodiment has the advantage of facilitating the impaction of the anchoring devices (DA) and / or of the graft (G), through the implant holder tube (Pl) towards the vertebrae (V), via an impactor for allow reliable, stable and minimally invasive anchoring.
    In certain embodiments, the instrumentation further comprises an implantation gun (P) comprising a handle (PPI) capable of connecting to the implant holder tube (Pl) through a connection means (CPI) so as to implant at least one implant (1), an anchoring device (DA) and / or a graft (G) to the vertebra (V). Indeed, as shown for example in Figures 20A to 20E, the connection means (CPI) is fixed, on the one hand, to the implant holder tube (Pl) by its anterior end, and on the other hand, to the handle (PPI) of the pistol (P) by its rear end. In particular, the rear end of the connection means (CPI) comprises at least one groove (PPI2) capable of engaging with at least one clip or tab (PPI1) disposed in an opening (PP12) of the handle (PPI ) of the pistol. Thus, by actuating the latch (L) of the gun (P), the clip or tab (PPI1) of the handle (PPI) disengages from the groove (PPI2) of the connection means (CPI) so as to release the tube holder implant (Pl).
    In various embodiments, the instruments, such as the deployer (D), the magazine (CA, CG) or the impactor (IG), can be successively coupled and uncoupled on the gun (P) during an implantation . Indeed, different types of instruments, for example and without limitation an implant deployer, a graft impactor, an anchor impactor or other types of instruments, can be mounted successively or not on the gun during 'an implantation between the intervertebral space. Therefore, the handle (PPI) of the gun (P) can be connected and disconnected several times and according to the need of the surgeon with or without the instruments (D, P3, CA, CG, IG) in the implant holder tube (PI ). This embodiment has the advantage of facilitating the implantation of an intervertebral implant in the intervertebral space using the gun. Indeed, the gun allows successively the implantation of an intervertebral implant, anchoring devices and the graft by the same instrumentation. The pistol is suitable for use with several types of magazine, that is to say both an anchor magazine and a graft magazine. The gun is also suitable for quick and easy assembly and disassembly with other implantation instruments, such as the spreader (D), the magazine (CA, CG) or the impactor (IG). Thus, this embodiment allows the surgeon to perform all the stages of a lordosis surgical operation, that is to say from the implantation of the intervertebral implant to the loading of the graft to facilitate arthrodesis, in optimizing the time and cost necessary for such an operation.
    In certain embodiments, the invention may also relate to a method of preparation for the implantation of an intervertebral implant (1) in at least one vertebra (V). In particular, the invention aims at good stabilization of the spine for arthrodesis, it will be preferred that the implant includes expansion means allowing deployment of the arms (2a, 2b, 2c, 2d) of the implant ( 1) along the secondary axis (Y) and / or the tertiary axis (Z). The method therefore comprises a step of inserting at least one intervertebral implant and / or a step of anchoring this implant with at least one anchoring device (DA) and / or a step of loading the graft (G) in situ, using implantation instrumentation (P, PI, P3, D, CA, CG, IG) which may include a gun (P) or not. In the case of implantation with the pistol (P), the intervertebral implant (1) is pre-deployed before being inserted into the intervertebral space by the implant holder tube (PI). Indeed, the action on the latch (L) of the gun (P), causes the disengagement of the clip or tongue (PPI1) of the handle (PPI) of the groove (PPI2) of the connection means (CPI) so as to release the implant holder tube (PI) and exert a small push allowing the pre-deployment of the implant in the intervertebral space. Then, the spreader (D) and the connector (P3) are mounted on the gun (P) so as to actuate the means of expansion of the implant and fully deploy the arms (2a, 2b, 2c, 2d) of the implant in the intervertebral space. Once the implant (1) is inserted into the intervertebral space, other instruments can be mounted on the pistol to enhance the stability of the implant. Indeed, for example and without limitation, at least one anchoring device (AA) and an anchor impactor can be mounted on the pistol (P) making it possible to implant said anchoring device (DA) through the implant (1) in at least one vertebra (V). In addition, for example and without limitation, a graft (G) and a graft impactor (IG) can be mounted on the gun (P) making it possible to insert graft into the implant (1) and reinforce bone fusion. On the other hand, as shown for example in Figure 21 A, the use of the gun (P) allows to align the flat (MP) and the handle (PPI) of the gun (P) with the implant holder tube (PI ) and the implant (1) according to the optimal indexing to obtain an easy and rapid implantation of the implant in the intervertebral space.
    The present application describes various technical characteristics and advantages with reference to the figures and / or to various embodiments. Those skilled in the art will understand that the technical characteristics of a given embodiment can in fact be combined with characteristics of another embodiment unless the reverse is explicitly mentioned or it is obvious that these characteristics are incompatible or that the combination does not provide a solution to at least one of the technical problems mentioned in the present application.
    In addition, the technical characteristics described in a given embodiment can be isolated from the other characteristics of this mode unless the reverse is explicitly mentioned.
    It should be obvious to those skilled in the art that the present invention allows embodiments in many other specific forms without departing from the scope of the invention as claimed. Therefore, the present embodiments should be considered by way of illustration, but may be modified in the field defined by the scope of the appended claims, and the invention should not be limited to the details given above.
    权利要求:
    Claims (23)
    [1" id="c-fr-0001]
    1. Intervertebral implant comprising a body (20) extending longitudinally along a primary axis (X), between a proximal end
    5 and a distal end, characterized in that it comprises:
    - a base (6) at the proximal end,
    a plurality of arms (2a, 2b, 2c, 2d) elongated along the primary axis (X) and each comprising at least one surface (4a, 4b, 4c, 4d) for vertebral support, the arms (2a, 2b, 2c, 2d) being articulated at least îo the base (6) so that the implant comprises, on the one hand, a folded position in which the arms (2a, 2b, 2c, 2d) are close to each other other, and on the other hand, a deployed position in which the arms (2a, 2b, 2c, 2d) are distant from each other along at least one secondary axis (Y) and / or at least one axis
    15 tertiary (Z), the primary (X), secondary (Y) and tertiary (Z) axes being substantially orthogonal to each other;
    - Expansion means (3, 8, 21, 21a, 21b, 22, 25, 66, 67, 151) of the implant between the folded and deployed positions, comprising at least two branches (151) pivotally mounted l ' one compared to
    20 the other and connected to the elongated arms (2a, 2b, 2c, 2d) by at least guide means (66, 67) so that a translation of the expansion means (3, 8, 21, 21a, 21b, 22, 25, 66, 67, 151) parallel to the primary axis (X) causes the branches (151) to pivot relative to each other and spreads the arms (2a, 2b,
    25 2c, 2d) from each other, along the secondary axis (Y) and / or the tertiary axis (Z).
    [2" id="c-fr-0002]
    2. Vertebral implant according to claim 1, characterized in that the expansion means comprise at least one insert (3) screwable through the base (6) to drive the translation of the expansion means (3, 8,
    30 21, 21a, 21b, 22, 25, 66, 67, 151) relative to the body (20) of the implant during the deployment of the elongated arms (2a, 2b, 2c, 2d).
    [3" id="c-fr-0003]
    3. Intervertebral implant according to one of claimsl to 2, characterized in that the pivoting of the branches (151) relative to each other occurs around at least one pivot axis (25) oriented parallel to the secondary axis (Y) to spread the elongated arms (2a, 2b,
    5 2c, 2d) along this axis and allow the expansion of the width of the implant.
    [4" id="c-fr-0004]
    4. Intervertebral implant according to one of claims 1 to 3, characterized in that the implant expansion means also include height expansion means (3, 8, 25, 66, 67, 151) of the implant, along an axis parallel to the tertiary axis (Z), by means of guiding means (66, 67) comprising interior surfaces (67) of the arms (2a, 2b, 2c, 2d) which are not parallel between them and divergent in the direction of the distal end, so that the arms (2a, 2b, 2c, 2d) are separated from one another along the tertiary axis (Z) during the translation of the expansion means according the primary axis (X).
    15 5. Intervertebral implant according to one of claims 1 to 4, characterized in that the pivoting of the legs (151) relative to each other occurs around at least one pivot axis (25) oriented parallel to the tertiary axis (Z) to spread the elongated arms (2a, 2b, 2c, 2d) along this axis and allow the expansion of the height of the implant.
    20 6. Intervertebral implant according to one of claimsl to 5, characterized in that the means for expanding the implant also include means for expanding in width (22, 21, 21a, 21b) of the implant, along an axis parallel to the secondary axis (Y).
    7. Intervertebral implant according to claim 6, characterized in that
    25 that the width expansion means (22, 21, 21a, 21b) of the implant comprise flexible blades (21) integral with the distal end of the arms (2a, 2b) of the implant and slidably mounted by relative to the rest of the arms (2a, 2b), but connected to the height expansion means, so that the actuation of the translation causes the flexible blades to slide and deform, inducing the expansion of the width covered by the 'implant.
    8. Intervertebral implant according to claim 6, characterized in that the width expansion means (22, 21, 21a, 21b) of the implant
    [5" id="c-fr-0005]
    5 include pivot arms (21a, 21b) pivotally mounted on a pivot axis (22) and with respect to the body (20) between the folded position in which the pivot arms (21) are substantially parallel to the axis (22) pivot and run along the body (20), and the deployed position in which the arms (21a, 21b) are distant from the body (20) and not parallel to the pivot axis (22) îo in order to deploy said implant along the secondary axis (Y).
    [6" id="c-fr-0006]
    9. Intervertebral implant according to one of claimsl to 8, characterized in that the base (6) comprises a joint (64) capable of joining the arms (2a, 2b, 2c, 2d) between them on the proximal end of the body (20), the joint (64) forming a ring segment.
    15
    [7" id="c-fr-0007]
    10. Intervertebral implant according to one of claims 1 to 9, characterized in that the implant (1) comprises articulations (61, 62, 63) articulating the base (6) and the arms (2a, 2b, 2c , 2d) elongated, between the folded position and the deployed position.
    [8" id="c-fr-0008]
    11. Intervertebral implant according to claim 10, characterized in that
    20 that the joints (61, 62, 63) form reciprocal coupling means (62, 63) between the base (6) and at least one of the elongated arms (2a, 2b, 2c, 2d).
    [9" id="c-fr-0009]
    12. Intervertebral implant according to claim 10, characterized in that the joints (61, 62, 63) comprise at least one plate (61)
    25 articulated both on the base (6) and on the proximal end of at least one elongated arm (2a, 2b, 2c, 2d).
    [10" id="c-fr-0010]
    13. Intervertebral implant according to claim 12, characterized in that the articulations (61, 62, 63) form reciprocal coupling means (62, 63), on the one hand, between the plate (61) and the base ( 6), and on the other hand, between the plate (61) and the proximal end of at least one of the elongated arms (2a, 2b, 2c, 2d).
    [11" id="c-fr-0011]
    14. Intervertebral implant according to one of claims 4 to 13,
    5 characterized in that the guide means (66, 67) comprise at least one projection (66) disposed on the expansion means, and at least one groove (67) disposed on at least one of the arms (2a, 2b, 2c, 2d) elongated, so that the groove (67) guides the projection (66) along the body (20) during the deployment of the arms (2a, 2b, 2c, 2d) elongated.
    îo 15. Intervertebral implant according to one of claims 1 to 14, characterized in that the expansion means (3, 8, 25, 66, 67, 151) comprise at least one attachment means (8) with at less instrumentation (PI, P3, D, D30, D31) and connected to the branches (151) so as to cause the translation of the expansion means (3, 25, 66, 67, 151) by
    [12" id="c-fr-0012]
    15 relative to the body (20) of the implant (1) during the deployment of the elongated arms (2a, 2b, 2c, 2d).
    [13" id="c-fr-0013]
    16. Intervertebral implant according to one of claims 2 to 15, characterized in that the insert (3) is configured to dissociate into at least two fragments, forming said branches (151), to cause the
    20 translation of the expansion means (3, 8, 21, 21a, 21b, 22, 25, 66, 67, 151) relative to the body (20) of the implant (1) during the deployment of the elongated arms ( 2a, 2b, 2c, 2d).
    [14" id="c-fr-0014]
    17. Intervertebral implant according to one of claims 1 to 15, characterized in that the branches (151) are arranged on the end
    25 distal of said body (20) of the implant (1) and comprise at least one projecting part (31) allowing the anchoring of said implant (1) on at least one vertebra (V).
    [15" id="c-fr-0015]
    18. Intervertebral implant according to one of claims 1 to 17, characterized in that the implant (1) comprises at least one anchoring device (DA) capable of passing through a passage passing through at least a portion of said implant (1) between a periphery of the implant (1) and at least one vertebra (V) and fix said implant (1) on said vertebra (V).
    [16" id="c-fr-0016]
    19. Intervertebral implant according to claim 18, characterized in that
    5 that the base (6) comprises at least one guide groove adapted to at least partially guide the anchoring device (DA).
    [17" id="c-fr-0017]
    20. Intervertebral implant according to one of claims 18 and 19, characterized in that the base (6) comprises at least one orifice adapted to at least partially accommodate an anchoring guide (GA) of the anchoring device ( DA).
    [18" id="c-fr-0018]
    21. Instrumentation for the implantation of at least one intervertebral implant (1) according to one of claims 1 to 20, between at least two vertebrae (V), characterized in that it comprises at least the following instruments:
    15 - an implant tube (PI) able to be fixed on the base (6) of the implant (1) and to guide it towards the intervertebral space,
    - a spreader (D) capable of fitting into the implant holder tube (PI) and comprising a connection rod (P3) capable of allowing actuation of the expansion means.
    20
    [19" id="c-fr-0019]
    22. Instrumentation according to claim 21, characterized in that the actuation is carried out by fixing the connection rod (P3) on the attachment means (8) of the implant (1).
    [20" id="c-fr-0020]
    23. Instrumentation according to one of claims 21 and 22, characterized in that it comprises at least one charger (CA, CG) capable of receiving at
    25 at least one anchoring device (DA) and / or a graft (G), and at least one impactor (IG) capable of impacting anchoring devices (DA) or of delivering a graft (G) through the loader (CG).
    [21" id="c-fr-0021]
    24. Instrumentation according to one of claims 21 to 23, characterized in that it further comprises a implantation gun (P) comprising a handle (PPI) able to connect to the implant holder tube (Pl) through a connection means (CPI) so as to implant at least one
    5 implant (1), an anchoring device (DA) and / or a graft (G) to the vertebra (V).
    [22" id="c-fr-0022]
    25. Instrumentation according to claim 24, characterized in that the instruments, such as the spreader (D), the magazine (CA, CG) or the impactor (IG), can be coupled and uncoupled successively on the pistol (P ) during an implantation.
    [23" id="c-fr-0023]
    26. Instrumentation according to one of claims 24 and 25, characterized in that the gun can be coupled and decoupled with or without the presence of instruments, such as the spreader, the magazine or the impactor, in the tube of the implant holder .
    1/21
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    法律状态:
    2018-02-22| PLFP| Fee payment|Year of fee payment: 2 |
    2018-05-04| PLSC| Publication of the preliminary search report|Effective date: 20180504 |
    2018-10-15| PLFP| Fee payment|Year of fee payment: 3 |
    2019-09-20| PLFP| Fee payment|Year of fee payment: 4 |
    2020-09-17| PLFP| Fee payment|Year of fee payment: 5 |
    2021-09-13| PLFP| Fee payment|Year of fee payment: 6 |
    优先权:
    申请号 | 申请日 | 专利标题
    FR1660472|2016-10-27|
    FR1660472A|FR3058042B1|2016-10-27|2016-10-27|EXPANDABLE INTERVERTEBRAL IMPLANT|FR1660472A| FR3058042B1|2016-10-27|2016-10-27|EXPANDABLE INTERVERTEBRAL IMPLANT|
    PCT/IB2017/001462| WO2018078450A1|2016-10-27|2017-10-27|Expansible intervertebral implant|
    US15/796,732| US10561502B2|2016-10-27|2017-10-27|Expansible intervertebral implant|
    US16/737,712| US20200205992A1|2016-10-27|2020-01-08|Expansible intervertebral implant|
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