ANCHORING DEVICE FOR SPINAL IMPLANT, SPINAL IMPLANT AND IMPLANTATION INSTRUMENTATION

专利摘要:
The present invention relates to an anchoring device (1) for a spinal implant (2), an implant (2), a surgical instrumentation for the latter and a spinal surgery system, the anchoring device (1) comprising at least one rigid plate (10) of longitudinal axis, configured so that its anterior end penetrates into at least one vertebral surface while its posterior end remains in a passage of the implant (2), characterized in that the implant (2) comprises at least one locking means (3) of the device (1) relative to the implant (2) and in that the anchoring device (1) comprises at least one stop (14), said locking means ( 3) comprising at least one flexible portion (30) and at least one stop (31), cooperating with said stop (14) of the device (1), the insertion of the anchoring device (1) in the passage to push back said abutment (31) of the locking means (3) thanks to the flexibility of said port flexible ion (30) which also allows the reciprocal engagement of the two abutments (14, 31) when they face each other, by the elastic return of the flexible portion (30)
公开号:FR3016793A1
申请号:FR1450749
申请日:2014-01-30
公开日:2015-07-31
发明作者:Herve Chataignier；Herve Dinville；Pierre Bernard；Craig Chebuhar；Emmanuel Bougere
申请人:LDR Medical SAS；
IPC主号:

专利说明:

[0001] BACKGROUND OF THE INVENTION The present invention relates to orthopedic implants, including in particular spinal (spinal) implants, such as interbody cages for example. The intersomatic cages can be implanted between two adjacent vertebrae for the placement and growth of bone grafts (or substitute) in the disc space and obtain arthrodesis (fusion of two vertebrae). For example, after placement of the cage, the intervertebral space is filled with autologous cancellous bone or suitable bone substitutes which may also (or as an alternative) be placed in a cavity of the cage prior to placement in the cage. space. The invention particularly relates to intervertebral implants such as interbody cages but also relates to other types of implants such as intervertebral disk prostheses or arthrodesis plates. In addition, the invention relates in particular to bone anchoring devices (anchors) for fixing implants in the vertebrae and the implantation of implants in the disc space by an instrumentation for implanting and fixing the implants to the implants. vertebrae by anchors. BACKGROUND OF THE INVENTION A problem in this area relates to the stability of spinal implants in the disc space once they have been implanted therein. This stability is essential for intervertebral disk prostheses which often preserve a certain degree of mobility at the vertebrae between which they are implanted, but also for other types of implants, especially when arthrodesis is desired, for example using intersomatic cages and / or other implants allowing arthrodesis (which may, for example, be performed using auxiliary stabilizing structures such as osteosynthesis bars). Indeed, there is, for example, a risk that the implant moves in the intervertebral space under the effect of forces experienced during patient movements, even when the implant is provided with notches or teeth on its surfaces. vertebral contact. It is therefore often necessary to fix the spinal implant to the adjacent vertebrae between which it is implanted. In the case of arthrodesis, it is also often provided osteosynthesis bars immobilizing the vertebrae, preferably with a lordosis, to prevent the cage can come out of the intervertebral space. It is known in the prior art solutions providing the spinal implant a bone anchoring device that securely attaches the implant in the vertebrae between which the implant is intended to be implanted. Another problem in the field concerns the invasiveness and in particular the access to the intervertebral spaces (disc spaces) which is often particularly delicate because of the congestion, in particular because of the presence of blood vessels and nerves around the the intervertebral space, as well as the proximity of the spinal cord. The bone anchoring devices which must penetrate the vertebrae deep enough to ensure good fixation, must also have a small footprint and allow to fix the implant without endangering the blood vessels and surrounding nervous tissues (for example in not requiring more space in the vicinity of the intervertebral space than necessary for implantation of the spinal implant itself). In particular, some implants (including interbody cages) are intended to be implanted by a posterior approach (from the back of the patient) or a transforaminal pathway (through the foramen). The posterior route generally requires partial resection of the articular joints and passes between the dura mater and the articular joints (generally there are two cages arranged substantially parallel to the sagittal plane). This path follows a path very close to the spinal cord and requires cages of reduced dimensions. The transforaminal pathway 5 takes an oblique path with respect to the sagittal plane and requires cages of small dimensions but of sufficient length to be arranged obliquely or perpendicularly to the sagittal plane. Pathways of the smallest possible access are generally sought to limit the invasiveness of the surgical implantation procedure. In addition, in order to limit invasiveness, it is possible to avoid the need for additional material (posterior or anterior), such as osteosynthesis bars (with pedicular screws in general) or dental plaques. osteosynthesis. The use of anchoring means for fixing the cages could make it possible to respond to this problem if these anchoring means are reliable. The cages are usually placed between the vertebrae at anterior position on the vertebral plateaus, to allow to impose a lordosis. The osteosynthesis bars may be used to impose a lordosis which prevents the cage from receding, but anchoring means will therefore be preferred if the fixation and stability of the implant obtained are reliable. Such anchoring means must preferably also respond to the problem of limiting invasiveness, in addition to reliability and stability. In addition, a particular problem for bone anchoring means relates to ablation. Indeed, it is generally desired to remove the bone anchoring means (and the implant in general). It is therefore necessary that the bone anchoring means are retained in the implant stably but that they can also be removed as easily as possible. In addition, easy removal should preferably also be feasible with the smallest possible invasiveness. It is known in the prior art, in particular from the published patent applications WO 2008/149223 and WO2011 / 080535 filed by the applicant of the present application, to which the reader may refer to examine the various problems solved and the advantages provided by this type of solution, an anchoring device adapted to be implanted securely and deeply enough in the vertebral plates 5 to ensure proper maintenance of the plated implant against these vertebrae, but along an axis of approach for the insertion, substantially (ie, generally) in the plane of the intervertebral space. This type of solution typically comprises at least one anchor formed by a plate, often curved and generally rigid, arranged to penetrate a plate of a vertebra through an implant and provided with at least one abutment for retaining this implant. against this vertebra. This type of anchoring device or anchor, including a plate intended to be planted in the bone can sometimes pose a problem of risk that the plate crack the vertebra, during its impaction in the vertebra or under the effect of forces exerted on the implant and / or on the anchor once planted in the vertebra. Similarly, this type of anchor can sometimes present a risk of causing a too large cut during its impaction in the vertebra, may induce the possibility of an unwanted play of the anchor that may make the fixation of the implant weak (fragile) and / or unreliable. Application W02011 / 080535 aims to respond to such problems. It will be noted that the term "impaction" here refers to planting the anchoring device in the vertebrae. Note that the present application discloses an impactor which is an impaction device because it is arranged to allow to plant an anchor device in a vertebra. On the other hand, another potential problem of this type of anchor having a plate is the rigidity. In certain circumstances, it is important that the anchor is rigid enough not to deform and / or present too much play under the effect of the forces that are exerted on it, to prevent it gradually emerging from the vertebra in which it is anchored and to limit the risk of mobility of the cage 30 in the intervertebral space. The rigidity of this type of anchor is therefore often an important feature to allow effective fastening, particularly more effective than staples or other thin and / or relatively flexible or even fragile devices. Finally, a last problem concerns the risks of weakening the implant by the arrangement of fasteners against the vertebrae. This problem concerns in particular the size of the anchor relative to the implant, but especially the size of the passage of the implant intended to receive this anchor. Indeed, the passage of the anchor through the implant and maintaining the stability of this type of anchor in the implant (possibly subject to a desired game, for example a minimum game) is also an aspect that is important for reliable fixation under certain circumstances. The application W02011 / 080535 also aims to respond to this type of stability problem. These anchoring devices provide a good anchoring solution with limited invasiveness, but they require a size that is still too large to accommodate the dimensional constraints of certain implants, such as the posterior or transforaminal cages and can therefore be improved to further limit invasiveness. In addition, the removal of this type of bone anchoring means is often problematic, especially if it is desired that the removal is easy while limiting the invasiveness. Similarly, application WO2013124453, filed by the applicant of the present application, aims to address these problems of embrittlement of implants by anchors and easy removal of anchors. However, it remains useful to propose other types of solutions, in particular responding even more effectively to these problems. In addition, depending on the type of implant concerned, it may be necessary for the anchor, which is generally rigid, to be retained by an equally solid structure, in order to prevent it from damaging the implant under the action of the implants. efforts exerted on the anchor and the implant. In particular, in the case of implant material softer or less solid than that of anchors, there may be a risk of embrittlement of the implant or the retention of the anchor in the implant.
[0002] In this context, it is interesting to propose a solution to overcome at least one of the drawbacks (and / or others) of the prior art.
[0003] GENERAL DESCRIPTION OF THE INVENTION Certain embodiments incorporating various technical features described in the present application are therefore intended to overcome at least one of the disadvantages (and / or others) of the prior art by proposing devices for anchoring for spinal implants which are (more) compact (space-saving) and / or whose possibility of removal is improved and / or which offers better reliability (increased stability of the anchor and the implant and / or reduced risk of weaken the implant). On the other hand, some embodiments also aim to solve various problems by providing an easily implantable anchoring device, in particular by an approach path along an axis substantially perpendicular to the axis of the spine, and which can be rigid and allow reliable fixation with a low risk of damage to the vertebrae, in particular by the posterior and / or transforaminal implantation pathways.
[0004] This type of goal is achieved, for example, by a bone anchoring device for spinal implant, arranged to be inserted through a through passage at least a portion of the implant, from an outer surface to a contact surface. vertebral device, the device comprising a body comprising at least one rigid plate and elongated along a longitudinal axis extending between an anterior end and a posterior end, the plate being configured so that its anterior end penetrates into at least one vertebral surface while its posterior end remains in the passage of the implant, retaining said implant against said vertebral surface, the device being characterized in that said body comprises at least one stop oriented non-parallel to the longitudinal axis and complementary to at least one stop at least one locking means of the device relative to the implant, said locking means equipping the implant, being provided with at least one flexible portion making it possible, on the one hand, to push back said abutment of the locking means for insertion of the anchoring device into the passage, and on the other hand, reciprocal engagement two abutments when they are found opposite each other, by the elastic return of the flexible portion. According to another feature, anchoring device comprises at least one attachment means, configured to hang the end of a tool for removal of the anchoring device. According to another feature, said attachment means is located near the rear end of the anchoring device. According to another feature, the anchoring device comprises at least one means of access to the locking means for disengaging the respective abutments of the anchoring device and the locking means. According to another feature, said abutment of the device comprises at least one abutment surface oriented substantially opposite the posterior end of the anchoring device, to cooperate with at least one complementary abutment surface, of opposite orientation, on the abutment of the abutment. locking means and thus oppose the removal of the device from said passage. According to another particularity, said abutment surface of the abutment of the device is oriented not perpendicularly to the axis of insertion of the anchoring device in the implant, to enable the abutment of the abutment of the locking means and thus to unlock the device anchoring by traction performed on a hooking means. According to another feature, said abutment of the device comprises at least one abutment surface facing the anterior end of the anchoring device, to cooperate with at least one complementary abutment surface, of opposite orientation, on the abutment of the means. locking and thus oppose an excessive advance of the device in said passage.
[0005] According to another feature, said stop of the device is a female stop cooperating with a male stop of the locking means. According to another feature, said stop of the device is a male abutment cooperating with a female stop of the locking means.
[0006] According to another feature, said stop of the device is a recess in a surface of the anchoring device, intended to cooperate with a projection forming the abutment of the locking means. According to another feature, said abutment of the device forms a protrusion protruding from a surface of the anchoring device and intended to cooperate with a recess in a surface of the locking means. According to another feature, said rigid plate is curved and complementary to the shape of the passage of the implant so as to pass through the implant without deformation and to be inserted along an axis not perpendicular to the vertebral surface in which the end must penetrate. earlier. According to another feature, the body describes at least one circular or elliptical arc having dimensions and at least one radius of curvature so that the anchoring device is implantable in a vertebral plateau along an approach axis forming with the vertical axis of the spine an angle of approximately 90 °, having its longitudinal axis substantially in the plane of the intervertebral space. According to another feature, the stop of the device is formed by a surface of the posterior end of the plate which is arranged to penetrate sufficiently into the implant. According to another feature, the body comprises a second plate 25 elongate along said longitudinal axis of the first plate and extending between the front end and the posterior end, the second plate being secured to the first plate and substantially perpendicular to the first plate, conferring on the device an L-shaped section complementary to the internal section of the passage in the implant. According to another feature, the body comprises, at least at its anterior end, at least one chamfer or bevel facilitating penetration of the device into said vertebral surface.
[0007] In another feature, the front end has at least one notch facilitating the penetration of the device in said vertebral surface. According to another feature, the body is provided with notches oriented so as to oppose withdrawal of the device once implanted in a vertebra. According to another feature, the body is provided, at the portion intended to penetrate the vertebral surface, at least one hole for bone growth through the anchoring device.
[0008] Another aim of certain embodiments incorporating various technical features described in the present application is to overcome at least one of the drawbacks of the prior art by proposing spinal implants, able to be fixed by anchoring devices according to various modes. of the invention, and which are (more) compact (compact) and / or whose possibility of removal is improved and / or which offers a better reliability (increased stability of the anchor and the implant and / or risk of weakening the implant). On the other hand, certain embodiments also aim to solve various problems by proposing an easily implantable vertebral implant, particularly by an approach path along an axis substantially perpendicular to the axis of the spine, and which can be fixed from reliably with a low risk of damaging the vertebrae, in particular by the posterior and / or transforaminal implantation pathways. This object is achieved, for example, by a spinal implant, comprising at least one external surface and at least one a vertebral contact surface through which the implant is intended to be placed in contact with at least one vertebral surface, said spinal implant being configured to receive at least one anchoring device according to one of the preceding claims, thanks to the at least one passage passing through at least a portion of the implant along an insertion axis, from said outer surface to said vertebral contact surface, implant being characterized in that it comprises at least one locking means of the device relative to the implant, said locking means being provided with at least one flexible portion and at least one stop oriented non parallel to the implant. insertion axis of the passage and complementary to said stop of the device to cooperate with it and thus lock the device relative to the implant, the flexibility of said flexible portion allowing, on the one hand, to push said stop of the means of locking for the insertion of the anchoring device in the passage, and, secondly, the reciprocal engagement of the two stops when they are found opposite each other, by the elastic return of the portion flexible.
[0009] According to another feature, the implant comprises at least one means of access to the locking means for disengaging the respective abutments of the anchoring device and the locking means. According to another feature, the implant comprises at least one access means, from outside the implant, to at least one attachment means 15 of the anchoring device configured to hook the end of a tool allowing the removal of the anchoring device. According to another particular feature, said abutment of the locking means comprises at least one abutment surface oriented substantially opposite the exit of the passage, towards the vertebral contact surface, for cooperating with cooperating with at least one complementary abutment surface, opposite orientation, on the abutment of the anchoring device and thus oppose its removal from said passage. According to another feature, said stop surface of the abutment of the locking means is oriented not perpendicular to the axis of the passage of the anchoring device in the implant, to allow the stop of the locking means to be pushed back and thus to unlock the anchoring device by traction performed on a fastening means of the anchoring device. According to another feature, said abutment of the locking means comprises at least one abutment surface facing the entrance of the passage, towards the outer surface, to cooperate with at least one complementary abutment surface, of opposite orientation, on the abutment of the anchoring device and oppose excessive advance of the device in said passage. According to another feature, said stop of the locking means is a male abutment cooperating with a female abutment of the anchoring device. According to another feature, said stop of the locking means is a female stop cooperating with a male stop of the device. According to another feature, said stop of the locking means forms a projection for cooperating with the stop of the device formed by a recess in a surface of the anchoring device. According to another feature, said abutment of the locking means is a recess in a surface of the locking means for cooperating with the abutment formed by a protrusion protruding from a surface of the anchoring device.
[0010] According to another feature, said passage is rectilinear or curved and complementary to the shape of the curved anchoring device so as to allow the anchoring device to pass through the implant without deformation, by insertion along a non-perpendicular axis to the vertebral surface into which the anterior end must penetrate.
[0011] According to another feature, the passage in the implant has an internal section L-shaped, complementary to the shape of the anchoring device whose body comprises a second plate elongated along said longitudinal axis of the first plate and extending between the anterior end and the posterior end, the second plate being secured to the first plate and substantially perpendicular to the first plate. In another feature, the locking means is retained in a housing of the implant and oriented in a direction not parallel to the axis of insertion of the anchoring device. According to another feature, the locking means is retained in the implant by means of retaining means preventing movement of the stop in the direction of insertion and / or removal of the anchoring device.
[0012] In another feature, the retaining means are configured so that the locking means is removable. In another feature, the retaining means are formed by notches on at least one surface of the locking means for anchoring in the walls of a housing of the implant in which is inserted the locking means. According to another feature, the retaining means are formed by at least one shoulder of the locking means intended to abut against the anchoring device, on either side of its abutment, so that the anchoring device prevents movement of the locking means in the spinal implant. According to another feature, the retaining means are formed by a recess in the locking means for receiving a pin or a staple inserted through the spinal implant to cooperate with this recess. According to another feature, the retaining means are formed by a housing in the locking means for receiving a rod inserted in this housing through a conduit of the spinal implant. According to another feature, said locking means is formed by an insert of elongate shape along a longitudinal axis not parallel to the insertion axis. According to another feature, said locking means is formed by a slotted ring-shaped insert inserted in a complementary housing of the spinal implant near said passage.
[0013] According to another feature, said locking means is formed by a cylindrical insert screwed into a housing of the spinal implant and its abutment is formed by at least one flexible tab opening into the passage to cooperate with the abutment of the anchoring device. According to another feature, the implant is formed by at least one intersomatic cage, comprising a body forming a means for maintaining the height of the intervertebral space, said at least one passage passing through said body from a peripheral wall to a surface vertebral contact of the cage. According to another feature, the implant is formed by at least one intervertebral disk prosthesis, comprising at least two plates articulated to each other by at least one curved surface, said at least one passage passing through at least one of the two plates, from an edge device of the tray or from an inner face of the prosthesis, to a vertebral contact surface of the prosthesis. According to another feature, the implant is formed by at least one osteosynthesis plate traversed by the passage from an outer face to a vertebral contact face of the osteosynthesis plate. According to another feature, said locking means is machined directly in the thickness of said plate or said plate. According to another feature, the implant comprises at least one attachment means for its gripping by a surgical instrument. Another object of certain embodiments incorporating various technical features described in the present application is to overcome at least one of the disadvantages of the prior art by providing surgical instrumentation for the implantation and fixation of spinal implants (vertebral). , especially intersomatic cages, in particular along an axis of approach substantially in the plane of the intervertebral space, to limit invasiveness. This object is achieved, for example, by surgical instrumentation, for implanting a spinal implant according to certain embodiments of the invention and for fixing this implant in at least one vertebra with at least one device. anchoring, according to some embodiments of the invention, the instrumentation comprising: - an implant holder elongated along a longitudinal axis extending between a first end, said gripping of the implant, and a second end, said pusher, the gripping end comprising a head provided at its end with at least one means for gripping the implant, the head being traversed by a longitudinal passage emerging on the implant and adapted to receive said anchoring device at least one impactor of elongated shape along a longitudinal axis extending between the two ends of the impactor, one end comprising at least one branch capable of penetrating into the implant holder; to push the posterior end of said anchoring device, while the other end of the impactor comprises a so-called impaction surface, arranged to receive a thrust or impact to penetrate the anterior end of said device; anchoring in a vertebra through the passage of the implant, - at least one guide surface of the anchoring device for guiding the sliding of the latter in the implant holder through the implant, the instrumentation being characterized in that it comprises at least one means of access to the complementary stops of the anchoring device and the locking means for pushing the locking means during the insertion of said anchoring device into the passage of the implant . According to another feature, the surgical instrumentation comprises at least one retaining means adapted to cooperate with said abutment of the anchoring device to retain the latter in the implant holder before actuating the impactor. In another feature, the surgical instrumentation comprises at least one loader slidable in the head of the implant holder and provided with said guide surface and said retaining means.
[0014] According to another feature, the surgical instrumentation comprises two loaders, each of them being, on the one hand, provided with a guide surface and a retaining means and, on the other hand, capable of sliding in the head of the implant holder. According to another feature, the impactor comprises two branches 30 able to push at the same time, in the head of the implant holder, two loaders on which are loaded the two anchoring devices.
[0015] According to another feature, the implant taking means is configured to cooperate with at least one attachment means of said implant. According to another feature, the surgical instrumentation comprises an anchoring device removal tool comprising a fastening means for one end of the removal tool which is configured to hang the anchoring device, so that traction on the tool to remove the latter from its passage in the implant. According to another particularity, the tool is configured to access the anchoring means of the anchoring device via an access means of an implant according to certain embodiments of the invention. Another aim of certain embodiments incorporating various technical features described in the present application is to overcome at least one of the drawbacks of the prior art by proposing a spinal (spinal) surgery system for the implantation and fixation of spinal (spinal) implants. This object is achieved by a spinal surgery system, characterized in that it comprises at least one anchoring device according to certain embodiments of the invention and at least one spinal implant according to certain embodiments of the invention, at least one locking means for locking said anchoring device relative to the spinal implant to ensure the stabilization of the latter in a vertebra. According to another particularity, the system comprises at least one instrument of an implantation instrumentation according to certain embodiments of the invention. DESCRIPTION OF THE ILLUSTRATIVE FIGURES Other features and advantages of the present invention will emerge more clearly on reading the following description, made with reference to the appended drawings, in which: FIGS. 1A and 1B represent, respectively, a partial view in section along the plane 1A-1A of FIG. 1B and a rear view of an implant provided with fixing devices according to one embodiment of the invention, FIG. 1C represents a perspective view of a fixing device according to an embodiment of the invention and FIG. 1D represents a perspective view of a locking device according to one embodiment of the invention; FIGS. 2A and 2B show, respectively, a partial sectional view along the plane 2A-2A of FIG. 2B and a rear view of an implant provided with fixing devices according to one embodiment of the invention; FIG. 2C represents a perspective view of a fastening device according to one embodiment of the invention and FIG. 2D represents a perspective view of a locking device according to one embodiment of the invention; FIG. 3B represents a rear view of an implant provided with fixing devices according to one embodiment of the invention, FIGS. 3A and 3C show partial sectional views, according to the cutting plane 3AC-3AC of FIG. 3B, two variants of this embodiment of the invention, Figures 3D and 3E are perspective views of a fastener, variants, respectively, of Figure 3A and Figure 3C, and Figure 3F is a perspective view of a locking device according to the embodiment of Figure 3A; FIG. 4B represents a rear view of an implant provided with fixing devices according to one embodiment of the invention; FIGS. 4A, 4C and 4D represent partial sectional views, according to the sectional plane 4ACD4ACD of FIG. 4B, three variants of this embodiment of the invention, Figures 4E and 4F are perspective views of a fastener, variants, respectively, of Figure 4C and Figure 4A, and Figure 4G shows a perspective view of a locking device according to one embodiment of the invention; FIGS. 5A, 5B and 5D represent, respectively, a profile view, a partial rear view and a sectional view along the sectional plane 5D-5D of FIG. 5B, of an implant provided with fixing devices according to a embodiment of the intention, Figures 5C and 5E show perspective views, respectively, of a fastener and a locking device, according to this embodiment of the invention; FIG. 6B represents a partial rear view of an implant provided with fixing devices according to one embodiment of the invention, FIGS. 6A and 6C show partial sectional views, according to the sectional plane 6AC-6AC of FIG. FIG. 6B, of this embodiment of the invention according to, respectively, an alternative variant and the variant of FIG. 6B, FIGS. 6D and 6E represent side views of the locking devices according to the variants, respectively, of FIG. 6C and FIG. 6A, and FIGS. 6F and 6G show perspective views, respectively, of a fastening device and a locking device, according to the alternative embodiment of FIG. 6A; FIG. 7B represents a rear view of an implant provided with fixing devices according to one embodiment of the invention, FIGS. 7A and 7C show partial sectional views, according to the sectional plane 7AC-7AC of FIG. 7B, of two variants of this embodiment of the invention, FIG. 7D represents a partial sectional view, according to the sectional plane 7D-7D of FIG. 7A, of the alternative embodiment of FIG. 7A, FIGS. and 7F are perspective views of a fastener, variants, respectively, of FIG. 7C and FIG. 7A, and FIG. 7G is a perspective view of a locking device according to the embodiment variant of FIG. Figure 7A; FIGS. 8A and 8B show, respectively, a profile view and a partial sectional view, according to the sectional plane 8B-8B of FIG. 8A, of an implant provided with fixing devices according to an embodiment of FIG. FIG. 8C shows a perspective view of a fastening device according to this embodiment and FIG. 8D is a perspective view of a locking device according to this embodiment; FIGS. 9A and 9B show, respectively, a partial sectional view, along the section plane 9A-9A of FIG. 9B and a rear view, of an implant provided with fixing devices according to an embodiment of FIG. 9C and 9D show, respectively, a perspective view and a side view of a fastening device according to this embodiment, and FIGS. 9E and 9F show, respectively, a profile view and a perspective view of a locking device according to this embodiment; FIG. 10B represents a rear view of an implant provided with fastening devices according to one embodiment of the invention; FIGS. 10A and 10C show partial cross-sectional views, according to the cutting plane 10AC-10AC of FIG. 10B, of two variants of this embodiment of the invention, FIG. 10D represents a partial sectional view, along the section plane 10D-10D of FIG. 10A, of the alternative embodiment of FIG. 10A, FIGS. and 10F represent, respectively, a profile view and a perspective view of a fastening device, of the variant of FIG. 10A, and FIG. 10G represents a perspective view of a locking device according to the embodiment variant. of Figure 10A; FIG. 11B shows a rear view of an implant provided with fixing devices according to one embodiment of the invention, FIGS. 11A and 11C show partial sectional views, along the section plane 11AC-11AC of FIG. FIG. 11B, of two variants of this embodiment of the invention, FIGS. 11D and 11E represent, respectively, a profile view and a perspective view of a fixing device according to the embodiment variant of FIG. 11A, and Figures 11F and 11G show, respectively, a profile view and a perspective view, of a locking device according to the alternative embodiments, respectively, of Figure 11C and Figure 11A; FIGS. 12B and 12E show, respectively, a rear view and a top view of an implant provided with fixing devices according to one embodiment of the invention, FIGS. 12A and 12C show partial sectional views, according to the sectional plane 12AC-12AC of FIG. 12B, of two variants of this embodiment of the invention, FIG. 12D represents a partial sectional view, along the sectional plane 12D-12D of FIG. 12E, of In this embodiment, Figures 12F and 12G show, respectively, a side view of a fastener and a perspective view of a latch according to this embodiment; FIG. 13B represents a rear view of an implant provided with fixing devices according to one embodiment of the invention, FIGS. 13A and 13C show partial cross-sectional views, respectively, along the section plane 13A-13A of FIG. FIG. 13B and according to the sectional plane 13C-13C of FIG. 13A, of this embodiment of the invention, and FIGS. 13D and 13E represent, respectively, a perspective view of a locking device according to this embodiment. embodiment and a front view of a locking device according to a variant of this embodiment; FIG. 14C represents a rear view of an implant provided with fastening devices according to one embodiment of the invention, FIGS. 14A, 14B and 14E show partial cross-sectional views, respectively, along the section plane 14A. 14A of FIG. 14C, according to the section plane 14B-14B of FIG. 14C and according to the sectional plane 14E-14E of FIG. 14A, of this embodiment of the invention, FIGS. 14D, 14G and 14F represent perspective views, respectively, of a fastening device, a locking device and a locking device holding means according to this embodiment; FIG. 15B shows a rear view of an implant provided with fixing devices according to one embodiment of the invention; FIGS. 15A, 15C and 15D show partial cross-sectional views, respectively, along the section plane 15A; 15A of FIG. 15B, according to the sectional plane 15C-15C of FIG. 15B and according to the sectional plane 15D-15D of FIG. 15A, of this embodiment of the invention, FIGS. 15E and 15F represent views. in perspective, respectively, of a fixing device and a locking device according to this embodiment; FIG. 16B represents a rear view of an implant provided with fixing devices according to one embodiment of the invention; FIGS. 16A, 16C and 16D represent partial sectional views, respectively, along the section plane 16A; 16A of FIG. 16B, according to the sectional plane 16C-16C of FIG. 16B and according to the sectional plane 16D-16D of FIG. 16A, of this embodiment of the invention, FIGS. 16E and 16F represent views. in profile, respectively, a fixing device and a locking device according to this embodiment; FIG. 17C represents a rear view of an implant provided with fixing devices according to one embodiment of the invention, FIGS. 17A, 17B and 17E show partial sectional views, respectively, along the section plane 17AD. 17AD of FIG. 17C, according to the sectional plane 17B-17B of FIG. 17C and according to the sectional plane 17E-17E of FIG. 17A, of this embodiment of the invention, FIG. 17D represents a partial view of FIG. section 17C-17AD of FIG. 17C of an alternative embodiment, FIGS. 17F and 17G show perspective views, respectively, of a fixing device and a locking device according to FIG. embodiment of Figure 17C; FIGS. 18A and 18C show, respectively, a sectional view along the sectional plane 18A-18A of FIG. 18C and a rear view of an implant provided with fixing devices according to one embodiment of the invention, FIGS. 18D, 18E and 18F show partial sectional views along the 18DEF-18DEF section plane of FIG. 18A, of three variants of this embodiment of the invention, FIG. 18G represents a profile view of a FIG. fixing device according to this embodiment and FIGS. 18B, 18H and 181 represent views of a locking device, respectively, in perspective according to the variant of FIG. 18D, of profile according to the variant of FIG. 18F and of profile according to the variant of Figure 18E; FIGS. 19B and 19C show, respectively, a rear view and a top view of an implant provided with fixing devices according to one embodiment of the invention, FIGS. 19A and 19D show partial sectional views, respectively, according to the sectional plane 19A-19A of Figure 19B and according to the sectional plane 19D-19D of Figure 19C, of this embodiment of the invention, Figures 19E and 19F show, respectively, a view of a fastener profile and a perspective view of a locking device according to this embodiment; FIGS. 20A, 20C and 20E show perspective views of an implant provided with fixation devices, before the ablation of the fixation devices according to three embodiments, FIGS. 20B, 20D and 20F represent the implants, respectively, Figures 20A, 20C and 20E during ablation of the fasteners; FIGS. 21A and 21B show perspective views of an implant provided with fixing devices, respectively, before and during the ablation of the fixing devices according to one embodiment of the invention, FIGS. 21C and 21D. represent, respectively, a top view and a perspective view of this implant during the ablation of the fixing devices, and FIGS. 21E and 21F show partial sectional views, respectively, along the section plane 21E 21 E of FIG. 21 D and the sectional plane 21 F-21 F of FIG. 21C; FIG. 22A represents a perspective view of an implant provided with fixation devices, before the ablation of the fixation devices according to one embodiment, FIGS. 22B, 22C and 20D represent this same implant during the ablation. one of the fasteners by a removal tool; FIGS. 23A, 23B and 23C show, respectively, a perspective view, a top view and a sectional view along a sectional plane 23C-23C of FIG. 23B, of a loader carrying a fastening device according to certain modes. embodiment and Figure 23D is a perspective view of a portion of an implant holder containing two loaders; FIGS. 24A, 24B and 24C show, respectively, a top view, a profile view and a sectional view along section plane 24C-24C of FIG. 24B, of an implant holder bearing an implant traversed by fasteners with an impactor according to some embodiments; FIG. 25A represents a perspective view of an implant holder carrying an implant traversed by fixing devices by an impactor according to certain embodiments; FIGS. 26B and 26A show, respectively, a profile view and a sectional view along the sectional plane 26A-26A of FIG. 26B, of an intervertebral disk prosthesis according to certain embodiments, FIGS. 26C and 26D. represent, respectively, a perspective view of a fixation device and a bottom view of an upper intervertebral disc prosthesis top plate according to a first embodiment and FIGS. 26E and 26F represent, respectively, a perspective view of a fixing device and a bottom view of an upper intervertebral disc prosthesis plate according to a second embodiment. DESCRIPTION OF THE PREFERRED EMBODIMENTS OF THE INVENTION Various embodiments of the invention will now be described with reference to the figures of the present application and they concern mainly 3 groups of objects: anchoring devices (1) ( or "fastening devices" or "anchors"), and / or anchoring systems comprising several anchoring devices (1) which may be identical or different, or even complementary to one another; intervertebral implants (2) arranged to receive one or more of such devices (1) or anchoring systems, including, but not limited to, intersomatic cages configured for posterior or transforaminal implantation; - Instrumentation (3, 4, 5) for the implantation of these implants (2) between the vertebrae and their attachment by such devices (1) or anchoring systems.
[0016] Each of these groups of objects may include various possible embodiments relating to a given object. Each of the objects comprises various elements (generally constituting the object) characterized by at least one technical characteristic. Each object (of a given group) concerned by at least one technical characteristic may be associated with at least one other object (of the same or of another group), for example with respect to at least one additional technical characteristic , so that object groups share a common inventive concept. The present invention may therefore also relate to an assembly comprising at least 2 of these objects, as well as each object individually. The various elements (for example, a plate, a stop, a slot, a chamfer or bevel, etc.) as well as their technical characteristics (for example, curvature, orientation, length, width, height, etc.) are described in more detail hereinafter in this application. At least one technical feature (or combination of features), corresponding for example to an element of a given object generally solves at least one technical problem, in particular among those mentioned in the preamble of the present application. The present application therefore describes various embodiments or configurations for each object or group of objects, by specifying at least one technical characteristic of at least one element. It will be understood from reading the present application that each of the technical characteristics of each element, described in at least one embodiment or configuration, may be isolated from the other characteristics of the object concerned (or the objects concerned and / or associated ) by said embodiment or said configuration (and thus relating to the same or a different element) and / or may be combined with any other technical feature described herein, in various embodiments or configurations, unless the opposite is explicitly mentioned, or that these characteristics are incompatible with one another and / or that their combination does not work, in particular because the structural adaptations that may be required by such isolations or combinations of features are directly appreciation of the functional considerations provided in this application e. Similarly, although certain technical features are discussed here with reference to the anchoring device, they may be incorporated in various embodiments or configuration of the anchoring systems. In general, the specific technical characteristic (s) for a given element should not be considered exclusive of those concerning another element, or other technical characteristics concerning the same element. unless it is clear that the combination is impossible or non-functional. Although the present application details various embodiments or configurations of the invention (including preferred modes), its spirit and scope should not be limited to the given examples. Various embodiments of anchoring devices (1) according to the present invention can be used with intervertebral implants (2) which may for example be such as intersomatic cages (intervertebral disk replacement cages for performing arthrodesis), cages corporectomy (vertebral segment replacement cages for arthrodesis) or intervertebral disk prostheses (intervertebral disk replacement prosthesis to preserve a certain degree of freedom of movement) or even osteosynthesis plates (plates fixed on the vertebrae to perform arthrodesis). Other uses of the anchors (1) are of course conceivable if the characteristics of the anchor are in accordance with the functional definitions provided in the present application. Intervertebral implants are generally intended to be implanted between two adjacent vertebras of the spine (spine) or to join two vertebrae, at their periphery in the case of osteosynthesis plates (which may be used alone or in combination). to an interbody cage, for example). The anchoring device (1) is intended to be anchored in one of the vertebrae so as to fix the implant on / against this vertebra. Various embodiments of devices (1) anchoring according to the invention comprise at least one rigid plate, preferably curved (but not necessarily), arranged to enter a vertebra through an implant to retain the implant against this vertebrate. The technical characteristics of "curvature" and "stiffness" concerning the "plate" element of the "anchor" object are described in more detail below. The device (1) for intervertebral implant anchoring (2) in the vertebrae is sometimes referred to herein as the "anchor" (1) with reference to its anchoring function, without inducing any limitation. Various embodiments of anchors have been described in the published applications WO 2008/149223, WO2011 / 080535 and WO2013124453 filed by the applicant of the present application, but the present application provides embodiments which improve the solutions provided by these applications. and apply more easily to any implant, in particular spinal (spinal being used here as identical to spinal or vertebral) but possibly with other applications. Thus, the present invention provides improvements in various structures and methods that can be used in various applications to reduce the invasiveness of the implant and anchor implant operations and to improve the reliability of the proposed solutions. In various embodiments, the anchor (1) comprises a body comprising at least one plate (10), preferably rigid, elongate along a longitudinal axis. This longitudinal axis of the anchor (1) extends between a first end, here referred to as "anterior end", intended to penetrate into a vertebra and a second end, referred to herein as "posterior end". Note that the designations of the "posterior" and "anterior" ends of the anchor (1), the implant (2) and the instrumentation (4, 5, 8) are used in this application with reference to FIG. meaning that the anchor (1) is inserted. Thus, for the anchor (1), the first end, said anterior, is the one intended to be inserted first and intended to penetrate into a vertebra to secure an implant.
[0017] Regarding the implant, its wall or its end designated as posterior is that comprising an opening of a passage for the insertion of the anchor, this wall is actually posterior to the implant or not during its deployment. In the case of the intersomatic cages (2) or disc prostheses or plates described in the present application, this posterior end may actually be placed towards the rear of the patient or not, particularly for cages which are essentially intended for implantation by way of posterior or transforaminal. Regarding the instrumentation, the so-called anterior end is that intended to abut on (or at least the closest to) the implant during implantation. Certain embodiments of implants (2), including certain embodiments detailed in the present application and relating to an interbody cage (2), are arranged for insertion into the disc space transforamally and the posterior end will be by therefore disposed on a lateral and rear side of the vertebrae while the anterior end will be disposed near the opposite front and side side. Nevertheless, the terms "anterior" and "posterior" are still used here because they are easier to understand from an implantation point of view and can be conveniently and commonly used with the anchor (1). implant (2) and instrumentation (4, 5, 8), regardless of the chosen implantation route. Therefore, the terms "anterior" and "posterior" are not intended to refer simply to the patient or to one of its anatomical characteristics, but to the direction of insertion of the anchor into the implant (that this implant is itself even implanted along an anteroposterior axis or not). On the other hand, the terms "height" and "thickness" are generally used here to denote the dimensions of the elements in an orientation parallel to the axis of the spine (once implanted therein) and the terms "upper" and "lower" ( or above and below) are generally also defined in this orientation (vertical when the patient is standing), without limiting implication for the invention. Similarly, the terms "vertical" and "horizontal" are used in a non-limiting manner with reference to the axis of the spine by considering the patient standing. On the other hand, the terms "width" and "length" refer to dimensions in a plane perpendicular to the axis of the rachis (a transverse plane), with the width generally being in the mediolateral direction whereas the length will be in the anteroposterior direction, without this conventional definition having the slightest limiting implication for the invention. Note also that reference is made here to a longitudinal axis between two ends and that this longitudinal axis possibly corresponds to an anteroposterior axis of the anchor (1), but that this axis is in fact oblique in general since the Anchor is often inserted from the periphery of the spine into a vertebral structure (a vertebral body most often and usually in a vertebral plateau). In addition, this axis of the anchor even follows a curved path in many embodiments and is therefore designated as anteroposterior to the ends of the anchor rather than referring to the spine. Similarly, the axis of the passage is designated using the same references while it is oblique and can be curvilinear or rectilinear. It will also be noted that this definition is also extended to the implant (2) and to the instrumentation (4, 5, 8), again with reference to the insertion direction of the anchor (1). It will also be noted that the term "substantially" or "substantially" is regularly used in the present description, in particular with respect to 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" should be interpreted as "at least approximately perpendicular" because it may be possible to choose an orientation that is not exactly perpendicular in order to nevertheless substantially fulfill the same function) . In addition, terms such as the term "substantially" used in this application may also be interpreted to mean that the technical characteristics may be "in general" ("generally"), and often "preferably" as indicated, but that other embodiments or configurations may be within the scope of the present invention. Some embodiments of the present invention relate to one or more bone anchor (or anchor) device (1) for an implant (2) (in particular spinal), arranged to be inserted through a through passage at the least one portion of the implant (2), from an outer surface (eg, peripheral, anterior, posterior, lateral, upper or lower) to a bone contact surface (in particular vertebral) of the implant. The anchoring device (1) generally comprises a body comprising at least one plate (10) rigid and elongate along a longitudinal axis extending between an anterior end and a posterior end, the plate (10) being configured so that its end anterior penetrates at least one vertebral surface while its posterior end remains in the passage of the implant (2), retaining said implant (2) against said vertebral surface. In general, the anchor according to various embodiments is arranged so that it can replace the fastening means conventionally used in the prior art, such as screws or staples. In particular, these anchors are generally formed by at least one plate-shaped element (for example a plate or two plates in T, V or L, or three U-shaped plates or even four plates, for example forming a tube of square or rectangular section, etc.) and often do not require additional structures entering the vertebrae. Indeed, the plate shape provides a two-dimensional surface particularly effective to oppose the movements perpendicular to this surface and the fact of having at least two plates (providing a three-dimensional structure) makes it possible to oppose even better the movements in several directions. Thus, the plate (s) of the anchor have their posterior end substantially inside the implant once they are completely inserted into the implant and they fix the latter to a structure bone. The term "substantially" is used here to emphasize that the anchor may protrude ("slightly") from the implant in a manner that is not significant in relation to the anchor dimensions. and / or the implant and / or which does not present a risk (too important) for the surrounding physiological structures of the patient. Locks of the locking means and abutment of the anchoring device: More specifically, the anchoring device (1) according to various embodiments of the invention comprises at least one stop (14) (sometimes limited to a single surface) complementary to a stop (31) (or surface also) of a means (or device) for locking (3) arranged to lock the anchor (1) relative to the implant (or vice versa). The abutment (14) of the anchor preferably comprises at least one abutment surface (141, 142) oriented non-parallel to the longitudinal axis (of the anchor), in order to effectively oppose the movements of the anchor. anchor along this longitudinal axis. This (or these) surface (s) (141, 142) is (or is) complementary to at least one abutment surface (311, 312) of the locking means (3) of the device (1) by relative to the implant (2). This locking means (3) is located on or in the implant itself. In fact, to meet one or more problems of the prior art, the inventors of the present invention have designed and put into practice a new arrangement of the anchors, implants and instrumentations, by providing a means (or device) for locking ( 3) that equips the implant itself ("team" meaning here as well as the locking means can be separate from the implant or integrated in, or in one piece with, the latter or planned integral with that although it is generally preferred that it be distinct and housed within the implant). This locking means (3) thus offers many advantages (most of which are detailed hereinafter), in particular answering at least some of the problems mentioned in the present application. This locking means (3) preferably comprises a body retained in the implant and provided with at least one flexible portion (30) and at least one stop (31) cooperating with said stop (14) of the device. (1), in general by contact of their complementary abutment surfaces (141, 142, 311, 312) to lock the device (1) relative to the implant (2). In various embodiments, advantage is taken of this flexibility which allows the locking means to facilitate the passage of the anchor before its stop engages with the abutment complementary to the anchor. For example, the insertion of the anchoring device (1) into the passage (in which the locking means protrudes at least slightly) makes it possible to push back said stop (31) of the locking means (3) and also allows the reciprocal engagement of the two abutments (14, 31), the anchor and the locking means (3), when they face each other, by the elastic return of the flexible portion (30) . In another example, as detailed below, it is possible to push the locking means by means other than the body of the anchor itself, for example using a tool, and when the action exerted on the locking means is released, which locks the anchor brought into the final position in the implant. Similarly, the spinal implant (2) according to various embodiments of the invention comprises at least one vertebral contact surface by which the implant (2) is intended to be placed in contact with at least one vertebral surface. and at least one outer surface (e.g. peripheral, lateral or even within the disc space, the outer term being used with reference to the anchor entering the vertebra from outside the implant entering through this surface and passing through the interior of the implant). This implant (2) spinal is configured to accommodate at least one anchoring device (1) according to various embodiments of the invention, with at least one through passage at least a portion of the implant (2) according to a axis, said insertion, from said outer surface to said vertebral contact surface. In addition, as detailed above, the implant (2) preferably comprises at least one locking means (3) of the device (1) relative to the implant (2). This locking means (3) comprises a body retained in the implant and provided with at least one flexible portion (30) and at least one stop (31) or surface for stopping the anchor (1) in the implant 30 (that is to say, oppose the movement of the anchor in at least one direction substantially parallel to its longitudinal axis or substantially tangential to its curvature). This abutment (31) of the locking means (3) preferably comprises at least one abutment surface (311, 312) oriented non-parallel to the axis of insertion of the passage (or to the longitudinal axis of the anchor, generally collinear with the insertion axis, at least approximately). The abutment (31) of the locking means (3) cooperates with the abutment (14) of the device (1) for fixing (or anchoring) by contact with their complementary abutment surfaces (141, 142, 311, 312). to lock the device (1) relative to the implant (2). As explained above, the flexibility of said flexible portion (30) allows pushing the locking means so that it does not protrude into the passage of the implant during insertion of the anchor. For example, the insertion of the anchoring device (1) in the passage pushes said stop (31) of the locking means (3), preferably in a housing provided for this purpose in the implant. On the other hand, this flexibility allows the mutual engagement of the two stops (14, 31) when they are found opposite each other, by the elastic return of the flexible portion (30) to its initial position. , wherein at least a portion of the locking means protrudes into the passage of the implant for receiving the anchor. Note that the term flexible is used herein to refer to the fact that the locking means moves from a rest configuration to a bent or twisted configuration by returning to the home position or a position close to the home position. The present application details how this flexibility (or rather elasticity as detailed hereinafter) can be obtained in various embodiments and it will be understood that this relative term finds its definition in the fact that a latch (means or device) is generally used. (3) locking) capable of flexing or twisting and returning to its initial position (eg, resting), or at least approximately to its initial position (if it plasticizes, it will be expected that it is negligible for the lock function). In addition, it is generally chosen rigid and solid material capable of withstanding the high stresses that can be exerted on it when locking the anchor (1). Thus, metal locking means, preferably biocompatible, such as titanium for example, are preferred, and an alloy is generally used. To offer the desired flexibility, it plays on the elasticity of a portion of the lock, that is to say, it is expected so that it does not exceed (or little) its elastic limit so to avoid irreversible deformation (accompanied by a break for a brittle material or a plastic deformation for a ductile material). It is therefore understood that the term flexibility is used here in the direction of elasticity by preferably providing to remain in values below the elastic limit of the lock, for example by using prior measurements of buckling, creep , compression, torsion, flexion, shear, etc. In addition, this relative flexibility is generally allowed by the sufficiently small dimensions of the flexible portion and the fact that the lock is in fact retained or secured (or held stationary or in one piece) of the implant on a portion and that the portion (s) forming the abutment (s) have a possibility of movement in the implant, thanks to the fact that beyond the portion retained or integral with the implant, the others portions, said free, of the locking means (including the flexible portion and the abutment) have at least one degree of freedom (not parallel to the axis of the anchor and its passage in the implant), thanks to the fact that the implant comprises a housing whose size at these free portions is greater than the size of these free portions. This arrangement is particularly advantageous in many embodiments and the latch is generally dimensioned according to its material to allow bending / torsion with a return since the latch and thus secured in the implant. Moreover, in various embodiments, the free portions have, in the implant (2), only one degree of freedom not parallel to the axis of the anchor (1), which allows the latch (3), once engaged with the anchor (1), can not move in the direction of removal or advance of the anchor, thus securing the locking of the latter. This type of arrangement of the anchor and the implant comprising a locking means has many advantages. Indeed, thanks to the fact that the implant comprises a locking means, the invention makes it possible to optimize the invasiveness and / or the reliability of the system, because the anchor can be smaller in size than in the absence a locking means provided in (or on) the implant. Conversely, the abutments used, and especially the elastic mechanism (flexibility) of reciprocal engagement, may be larger in size, without this leading to a problem of obstruction and / or invasiveness of the anchor. Thus, the system is more reliable because the anchor can be effectively locked with abutments of satisfactory size, especially greater than those known from the prior art. Indeed, it is important to provide an effective locking mechanism because the anchors according to the present invention are generally retained solely by this mechanism, unlike other anchoring devices known from the prior art (which answers the problem of reliability and has many additional benefits, such as cost and simplicity of implementation for example). Thus, in the present invention, there is generally provided a means of locking of dimensions and arrangement adapted to withstand significant stresses, as detailed in the present application. On the other hand, this type of arrangement of the locking means can provide the additional advantage of allowing the stops to be provided in a solid material, even if the implant is made of a softer material. Indeed, for example in the case of interbody cages, it is common that the material is relatively soft, such as PEEK (acronym for polyetheretherketone). In contrast, the bone anchoring devices must generally be made of solid material, especially when they are intended to be planted directly in the bone without first sparing housing to receive them. Thus, it is preferred to use a rigid material device that will withstand impaction in bone and provide good stability, such as titanium. Thus, an anchor made of a solid and often rigid material presents a risk of damaging the softer material of the implant if stops of the anchor must bear (ie, abut) against structures or surfaces of the implant. . In the present invention, this risk is avoided by allowing it to be on the locking means that the anchor abuts. It is then preferably provided that this locking device is also made of solid material, that is to say a material that has a low risk of being damaged by the support of the anchor above. One can for example choose a locking means in the same material as that of the anchor (for example titanium). In addition to avoiding damage to the implant (which, depending on the size, may jeopardize the entire system), this benefit is accompanied by increased reliability of maintaining the anchor in the implant. . In addition, this type of arrangement allows one and the same locking means to provide two different types of stops. Indeed, it is possible to provide a single abutment surface to oppose the movement of the anchor in one direction (the direction of penetration into the implant and the vertebra or the direction of removal of the anchor out of the implant or the vertebra) or two opposing surfaces to oppose the movement of the anchor in both directions (penetration and withdrawal). Thus, in certain embodiments, said abutment surface (141) present on the abutment (14) of the device is oriented facing the posterior end of the anchoring device (1) so that the abutment (31) of the locking means locking (3) allows to oppose the withdrawal of the device from said passage. Alternatively, said abutment surface (142) 20 on the abutment (14) of the device is oriented facing the front end of the anchoring device (1) so that the abutment (31) of the locking means (3) allows to oppose an excessive advance of the device (1) in said passage. Advantageously, these two non-exclusive alternatives may be combined so that the abutment has both an abutment surface (141) facing the posterior end of the anchoring device (1) and an abutment surface ( 142) on the stop (14) of the device is oriented towards the front end of the device (1) anchoring. Thus the locking means (3), with its abutment (31) having complementary surfaces (311, 312) of these surfaces (141, 142) of the anchor, makes it possible to oppose both the involuntary withdrawal and to an excessive advance of the anchor. Thus, it is possible to provide that the respective stops (14, 31) of the anchor (1) and the locking means (3) oppose the advance and / or removal of the anchor. Indeed, in a manner complementary to the arrangements of the anchor described above, said abutment surface (311) on the abutment (31) of the locking means (3) can be oriented facing the exit of the passage to the surface vertebral contact to cooperate with the abutment surface (141) present on the abutment (14) of the anchoring device (1) and thus oppose its withdrawal from said passage. The abutment (31) of the locking means (3) can alternatively or additionally have an abutment surface (311) facing the inlet of the passageway towards the outer surface to cooperate with said abutment surface (142). present on the abutment (14) of the anchoring device (1) and oppose excessive advance of the device (1) in said passage. For example, in FIGS. 1A, 2A, 3A and 4A, the abutments oppose only the withdrawal of the anchor. On the other hand, in FIGS. 3C, 4C and 4D, for example, the abutments comprise two substantially opposite surfaces to oppose the withdrawal but also to limit the advance of the anchor. Thus, it is possible to do without means limiting the stroke of the anchor in the implant, although it is generally preferred to provide such means (generally on surgical instrumentation). In some embodiments, said stop (14) of the device (1) is a female stop cooperating with a stop (31) male locking means (3). For example, said abutment (14) of the device is a recess, a notch, an asperity or any other shape cut into a surface of the anchoring device (1), intended (e) to cooperate with a projection forming the abutment (31). ) of the locking means (3). For example, FIGS. 1A, 1C, 2A, 2C, 3A, 3C, 3D, 3E, 4C and 4E show, in an illustrative and nonlimiting manner, various variants of such a female abutment of the anchor. Alternatively, in some embodiments, said stop (14) of the device (1) is a male stop cooperating with a stop (31) female locking means (3). For example, said stop (14) of the device (1) forms a protrusion protruding from a surface of the anchoring device (1) and intended to cooperate with a recess in a surface of the locking means (3). The shape of such a male means, forming for example a projection on a surface of the anchor may vary, as the position of this male means on the anchor may also vary in various embodiments. FIG. 4D shows an example of such a male means of the anchor engaging in a female means of the locking device (3). This example is of course not limiting and the skilled person can provide various forms and arrangements of such a male means. On the other hand, in some embodiments, the abutment (14) of the device is formed by a surface of the posterior end of the plate (10) which is arranged to penetrate sufficiently into the implant (2). For example, there is an end of the plate, which can be considered as a male or female means, and a shoulder on the locking means, which can be considered as a female or male means. For example, in Figures 4A, 4F and 6A, it is on the surface of the rear end of the anchor is formed the abutment of the anchor. Indeed, the locking means, as for example visible in FIGS. 4G and 6G, comprises an abutment surface (311) which is intended to come into contact with this posterior end to oppose the withdrawal of the anchor (1 ). It is understood that in such embodiments, only the withdrawal of the anchor (1) is prevented, but the advance (penetration) of the anchor is not limited by the abutment of the locking means (3) . Complementary to the variants of the anchor above, the stop (31) of the locking means (3) may be a female stop cooperating with a stop (14) male of the device (1). For example, said abutment (31) of the locking means (3) is formed by a recess or recess in a surface of the locking means (3), intended to cooperate with the abutment (14) formed by a protrusion projecting from a surface of the anchoring device (1). Figure 4D shows an example of housing in a tab of the locking device for receiving a pin of the anchor. Similarly, Figure 11F shows another example of a housing in the locking means for receiving a protrusion of the anchor (not shown). As for the examples provided above for the anchors, these examples for the locking means are purely illustrative and are not limiting. On the other hand, as mentioned above, the stop (31) of the locking means (3) can be a male abutment cooperating with a stop (14) female device (1) anchoring. For example, said abutment (31) of the locking means (3) forms a projection intended to cooperate with the abutment (14) of the device formed by a recess in a surface of the anchoring device (1). Figures 11A and 11C show examples of such male abutment means (31) on the locking device (3). It will be further noted that such male abutments (31) may also be formed by the body of the locking means (3) itself, instead of being formed by a protuberance on one of its surfaces.
[0018] Indeed, in some embodiments, the locking means comprises a body of which a flexible portion allows a portion of the body forms the stop. For example, in FIGS. 12G, 13D, 14G, 15F, 16F, 18B, 18H, 181 and 19F, the stop (31) of the locking means is formed by a portion of the body of this locking means and does not require any arrange a structure on its surface. This type of arrangement is advantageous because it provides a solid stop that is more resistant to the forces exerted on it than would a small element projecting from a surface. It will be noted that various embodiments of the complementary abutments of the anchor and the locking device preferably give preference to the retention of the anchor in the implant (by at least one abutment opposing the withdrawal of the anchor) or the holding the implant against the bone in which is intended to penetrate the anchor. Indeed, a stop opposing the advancement of the anchor beyond a certain distance in the implant has the additional effect of pressing the implant against the bone. The implant is then firmly fixed against the bone (the vertebra in particular). On the other hand, an abutment opposing the removal of the anchor (called abutment stop) prevents it from coming out of the bone, but may have the effect of pulling on the implant if it is caused to undergo forces. tending to get her out of the bone. Nevertheless, various embodiments provide that the orientation of the anchor in the passage and orientation of the abutment abutment surfaces are such that movements in the direction of withdrawal of the anchor do not induce or little movement of the implant. For example, the oblique and / or curvilinear path of the anchor in the implant prevents the anchor from moving the implant and instead allows it to be better plated against the bone. On the other hand, it is generally preferred to have at least one retraction abutment to prevent the anchor from coming out of the bone and implant until it has been decided. In fact, it is not necessarily necessary to have an advancing abutment (penetration) because the implant is often maintained in a sufficiently stable manner by the anchor, thanks to the oblique orientation of the latter (by relative to the axis of the spine), or even thanks to its curvature in some embodiments. Likewise, rather than an advancing stop, it is possible to provide a thickening of the anchor plate near its rear end so that the thickness is substantially equal to or slightly greater than the width of the passage in order to obtain a blocking of the advancement of the anchor in the implant and to ensure a good hold of the implant against the bone, without the need for a stop that is not parallel to the longitudinal axis of the anchor. Nevertheless, it is sometimes possible to provide at least one advancing stop, limiting the stroke of the anchor in the implant and allowing the implant to be pressed against the bone, without providing a withdrawal stop, for example when the The orientation of the anchor in the implant and with respect to the bone is such that the risk of spontaneous withdrawal is very limited. However, it is generally preferred to have both types of abutments to abut the implant and to prevent the anchor from coming out alone under the action of the forces exerted on it. Various embodiments of the present invention, as explained above with reference to the abutment surfaces (141, 142) of the anchor, therefore include abutment surfaces (311, 312) of the locking means which are complementary to the abutment surfaces (141, 142) of the anchor (1). These embodiments therefore allow double locking (in advance and in withdrawal) of the anchor, which is advantageously obtained with a single locking means (3). Fixing / Anchoring Device or Anchor: As explained above, the fixing device (1) comprises at least one rigid plate (10) allowing the implant to be firmly fixed to the bone structure with which it must be in contact ( the vertebral body generally in the present application). In various embodiments, this plate is curved and complementary to the shape of the passage of the implant (2) so as to pass through the implant without deformation and to be inserted along an axis not perpendicular to the vertebral surface in which must penetrate the anterior end. The term "rigid" is here used to specify that it is preferred that the anchor passes through the implant without having to undergo elastic deformation or any deformation. In addition, it means that it can offer rigidity and strength sufficient to withstand the stresses that will be exerted on it, without deforming or at least without deforming too much. The passage in the implant may then, to accommodate this curved anchor, be preferably curved, but it may be straight as long as its dimensions are adapted to those of the anchor and the (x) radius (s) of curvature of the latter. An alternative, generally preferred, consists of a passage comprising two rectilinear portions of different orientation so that the walls of the passage are substantially tangent to the radius (s) of curvature of the anchor. This arrangement is advantageous for maintaining the anchor (more than a single rectilinear portion) and for ease of manufacture (cost). In some of these embodiments, the body of the anchor (1) describes at least one circular or elliptical arc having dimensions and at least one radius of curvature made such that the anchoring device (1) is implantable in a vertebral plateau along an approach axis forming with the vertical axis of the spine an angle of approximately 90 °, having its longitudinal axis substantially in the plane of the intervertebral space. Complementarily to the curved anchor, said passage is rectilinear or curved and complementary to the shape of the curved anchor device (1) so as to allow the anchoring device (1) to pass through the implant without deformation, by insertion along an axis not perpendicular to the vertebral surface into which the anterior end must penetrate. This type of curved anchor makes it possible to limit the bulk and especially the invasiveness by limiting the necessary space around the implantation site. In certain particularly advantageous embodiments, the anchoring device comprises at least two plates (10) whose longitudinal axes are parallel to each other, but whose transverse axes are not parallel to each other. Preferably, their transverse axes are perpendicular to each other, giving an L-shaped section to the anchoring device (1), but they may also have an angle other than 90 °, for example by giving the device a V-shaped section. , it is conceivable that it is in fact a single plate but which is curved in this transverse dimension, so that the device has a section C. This type of arrangement is advantageous because the rigid plates used in the present invention are more stable than other less solid fastening means, such as nails or staples, but having an anchor whose width (the dimension transverse to its longitudinal axis) has 2 edges different orientations (in that it comprises two non-parallel plates or a curved plate) makes it possible to oppose the movements of the anchor in the bone in at least two different directions. Thus, the anchor is clearly stabilized in the bone and is not likely to cut or cut the vertebrae by lateral movements. The term "two plates" and "L-section" is therefore used here to mean the possibility of providing a second surface opposing the movements in a second direction, whether in fact a single curved plate or two plates (non-parallel but variable directions, for example L or V). Thus, certain embodiments of the invention relate to an anchoring device (1) whose body comprises a second plate (11) elongated along said longitudinal axis of the first plate (10) and extending between the front end and the posterior end, the second plate (11) being integral with the first plate (10) and not parallel to the first plate (10), giving the device an L, V or C-shaped section, complementary to the internal section of the passage in the implant (2). This type of advantageous arrangement can be envisaged regardless of the type of abutments used, that is to say with or without abutments (14, 31) described in the present application in cooperation with a device (or means) of locking (3). Illustrative and nonlimiting examples of such anchors are shown in FIGS. 5B, 5C, 6A, 6B, 6C, 6F, 8A, 8B, 8C, 9B, 9C, 9D, 10B, 10D, 10E, 11B, 11D, 12B, 12D, 13B, 14C, 15B, 15D, 15E, 16B, 17C, 17E, 17F, 18C, 18D, 18E, 18F, 19B, 19D, 19E, 20A, 20B, 20C, 20D, 20E, 20F, 21A, 21B , 21C, 21D, 21E, 21F, 22A, 22B, 22C and 22D. Such anchors have the advantage of reducing the bulk in the implant. Indeed, the sections L, V or C are particularly suitable for surrounding the attachment means (26) of the implant for receiving a surgical tool such as an implant holder. Indeed, we see in these figures that the implant is thus provided with two anchors whose non-planar sections are arranged around the attachment means formed by a housing accessible from outside the implant. In addition, this type of anchors has the advantage of ensuring a stable attachment while limiting the size of the anchors themselves. Indeed, the two plates of the anchor (1) can have relatively small dimensions as one another since they cooperate with each other to oppose movements of the anchor and the implant in two directions (and do not need to be as wide as if it were a single plate, even with a rib). The passage in the implant (2) has an internal section of shape complementary to that of the device. There is therefore provided a passage whose inner walls follow the shape of L, V or C, so that it is complementary to the shape of the anchoring device (1) whose body comprises a second plate (11) elongated along said longitudinal axis of the first plate (10) and extending between the anterior end and the posterior end, the second plate (11) being integral with the first plate (10) and substantially perpendicular to the first plate (10). ). This type of arrangement of the anchor (1) in L, V or C also offers the additional advantage that it is easy to provide at least two anchors for the same implant and in particular an anchor for each of the adjacent vertebrae between which the implant is intended to be implanted, without the anchor paths intersect in the implant, even in the case of curved anchors whose radius of curvature may be important. Indeed, with small plates (small width), it is easier to predict their path through an implant, even when the size of the implant is small (i.e., the size is important). Note that the two plates may have the same extent (width) or may be different, as for example particularly visible in Figures 16B, 17C, 18B and 19B where the plate which is oriented vertically is wider than the other. In particular, in these examples of the figures, the anchors 10 are curved and one of the plates (the widest) is curved in the direction of its width, while the other (the least wide) is curved in the direction of its thickness. . The abutment (14) of the anchor is generally provided on the widest plate, in particular when this abutment (14) is female. However, the same type of double plate arrangement may be provided in the case of straight anchors. Similarly, the two plates may have identical lengths or have different lengths. For example, as seen in the example of FIG. 17F, the plate intended to be oriented vertically (that bent in the direction of its width) is shorter, to facilitate penetration into the bone, but provision can be made for 20 reverse configuration or even an intermediate configuration in which it is the part that forms the junction (angle) between the two plates which is the longest. Indeed, it is generally desired to optimize the penetration into the bone and the use of sharpened profiles or bevels is common. In some embodiments, the body of the anchor (1) has, at least at its forward end, at least one chamfer or bevel (18) facilitating penetration of the device (1) into the bone (in particular). particularly the vertebral surface). In the illustrative and nonlimiting examples of FIGS. 1C, 2C, 3D and 3E, the anterior end of the anchor comprises several chamfers, in particular at least one chamfer on at least one of its two upper and lower faces and at least one a chamfer on its side edges. Thus, the tip is sharpened to penetrate more easily into the bone. It is possible to provide a pointed end also, but as the impact suffered during the anchoring in the bone is important, it is preferred to avoid having a too fine structure at the front end. In the illustrative and nonlimiting examples of FIGS. 12B, 13B and 14C, the front end of the anchor comprises only at least one chamfer on at least one of its two upper and lower faces, but is not sharpened on its edges. side. In the examples of FIGS. 12B and 13B, the chamfer is oblique so that the end of the anchor forms an oblique end blade, whereas in the example of FIG. 14C, the chamfer is perpendicular to the axis. longitudinal, so as to form a sharpened straight end. In the examples of FIGS. 7E and 7F, the front end is not sharpened on its lateral edges but only on at least one of its two upper and lower faces. In the examples of FIGS. 5C and 6F, the characteristics of which will be detailed below with regard to the arrangement of the anchor in the form of two perpendicular plates forming between them an L-shaped section, the end is sharpened for a only two plates, while the other is left flat, while in the examples of Figures 9C, 9D, 10E and 10F, the ends of the two L-shaped plates are sharpened. Note that a chamfer of the anchor may have a variable extent from the anterior end to the posterior end. All of the above examples show, in a non-exhaustive manner, the variety of form possibilities of the anchor, especially as regards its sharpening. In addition, in some embodiments, the anterior end has at least one notch (not shown) facilitating the penetration of the device (1) into said vertebral surface. Such a notch can also be sharpened to further facilitate penetration. On the other hand, in some embodiments, the body of the anchor (1) is provided with notches (16) oriented to oppose the removal of the anchor (1) once implanted in a vertebra. Similarly, such an effect can be obtained, in some embodiments, by the fact that the body is provided at the portion intended to penetrate the vertebral surface, at least one hole (19) for growth bone through the anchoring device (1). Illustrative and non-limiting examples of such holes (19) bone growth are shown in particular in Figures 9C, 9D, 10E, 10F, 11B and 12F. However, the present invention also provides many embodiments in which it is preferred to provide the possibility of withdrawal (this removal being often referred to as "ablation") of the anchor if necessary. Physical quantities (illustrative and non-limiting): In various embodiments, the plate of the anchor (1) curve describes, along the longitudinal axis, at least one circular arc and / or at least one elliptical arc which the dimensions and the radius (s) of curvature are made such that the anchoring device (1) is implantable in the vertebral endplate of a vertebra with its longitudinal axis substantially in the plane of space intervertebral, that is to say along an axis of approach substantially perpendicular to the axis of the spine (ie, said plane or said approach axis being substantially tangential to at least a portion of the anterior end when the anchor approaches the vertebrae). Various embodiments of the various objects of the present invention relate to the technical characteristic of the (or) radius (s) of curvature of the device (1) anchoring. Various embodiments of the anchoring device (1) actually have a different radius of curvature from one anchor to another and / or several different radii of curvature on different portions of the body of a given anchor (1). Thus, for example, the body of the anchor (1) may have a shape of a circular arc or an elliptical arc, but it may also describe a more complex curvature, such as if several arc (s) of circle, having the same radius of curvature or different radii of curvature, were placed end to end or if several elliptical arc (s), having the same radius of curvature or different radii of curvature, were placed end to end , or any combination of circular or elliptical arcs or even a radius of curvature varying along the body. In the present description, the terms "arc of circle" or "radius of curvature" correspond in fact to all of these different possibilities. Thus, various embodiments of the present invention provide different variations regarding the radius of curvature and certain related aspects of the anchoring device (1), as well as implants (2) and instruments (4, 5, 8) that can to be associated with him. Indeed, for example, depending on the use of the device (1) for anchoring and, in particular the location in the spine which is intended for it, it may be preferred to have a radius of curvature more or less important. As a function of the radius of curvature of the anchoring device (1), the axes passing respectively through the penetration end and the stop end of the device (1) form an angle, typically approximately between 90 ° and 180 ° although it can also be chosen less than 90 °. Preferably, this angle will be between 110 ° and 160 ° which in many circumstances will facilitate the implantation of the device (better than an angle out of these values). Depending on the attachment that is desired through the device (1) anchoring, a more or less open angle will be chosen. If, for example, it is desired to promote a firm and solid fixation of the implant against the vertebral endplates, an angle of between 120 ° and 180 ° may be preferred, whereas it is preferable to avoid the displacement of the implant. in the plane of the disc space, we can prefer an angle between 90 ° and 150 °. Although these variations of the angle are not shown in the figures, different angles for the anchoring device (1) thus make it possible to cover the various types of anchoring that are desirable, in order to ensure an appropriate fixation of the implants according to the case. It is also possible, in one of the preferred embodiments, to provide a device (1) whose angle is at an optimum value, for example close to 135 °, for fixing the device both by pressing the implants against the trays. vertebral and avoiding their displacement in the plane of the disc space. In addition, depending on the various embodiments of the implant (2), it will be possible to choose different angles for the anchoring device (1), in particular to allow good fixation despite possible lordosis or kyphosis, or even a scoliosis, whether natural, pathological or imposed by the implant. Thus, various embodiments of the device (1) for anchoring and the implant (2), thanks to its radius of curvature and the orientation of the passage of the implant (2) in which it is intended to be inserted, can be implanted along an axis of approach substantially in the plane of the intervertebral space, that is to say the plane in which is implanted the implant (2), which facilitates the approach of the set of elements of the implant and the device in the vicinity of the intervertebral space. In certain embodiments, the arc (or arcs) described by the body of the anchor (1) has dimensions and at least one radius of curvature so that the device (1) ) anchoring is implantable in a vertebral plateau along an approach axis forming with the vertical axis of the spine an angle of between 40 ° and 140 ° and preferably an angle of approximately 90 °. This angle may vary for the same device (1) for anchoring as a function of the space around the vertebrae and may also vary from one anchoring device (1) to another depending on the radius of curvature of the device (1) used (and thus the angle formed between its anterior and posterior ends). In addition, various embodiments provide an anchor (1) having at least one plate (10) straight (not curved). Note that in the case of anchors (1) straight (i.e., comprising at least one straight plate), the axis of approach is preferably not in the plane of the disc space but can be oblique. This type of oblique axis is generally not preferred because of the congestion of access to the vertebrae, but it is sometimes possible and can be used in certain circumstances. The implants (2) used with such straight anchors (1) will preferably comprise at least one straight passage (rectilinear) and oriented towards at least one vertebra, in an oblique path (not perpendicular to the axis of the spine) between the periphery spine and vertebrae. The instrumentation used with such straight-through implants (2) and such straight anchors (1) will preferably have a contact area with the implant, at the anterior end, inclined with respect to its longitudinal axis (anterior to posterior according to the convention used in the present application), so as to allow an oblique approach axis relative to the vertebrae.
[0019] It is generally preferred that a substantial portion of the anchor remains in the implant to retain the implant and that a substantial portion enters the vertebra so as to anchor well in the vertebra (and thereby retain the 'implant). The anchor is therefore generally dimensioned according to the type and size of the implant used, which is itself generally dimensioned according to the vertebral (eg, cervical, thoracic or lumbar, or even sacral) level in which it is intended. to be implanted. In addition, the possible curvatures and orientations of the anchor and the implants (in particular their vertebral contact surfaces) are also provided in general according to the vertebral level, but also according to the pathologies or various parameters chosen by the surgeon, particularly as detailed above. It is therefore understood that the choice of the length of the anchor (1) will be influenced by the value of its curvature and the size of the implant. These considerations are generally known to those skilled in the art, but it may be useful to specify some orders of magnitude significant for the present invention, even if it is not limited to the examples provided. Thus, exemplary and non-limiting examples of the sizes of vertebrae and mean intervertebral spaces that make it possible to set the context of the normal (healthy) physiological values, although it is clear that these values are indicative and that particular morphologies of some patients lead to dimensions different from those mentioned. In addition, pathologies or conditions of the spine will of course affect these values and implants are precisely "adaptations" to these pathologies to integrate into the patient and possibly restore as much as possible physiological values. To define the dimensions of a vertebra, we refer below to the "width" to designate its dimension along a mediolateral axis (ie, along the axis of intersection of the coronal and transverse planes) and the "depth" to designate its dimension along an anteroposterior axis (ie, along the axis of intersection of the sagittal and transverse planes). At the cervical level, there is generally a width of about 10 to 25 mm, with a depth of about 10 to 25 mm, for a vertebral height of about 10 to 25 mm and an intervertebral height of about 4 to 10 mm (height being here along the axis of the spine as already explained). At the thoracic level, we find a width of about 20 to 40mm, with a depth of about 15 to 35mm, for a vertebral height of about 15 to 40mm and an intervertebral height of about 6 to 12mm. Finally, at the lumbar level, there is usually a width of about 30 to 60mm, with a depth of about 24 to 45mm, for a vertebral height of about 30 to 60mm and an intervertebral height of about 6 to 18mm. These values make it possible to estimate the dimensions of the implants used, which do not exceed these values in width and depth, and whose height can be variable (and even irregular to impose an angle to the spine, such as for example a lordosis, a kyphosis or catch up with scoliosis). The corporectomy cages will have a height corresponding to the size of the vertebral segment to be replaced (at least a portion of at least one vertebral body, usually with at least a portion of at least one adjacent disc). However, intervertebral implants (cages or prostheses) will have heights approximately corresponding to the intervertebral heights of the lumbar levels detailed above (with the "adaptations", as detailed above). On the other hand, one also chooses the dimensions in width and in depth according to the implantation way. In addition, the dimensions of the implants are defined below by using the term "length" to denote the dimension along a substantially horizontal axis (relative to the spine) and oriented between the face where the implant is held by the surgical instrumentation. during implantation and the face of the implant that is inserted first. Thus the term "width" refers to the dimension in the same plane, but perpendicular to the length. It is understood from the following that these widths and lengths will actually be in various orientations relative to the spine (particularly with respect to the sagittal axis of the patient) and that we must therefore refer to the anteroposterior and mediolateral axes of the patient. patient (substantially perpendicular to the sagittal axis) to designate the orientations of the widths and lengths of the implants. Indeed, at least in the case of intersomatic cages, the approach to the vertebrae depends on the choice of the surgeon, usually constrained by the surrounding tissues (veins and nerves mainly since they are the riskiest). For an anterior approach (approach) approach, the implant (cage or prosthesis) will generally occupy almost all of the intervertebral width and depth. For a transforaminal approach, a cage intended to occupy the diagonal vertebral plateaux (an oblique axis with respect to the antero-posterior and mediolateral axes) is inserted and generally large lengths are provided (for example of the order of 30 to 35 mm approximately), greater than the anteroposterior dimension (length) of the vertebrae, but a small width (about 10mm for example) because of the passage close to the nerve roots. For a lateral approach, the implant (cage in general) will have a length occupying the quasi-totality of the medio-lateral dimension of the vertebrae but will have a width inferior to the anteroposterior dimensions of the vertebrae (approximately 15 to 20 mm for example) . Finally, for a posterior approach, a cage is generally chosen with a width as fine as with the transforaminal approach (approximately 10 mm for example), but with a shorter length since it will have to correspond approximately to the size of the vertebrae. along the anteroposterior axis. In this context of vertebral, intervertebral and implant sizes, it is understood that the anchor must be dimensioned with respect to the implants as a function of the vertebral stages (levels) and possibly according to the chosen approach path. Nevertheless, examples that may be mentioned are illustrative and non-limiting, such as that of an anchor whose plate has a length of 15 to 20 mm and a width of about 4 mm. If an anchor is provided with at least one other plate, it may have dimensions of the same order, for example between 2 and 5mm. The thickness of the (or) plate (s) of such an anchor will be (or will be) of the order of 1 mm in general. Note that we are talking about plate thickness and not the anchor because in the case of several plates in L, V, T, etc. we will of course have a total height of the anchor much greater than the thickness of the plates. However, as mentioned above, the L-shaped or V-shaped are preferred since they make it possible to limit the space requirement and the necessary space in the implant (thus less weakened if it is small) while guaranteeing a reliable fixation. In general, such an anchor will be used for an implant having a width of the order of 5 to 15 mm and a length of the order of 25 to 35 mm. Indeed, it is generally desired that there is at least half the length of the anchor protruding from the implant and thus enters the vertebra (for example about 10 to 15 mm, depending on the vertebral level and therefore the height of the vertebrae). In general, it is preferable to use an anchor whose width is less than half or even third, or even 1/5 of the width of the implant, but whose length is greater than one third, or even less than half the length of the implant and can be up to a substantially identical length if the orientation and / or the curvature of the anchor and the vertebral height allow. On the other hand, one understands from these dimensional considerations of the anchor (1) and the implant (2), but also more detailed elastic limit physical property considerations, that the lock (3) must also be dimensioned relative to the anchor (and, by extension, to the implant). Indeed, the invention aims in particular to ensure good reliability of maintaining the anchor in the implant and therefore a reliable fixation of the implant relative to the vertebrae. A lock is preferably used, the dimensions of the abutment (31), and generally of the abutment (14) of the complementary anchor (1), represent at least 5 to 10% of the size of the plate of the anchor (1) at which the stop (31) will retain the anchor. The stop (31) of the lock is preferably about 25% of the width of the plate with which it engages reciprocally. For example, in the case of a female means on the anchor, the male means of the lock will be between 5% and 50% of the width of the plate, preferably 25%. Thus, in the examples of L-shaped anchors (1) with a 4mm plate and a 2.4mm plate, the notch forming the abutment (14) of the anchor (1) may extend over approximately 1mm in the width of the 4mm plate and the abutment (31) complementary to the lock may have substantially the same dimensions, even it is generally expected that the notch is a little wider than the lock (eg 1.1mm). In general, the dimension of 1 mm (+/- 10%, therefore between 0.9 and 1.1) is particularly advantageous (for example 1 mm in diameter for the cross section of a bolt in the form of a cylindrical rod) because, in general, it offers (depending on the material) sufficient strength to meet the authorities' safety requirements for spinal implants. Indeed, with such a large size, the latch can hold the anchor in its path even when strong stresses are exerted on it, even parallel to the axis of the passage and the anchor. In general, this satisfactory restraint is reinforced in the case where the "free" portion of the lock (3) where the stop (31) is located has only one degree of freedom in the implant. In such cases, the abutment resists extreme forces and it is usually the material (bolt, or anchor in general) that will undergo a matt or shear if the anchor is to be expelled by the forces exerted . In addition, the preferred size range can be widened between 0.7mm and more than 1.2mm, because it has been observed that, for a size of 0.8mm, the stiffness was not optimal (making the movements of the lock too easy), but the elastic limit was slightly higher than for 1 mm where it was slightly low because the lock had undergone a slight plastic deformation. However, even with this slight deformation (approximately 10% or only 0.1 mm for a movement of 1 mm amplitude during the passage of the anchor), the elastic return, during the reciprocal engagement of the anchor and the lock, was still enough. Thus, 1mm remains preferred but one can choose lower values in some cases. It is therefore understood from the foregoing, in particular in combination with the explanations of the materials and arrangements of the housing of the abutment (31) of the lock (3) in the implant, the range of parameters that can be used for stiffness and elasticity. and, in general, the mechanical strength of the latch (3). Finally, mention is made here of the example of the cylindrical rod as a lock (3) housed in the implant (as for example in FIGS. 18C or 19D), but it is understood that this rod may not be cylindrical and that it will be possible to choose dimensions of the order of those provided for making locks (3) meeting the mechanical requirements. For example, a stop of rectangular section with the length of the rectangle oriented parallel to the direction of insertion of the anchor and the width oriented perpendicularly allows to combine the good stiffness of the dimension of 1 mm for the length with the good yield strength of the 0.8mm dimension for the width. Those skilled in the art will therefore appreciate the possible variations and will have understood that various embodiments of the invention are clearly distinguishable from known systems by the arrangement, but also by the dimensioning of the cooperating elements with each other. Similarly, the length of the lock, in particular the length of the flexible portion conferring elasticity to the lock is important. It depends of course other dimensions (diameter or width or length, etc.) to obtain a sufficient clearance of the stop and a suitable springback to the respective dimensions of the stop of the anchor and the stop of the lock. Similarly, the fixed portion in the implant (with or without specific retaining means such as those described below) must ensure good retention of the anchor. Finally, the size of the abutment portion (31) of the lock relative to the stop of the anchor (14) has already been described above with respect to the dimension in the axis of insertion of the anchor and the dimension in the axis of the deflection of the lock, but it will also be noted that the last dimension will also correspond to at least the same dimension found at the anchor. For example, for an anchor with a plate 1 mm thick and a notch forming the abutment (14) of the anchor, the stop of the lock can measure at least as much as the thickness of the plate (or 1mm) but one generally prefers larger dimensions, or even much greater (for example double, 2mm) to ensure a good mutual engagement despite the bending or twisting of the lock (3). Thus, by way of nonlimiting example, in the case of a rod of the type shown in FIGS. 18D and 19D (and as visible in FIG. 18B for example), it will be possible to choose lengths of the order of 2.5 mm in the implant for the fixed retention portion (32), of the order of 4.5 mm for the flexible portion (30) and of the order of 2 mm for the stop (31).
[0020] It is understood by generalising in a reasonable manner this example that the flexible portion is dimensioned so that a good deflection is possible without risk of elastic deformation. This dimensioning of the flexible portion (in this case of 4.5mm for a total length of 9mm) can therefore be generalized as being of the order of 30 to 70% of the largest dimension of the lock, for example perpendicularly or tangentially to the axis in which the deflection must take place (in flexion or torsion).
[0021] Ablation: Thus, various embodiments are arranged to allow removal of the anchor (or removal of the implant). In particular, various embodiments are provided so that the anchor (1) and / or the implant (2) and / or the locking means (3) comprise (s) at least one means of access by means of locking (3) for disengaging the respective stops (14, 31) of the anchoring device (1) and the locking means (3). For example, Figures 2C, 3D and 3E show anchors (1) whose stop (14) has a groove on one side of the anchor plate. This groove extends to the rear end, so that it is possible to introduce a tool to disengage the stop of the locking means. Thus, it is understood from these illustrative and non-limiting examples that it is possible to provide, on the anchoring device itself, a means of access to the stops to disengage one from the other. The illustrative and nonlimiting examples of FIGS. 1C, 4E, 4F, 5C, 6F, 7E and 7F represent anchors for which it is preferably the locking means (3) which makes it possible to unlock the anchor and to release it from the implant. Indeed, in some embodiments, these access means are obtained by the fact that the locking means is accessible in the implant, from the outside. The locking means is then directly accessible, for example because it is visible from outside the implant, for example in the embodiments of FIGS. 1A, 4A, 4C, 4D, 5A, 5B6A, 6B, 6C. or 17C. On the other hand, it is sometimes almost invisible from the outside as for example in the embodiments of FIGS. 7A, 7B, 7C, but it is possible to leave it accessible by providing room for introducing a tool, for example a flat blade. in the example of Fig. 7, to actuate the locking means so that it releases the anchors, although this embodiment is rather intended not to allow ablation. In addition, it is possible to provide that the implant comprises at least one access means, such as for example a recess or a channel opening on the abutments of the anchor and the locking means. For example, in FIG. 8B, the locking means is a split ring (of the "clamp-clip" type) accessible via a conduit in the implant via which it has been introduced. In the example of FIG. 9A, the hook-shaped locking means is housed in the implant and accessible from the outside even when the anchor is inserted into the implant. In the example of FIG. 10A, the locking means (3) is accessible from the outside of the implant thanks to the shape of its abutment (31) and to that (14) of the anchor (1) which only has a retraction abutment surface, whereas in the example of FIG. 10C, the double (retracted-advanced) stop (31) of the locking means is not directly accessible. Nevertheless, it is possible to provide an access channel in such embodiments, although this is often not preferred for reasons of implant strength. Indeed, it is often preferable to avoid multiplying the housings and channels in the implant to ensure its strength and various embodiments of the invention thus take advantage of other functional elements of the implant to provide this function additional access to the locking means (3). Thus, for example, in FIG. 8B, the housing of the split ring provides access to place the ring in the implant, but it also provides a hooking means (26) formed by a channel in the implant. , allowing its grip by an instrument such as an implant holder (5) for example, as detailed below. Similarly, in embodiments of the type of those of Figures 18 (A to I) and 19 (A to F), it is also used this attachment means (26) formed by a channel, which allows the insertion of a tool, as for example shown in Figures 20 (A to F) and 21 (A to F). These figures illustrate various types of tools for ablation, such as a tool (6) whose end (61) comprises a self-drilling screw thread (62) for Figs. 20A and 20B or as a kind self-drilling screw (7) (able to drill the implant by its screwing) for Figures 20C and 20D, or as a kind of threaded screw (7) (72) complementary to a tapping in the d hook (26), or as a kind of pointed pin (7) and without threading as for example in Figures 21A and 21B. In the case of self-drilling screw threads (62, 72) as in FIGS. 20A and 20C for example, it is in fact planned to screw the tool (6) or the tool into the posterior end of the implant. screw (7), whether or not the implant has an attachment means (26) such as a hole. Screwing is sometimes accompanied by drilling or at least widening of the hole (26). In the case of the additional thread of a tapping hole (26) as in Figure 20E for example, no drilling is necessary and the screw (7) does not widen the hole. In these examples of screws, there is of course a screw head manipulable by a tool (screwdriver, flat or cruciform, or Allen key, for example). In the case of the pin of FIGS. 21A and 21B, no head allowing the rotation of the pin (7) to be actuated is necessary, but it is nevertheless possible to provide a hole (73), for example tapped or with a flat or a notch, in the posterior face of the pin (7) to facilitate removal from the implant. FIGS. 21E and 21F show in an illustrative and nonlimiting manner the manner in which the unlocking can take place in this type of embodiment, thanks to the end of the tool, the screw or the pin which opens onto the means locking and regrowing (in the space provided for this purpose in the implant) to disengage it from the stop (14) of the anchor (1), thanks to its flexibility. Note that this type of mechanism can also be used for implantation and not just ablation. Indeed, an implant carried by its implant holder may have its locking means (s) pushed (s) during the insertion of the anchoring device and, when the implant is released, the stops (14). 31) complementary to the anchor (1) and the locking means (3) can engage with each other. In addition, to facilitate the ablation, various embodiments provide that the anchor (1) comprises at least one attachment means (17), configured to hook the end of a tool for removal of the device (1). ) anchoring. Preferably, said attachment means (17) is located near the rear end of the device (1). In a complementary manner, the implant comprises, in various embodiments, at least one access means, from outside the implant, to at least one attachment means (17) of the anchoring device (1). ), configured to hook the end of a tool for removal of the anchor. Thus, as for example represented in FIGS. 22A, 22B, 22C and 22D, the anchors may comprise a housing or a lug or any irregularity of shape adapted to form a fastening means for the end of a tool (9). . Such a tool (9) may be, for example, of the type shown in FIGS. 22B, 22C and 22D, comprising for example a handle for its gripping by hand and an end (97) of complementary shape to the attachment means ( 17) of the anchor (1). For example, as shown in FIG. 22B, the end (97) forms a kind of hook engaging in a housing or hooking a lateral projection on the posterior end of the anchor so as to be able to pull on it. Of course, these examples of structures are not limiting and it is the functional definition of hooking by the tool that matters here that the functional means are male or female on one or other of the tool and the anchor, or that they are simply formed by complementary shoulders of the anchor and the tool which are brought into contact to pull the anchor. Note that in the illustrative and non-limiting examples of Figures 22A, 22B, 22C and 22D, this withdrawal is achieved by having unlocked the anchor with a pin, but that type of removal by a tool applies to any type unlocking, including those described above. On the other hand, in certain embodiments, thanks to the reliability of the present invention, it is possible to provide a possible ablation without resorting to a direct actuation on the locking means (3). Indeed, in certain embodiments, at least one of the surfaces, among the abutment surface (141) of the abutment (14) of the device (1) and the abutment surface (331) of the abutment (31) of the latch (3), is oriented not perpendicularly to the axis of insertion of the device (1) for anchoring in the implant (2), to allow to push the stop (31) of the locking means (3) and thus unlock the device (1) for anchoring by traction carried out on the anchor (1), for example via a fastening means (17), for example using a tool (9). Thus, with a slightly inclined surface (141 and / or 311, as the case may be), the traction allows the abutment surfaces (141, 311) to slide on one another by pushing the latch into its housing to let leave the anchor (1). Thus, for example, in the case of notches, it is possible to provide a V-notch, or even with only one inner wall inclined towards the exit of the passage, the other wall being perpendicular to the axis of the passage or also inclined towards the instead of being inclined towards the entrance of the passage as for a V-notch. This type of shape will further facilitate ablation if it is not planned (or possible to provide) means of access lock (3). Note also that in the case where the second wall is also inclined towards the outlet of the passage, there is obtained an advantageous embodiment in which the lock may itself be slightly locked in the passage of the anchor in the implant, thanks to this inclined wall. Locking means and restraint: The locking means, as explained above can be made of various materials, identical or different from the implant, and it can have various shapes since it is only important that it can prevent the anchor (1) to leave the implant (2) and / or limit the advance of the anchor (1) in the implant (2) and the bone. The number of anchors (1) and stops of the locking means in the variants described in the present application should not be interpreted in a limiting manner, but it is often taken advantage of having only one means of locking (3) to lock two anchors (2). Similarly, the positions of the locking means with respect to the anchors are described with reference to the examples given in the figures illustrating particularly advantageous embodiments for the space saving achieved, but it is clear that the various elements cooperating with each other. others could be positioned differently from the positions shown in these examples, for example because the implant has enough room to vary the positions and orientations of the various elements. Also, the present application provides numerous embodiments for the shape of the locking means (3) and the illustrative examples provided, particularly in the figures, are not limiting (which is valid for all the elements and characteristics described in this application). Finally, the present description frequently mentions that the locking means (3) is "formed by" but it must be clear that this term is not limiting because it is in fact at least one lock that is obtained by the structures described. , while it is quite possible to provide combinations of the functional and / or structural characteristics described, from one anchor to another or sometimes for the same locking means. In some embodiments, the locking means (3) has substantially the shape of a harpoon as for example shown in Figures 1D, 2D and 3F. In certain embodiments, as for example in FIG. 1D, the locking means (3) has a body, for example parallelepipedal (or cylindrical or any other form in other possible variants), extending by a thinned portion forming the flexible portion (30) at the end of which a head, for example with a triangular section, provides at least one projecting edge forming the stop (31).
[0022] In some variants, as for example in Figure 2D, the body is extended by a head provided with at least one flexible lug (30) whose end forms the stop (31). In some embodiments, as for example in FIG. 3F, the body separates into two branches each carrying a flexible tab (30) which forms a stop for an anchoring device each. In these embodiments, the head or the branches are preferably refined, for example with a triangular section, so as to facilitate the passage of the anchors (1) by pushing the head or the legs thanks to the flexibility of a portion ( 30) of the locking means (3). In certain embodiments, as for example in FIG. 4G, the locking means (3) comprises a body intended to be housed in the implant and extended by two branches extending towards the entrance of two passages intended to receive each an anchor (1). These branches terminate in abutments (31), for example in the form of small studs projecting at the ends of the branches in FIGS. 4A and 4G, or near the end of the branches in FIG. 4C. In the variant of FIG. 4C, the abutments (31) of the locking means (3) are formed by housings accommodating small studs present on an edge of the anchors (thus opposing both withdrawal and advancement). ). It will be understood from the foregoing that various arrangements of the locking means (3) may be provided and that the above examples have in common that they rest on a flexible portion (30) arranged to allow bending resulting in movement. substantially vertical stops, and pushed (up or down) to let the anchors (1), then returning to the initial position to lock them. In the example of FIG. 9F, the locking means (3) is formed by a rod oriented along the anteroposterior axis of the implant, but one end of which is curved to engage in a housing of the implant ( 2) along an axis not parallel to the anteroposterior axis, to thereby retain the locking means (3) while allowing the bending of the rod in a substantially vertical movement during the passage of the anchor (1). The other end of the rod comprises the stop (31), for example formed a notch for cooperating with a notch complementary to the anchor (1). In the example of FIG. 10D, the locking means (3) is formed by a rod oriented non-parallel to the anteroposterior axis, and one end of which comprises the flexible portion (for example by a thinning of the rod). at the end of which is disposed a tab opening into the passage of an anchor, via a duct sized so that the flexible portion can flex and let the anchor and then engage in a notch (Figure 10C) or against a notch (Figure 10A), for example on a side edge of the anchor. In the examples of FIGS. 11F and 11G, the locking means (3) is formed by a rod housed in a conduit of the implant and oriented along the anteroposterior axis of the implant, but one end of which has a stud (32) protruding in a housing of the implant (2) along an axis not parallel to the anteroposterior axis, thereby to retain the locking means (3) while allowing the bending of the rod in a substantially vertical movement during the passage of the anchor (1). This same end of the rod comprises the abutment (31), for example formed by a housing (FIG. 11F) or a notch (FIG. 11G) intended to cooperate with an abutment (14) complementary to the anchor (1), for example as shown in Figs. 11A and 11C. In some embodiments, the flexible portion (30) is arranged to allow a substantially horizontal movement of the stops which are thus pushed laterally. For example, in FIGS. 5E and 6G, the locking means (3) comprises a body that tapers (laterally / in the horizontal plane) close to a head bearing, on its lateral edges, two stops (31). each having a shape allowing the passage of an anchor and its locking during the springback. In the example of FIG. 5E, the stops (31) of the locking means (3) are male means which penetrate into female means (14) formed in the anchors (1), while in the example of the 6G, the stops (31) of the locking means (3) are formed by shoulders formed on the edges of the head and matching the shape of the posterior end (14) of the anchors (1). In particular, in this example of FIG. 6G, the abutment surface (311) opposing shrinkage has a concave shape to match the convex shape of the back of the anchor. It should also be noted that it is generally preferred to have a shape of the back of the anchors, as well as for the edges of the implants, to avoid having protruding or sharp structures that can damage the surrounding tissue. In the example of FIGS. 6B, 6C and 6D, the locking means has the same abutment surface curve type (311) for retraction, but it also has an abutment surface (312) to limit the penetration of the abutment surface (311). anchor (1) in the implant (2). This abutment (312) of advance is preferably formed with a more salient angle since it must stop the anchor and it does not risk damaging surrounding tissue since it is intended to be in contact with the abutment (14) of the anchor (and even covered by the abutment in this particular example). In addition, it will be noted that in this example, the end of the notches forming the abutment (31) has, between the abutment surfaces (311, 312), a beveled surface at an angle corresponding preferably to the insertion angle. the anchor, so that the latter can slide more easily along the beveled surface. In addition, the end of the head of the locking means between the two abutment stop surfaces (312) is arranged so that the forward stop surfaces (142) of the anchors can pass freely to the contact two abutment surfaces (312) for advancing the locking means (3). This head will therefore preferably have a tip profile with surfaces substantially parallel to the axis of insertion of the anchors (1), for example as shown in Figure 6D. In some embodiments, the flexible portion (30) is arranged to allow rotational or torsional movement. In particular, in the example of FIG. 7G, the locking means (3) comprises a body extended by a thinner neck and flexible (30) at the end of which is formed a head wider than the body is oriented obliquely so its torsion authorizes the passage of the anchors and locks them by the elastic return of the flexible portion (30). The abutments (14) of the anchors can then be grooves near the lateral edge of one of the surfaces of the plate (in this case the convex face in the example shown). In the example of FIG. 13D, the locking means (3) comprises a parallelepipedal body, of substantially rectangular cross-section for example, in which cutouts are formed, preferably in the shorter edges of the rectangle and approaching the one of the other near the center of the locking means (3), thus providing flexibility of the central portion (30) and thus defining four branches, two of which are intended to undergo a twist, to let an anchor and for that their edge engages in a notch of the anchor to lock the latter. In the example of Figure 13E, the parallelepiped body is equipped with four cutouts to improve the flexibility of the central portion (30). In the example of FIG. 17G, the locking means (3) is formed by an insert, preferably of substantially cylindrical shape, preferably screwed or slidably inserted into a housing of the spinal implant (2). In this example the stop (31) is formed by at least one tab, for example flexible or made movable by cutting a portion of the cylindrical periphery at its base. This tab opening into the passage is thus arranged to undergo a twist and to engage by elastic return in the abutment (14) of the anchoring device (1) (then formed by a notch or a notch in an edge of the anchor). In some embodiments, this cylindrical insert may be hollow and threaded so that it forms a means for attaching (26) the implant by an instrument (an implant holder (5) for example).
[0023] In some embodiments, the flexible portion (30) is arranged to allow compression movement. For example, as shown in FIG. 8D, the locking means (3) may be formed by a split ring shape inserted into a complementary housing of the spinal implant (2) in the vicinity of the anchor receiving passages. The edges of the ring protrude slightly in the passages and thus form the stops (31) of the locking means (3). In a complementary manner, the anchors have notches (14) on one of their lateral edges to receive the edges of the ring. This simple embodiment has the advantage of locking in the direction of withdrawal and advancement, and allows to lock two anchors (1) with a single ring (3). In certain particularly advantageous embodiments, the locking means (3) is formed by an insert of elongate shape along a longitudinal axis not parallel to the axis of insertion, such as for example a rod or a stick. These embodiments generally have the advantages, moreover, of a great simplicity and a low cost of implementation, while providing an effective solution for locking. In the example of FIG. 12G, the locking means (3) is formed by a rod oriented non-parallel to the anteroposterior axis, and housed in a conduit of the implant so that a portion of the stem protrudes inside the passage of the implant (2) for receiving the anchor. As particularly visible in FIGS. 12E and 12D, the orientation of the rod may be oblique with respect to the anteroposterior axis of the implant, but preferably also oblique with respect to the vertical and horizontal axes, so that the conduit and the rod does not weaken the implant too much and does not coincide with another element of the implant, such as for example a means of attachment (26) of the implant by an instrument (5). The stem, which is preferably rectilinear, is therefore a very simple and inexpensive element, as well as its arrangement in the implant, which then comprises a conduit complementary to the dimensions and shapes (for example cylindrical) of the rod at one end of the rod. . This duct is, however, widened at the other end of the rod, so as to allow the flexion of its flexible portion (30). It will be noted here in particular, but with the knowledge that this is valid for many embodiments, that the flexible portion (30) is defined by its deflection function but that it is not necessarily different from the other portions of the deflection means. locking (3), except sometimes for its dimensions, deliberately thinned to facilitate flexion. Indeed, in the embodiments where the locking means (3) is formed by a rod, the flexible portion is in fact generally a portion from which the bending of the locking means (3) is permitted by the dimensions of the led in the implant while it can quite be identical to the other portions of the locking means (3). The rod of FIG. 12G introduced into its channel or duct of the implant may flex to allow an anchor to pass and may, by elastic return, engage with this anchor, for example on a notch of the anchor (FIG. 12A ) or in a notch of the anchor (Figure 12C). In certain embodiments, the rod (3) comprises at least one flat that optimizes the contact between the locking means (3) and the anchor (that the latter comprises a stop in the form of a notch or a notch ). In certain preferred embodiments, the locking means (3) comprises at least one wedge facilitating the passage of the anchor (1), so that the anchor (1) can slide along the locking means (3). while avoiding being damaged and / or damaging the locking means (3). Indeed, since it is expected that at least a portion of the locking means (3) can be pushed into a housing of the implant to let the anchor, it is preferable that the surface on which the locking means is likely to be repulsed either too prominent or contending. Therefore, at least one bevel or convex portion is preferably provided on this surface to facilitate passage and to avoid damage to the anchor (1) and / or the locking means (3) since minute debris could be produced and forgotten. in the patient's body. Thus, the harpoon shape described above for FIGS. 1D and 2D is not limiting but reflects the presence of such bevels. Similarly, in FIG. 4G, it can be seen that the abutments bear, on the face which does not form a stop, a bevel to facilitate the passage of the anchor (contrary to FIG. 4C where the two faces form a stop). Likewise, in FIG. 6G, the lateral edges of the abutment are bevelled to facilitate the passage of the anchors by laterally pushing the abutment (31). Thus, bevelled or curved surfaces are preferred and embodiments where the stops (31) of the locking means are convex are often preferred, as for example in FIGS. 18 and 19. In some embodiments, the locking means (3) and the implant (2) are arranged to avoid as much as possible to weaken the implant by the presence of the locking means (3) and in particular of its conduit in the implant (2). Indeed, in certain embodiments described above, the locking means (3) is inserted into the implant near the posterior end of the implant and the amount of material that holds the locking means (3). ) is therefore limited (FIG. 12A shows, for example, a quantity of material which is reasonable but which can be optimized, as for example in FIGS. 14A, 15A, 16A or 18A). To avoid any risk of rupture or instability, some advantageous embodiments thus provide for positioning and / or orientation of the locking means (3) which aim at preserving the integrity of the implant (2). In addition, in the example of FIG. 12B for example, the arrangement of the locking means (3) requires an anchor locking means (3), because of the position and the orientation of the means. locking (3). Some embodiments therefore aim to optimize this position and orientation as well so that only one locking means (3) can lock two anchors at the same time. Thus, various embodiments of the present invention respond to these problems by providing a space-saving, reliable solution that avoids embrittlement of the implant, possibly by limiting the number of locking means (3) necessary to lock several anchors (1). . In the example of FIGS. 14E and 14G, the locking means (3) is formed by an insert, preferably of substantially cylindrical shape, such as a stem for example, housed in a conduit of the implant which is oriented by example in a plane perpendicular to the anterior-posterior axis of the implant, but especially oriented so that the same locking means (3) can lock two anchors at the same time, which generally implies an oblique orientation with respect to the horizontal plane, for example as particularly visible in the example of Figure 14E. Figure 14A clearly shows that this type of locking means (3) is disposed in a conduit located at a distance from the posterior end to avoid embrittlement of the implant. Thus, the rod forming the locking means (3) is arranged obliquely in a conduit of the implant whose middle portion is complementary to the rod but which flares in its lateral portions so that the rod can flex and allow the anchor passage. The embodiment variants presented in FIG. 15D for example, or FIG. 16D in a similar manner have the same advantages generally, the main distinction being the way in which these locking means (3) are retained in the implant (2), as detailed below. Note however that in Figure 14G, it is shown that the rod has two flats, while Figures 15F and 16F do not clearly show the presence of a second flats. This potential difference reflects the possible presence of a retraction abutment surface and a thrust abutment surface, as detailed above. It is understood, however, that we can provide on the anchor a notch comprising two surfaces (141, 142) to oppose the movements of the anchor in both directions. In the examples of FIGS. 18D, 18E and 18F, a locking means (3) is used for each anchor (1) 3016 793 66, but the proposed arrangement still makes it possible to avoid weakening the implant ( 2), thanks in particular to an advantageous position and / or orientation of the locking means (3). In these examples, there are two locking means (3) formed by rods substantially parallel to each other and housed in oblique ducts, arranged not parallel to the horizontal plane but perpendicular to the anteroposterior axis of the implant. Although the advantage of only one locking means (3) is lost in this type of embodiment, they nevertheless offer another advantage of allowing easier anchorage of the anchors, in particular as detailed elsewhere in the present application. . On the other hand, these examples of FIGS. 18 respond to the problem of fragility thanks to a substantial distance between the posterior end of the implant and the locking means (3), but this type of solution can be further optimized by providing locking means (3) abutment and complementary conduits 15 which are not parallel, as for example in the embodiments particularly visible in Figures 19C and 19D. Indeed, in these embodiments, the rods forming the locking means (3), as well as their respective complementary conduit in the implant, are oriented obliquely with respect to the vertical or horizontal axis, but also obliquely with respect to to the anteroposterior axis of the implant, so that the amount of material that separates these conduits and the rods is greater than that of the embodiments of Figures 18, except at the portion where they intersect. It will be noted moreover that this portion where the two locking means intersect may be central (in particular 25 medio-laterally, as shown) and that it is possible, particularly in the case of an intersomatic cage as in this example , that the crossing is done at a central cavity of the cage as visible for example in Figure 19C or, more generally, at an edge of the implant, so that the latter is not too weakened by this crossing of the stems. In addition, Figures 18 and 19 clearly show that the anchor has a notch forming the abutment (14) of the anchor which provides locking in the direction of withdrawal and advancement. Although no flat is shown in Figures 18 and 19, it is possible to provide as in other embodiments or to provide rods of non-cylindrical section, but it may be preferred to have a cylindrical rod and without flat to limit the friction between the anchor and the locking means (3), facilitate the manufacture of the implant and avoid having to respect a particular orientation assembly. As explained above in the present application, the locking means (3) can be integral with the implant (fixed in or made in one piece with the implant, as for example shown in FIGS. 26D and 26F) but it can also be separate and housed in the implant. Nevertheless, a locking means housed in the implant is generally preferred as explained in the present application, since the housing and the walls of the implant which surrounds the lock (3) prevent it from having other degrees of freedom. that the only essential (in the axis of its travel to let the anchor) for the elastic locking function. Thus, in these embodiments where the implant is housed and has only one degree of freedom, it is not only thanks to its dimensions parallel to the axis of insertion of the anchor that it retains the latter, but also thanks to the surfaces of the implant itself against which it will be plated to oppose the movements of the anchor in the longitudinal axis of the latter. Thus, it can be seen for example in FIG. 26A that, even in the case of intervertebral disc prostheses (or osteosynthesis plates), a lock housed in the thickness of the plate (or the osteosynthesis plate) is preferred. rather than flexible tabs that will not be retained as in Figures 26D and 26F. This preference will therefore be used if the thickness of the plates of the prosthesis or the osteosynthesis plate allows it. In general, the various possibilities of arrangement of the lock (3) in the implant (2) are denoted here by the fact that the locking means (3) is retained in a housing of the implant (2). (preferably oriented in a direction not parallel to the axis of insertion of the anchoring device - or the anteroposterior axis of the implant, also used as a reference even if they do not generally coincide) . The locking means may be retained in the implant simply because it is housed in a housing from which it can not escape or because it is retained by specific means. Thus, in some embodiments, the locking means (3) is retained in the implant (2) by at least one retaining means (25, 32). Such retaining means (32, 25) prevent movement of the locking means, in particular the stop (31), preferably in the direction of insertion and / or removal of the anchoring device (1). . Such a retaining means (32, 25) can be obtained in that at least a part of the locking means (3) is disposed inside a housing in the implant (2), in particular a housing avoiding any movement in a direction jeopardizing the locking of the anchor in the implant, or even by the fact that it is integral with the implant (formed in one piece in the implant or attached to so that it is immobile with respect to the implant). Nevertheless, various possibilities are envisaged, such as those detailed in the present application and it is important that the locking means can not move, preferably in the direction of insertion and / or removal of the anchor, of so that it is well locked with respect to the implant. In addition, in some embodiments, the retaining means (32, 25) are configured so that the locking means (3) is removable. In certain embodiments, the retaining means (32, 25) are formed by notches (32) or any type of relief or roughness on at least one surface of the locking means (3) for anchoring in the walls. a housing of the implant (2) in which is inserted the locking means (3). For example, the locking means (3) shown in FIG. 1D has notches intended to counter the movement of the locking means (3) in the direction of the withdrawal of the anchor and / or in the direction of withdrawal of the means. locking 30 (3) of its housing or leads into the implant. Similarly, in the example of Figure 18B, the locking means is fitted into a housing of the implant, with a portion (32) retaining. Preferably, the restraint 3016 793 69 exerted by this portion may, for example, be improved by providing that it is of the same size as that of its housing, or even slightly greater to be forced back inside. One can also provide a thread, for example complementary to a tapping in the housing 5 of the implant or simply a thread or any type of relief or roughness that allow insertion into the housing and will be sufficient to exercise effective restraint. In some embodiments, the retaining means (32, 25) is formed by a housing (32) in the locking means (3) for receiving a rod (25) inserted into the housing (32) through a conduit (250) of the spinal implant (2). This retention by a dowel-mortise type mechanism can naturally find many embodiments. For example, in some embodiments, the retaining means (32, 25) is formed by a recess (32) in the locking means (3) for receiving a pin (25) or a staple (25) inserted ( e) 15 through the implant (2) spinal to cooperate with this recess (32). For example, FIGS. 2D, 3F, 10G, 14B, 14E, 14F, 15C, 15D, 16C, 17B, 17G show various non-exhaustive variants (such as pions, staples, rods or other simple and functional structures) of retaining means (32, 25) for preventing the locking means (3) from emerging from the implant. In the case of locking means (3) advantageously comprising a rod housed in the implant as detailed above and in particular with reference to Figures 18D, 18E and 18F, but also in other embodiments such as those presented for example In Figures 4C, 6A and 6C, it is intended to take advantage of the simplicity of the arrangement to provide a simple and effective solution for retaining the locking means (3) in the implant (2). Indeed, a shoulder or a base located at one end, or near one end, of the body of the locking means (for example a base (32) at the end of the rod in FIG. the latter in the implant (2). For example, in FIGS. 4C, 6A, 6C and 6E, the locking means (3) can be inserted into its housing through a conduit of the implant and it is therefore possible to provide, for example at the (or near) its end opposite to that which retains the anchors, a base or lugs (or any type of equivalent abutment) to bear on the input of this conduit, as for example shown in Figure 6E, or to be housed in a housing provided for this purpose in the walls of this conduit, as for example shown in Figure 6C. In addition, in the case of such lugs (32), it is possible to provide a flexible portion, for example obtained by means of a cutout forming at least two branches carrying the lugs (32) retaining. This type of variant makes it possible to insert the locking means in its conduit from the end of the duct opening at the level of the anchors (1). In addition, in the case of lugs housed in recesses of the walls of the duct, as for example in Figure 6E, the arrangement allows the locking means (3) to be retained in the direction of its withdrawal and in the direction its advance in the conduit, which is particularly advantageous in the case of Figures 6B, 6C and 6E since the locking means (3) comprise abutment surfaces (311, 312) to oppose the withdrawal of the anchor (1) but also to limit the advance of the latter in the implant (2). It is therefore understood that various arrangements of the retaining means (25, 32) are provided in the present application to prevent the movement of the locking means (3) in various directions and thus ensure the locking of the anchor (1) which must not move in the direction of the advance (penetration) and / or in the direction of the withdrawal. In general, therefore, a restraint (25, 32) of the locking means (3) is preferably provided as a function of the locking it is intended to exert on the anchor (1). In certain particularly advantageous embodiments, as for example shown in FIG. 18H, the retaining means (32, 25) are formed by at least one shoulder (32) of the locking means (3) intended to abut against the anchoring device (1), on either side of its abutment (14), so that the anchoring device (1) prevents movement of the locking means (3) in the spinal implant (2) . This type of retaining means has the additional advantage of not requiring the provision of an additional or wider duct than that necessary for the insertion of the locking means (3) into the implant. In addition, in the example of FIG. 18H, the rod forming the locking means (3) actually comprises two shoulders (32) because the abutment (31) is formed by a thinning of the rod (preferred to a thickening which is possible if the conduit allows it). This variant embodiment has the additional advantage of allowing the rod to be retained in its conduit once the anchor (1) has been locked by this thinned portion forming the abutment (31), providing that the notch ( 14) of the anchor has dimensions complementary to the thinned portion and is smaller than the two thicker portions on either side of the stop. Thus, the rod is retained in both directions along its conduit. This has the additional advantage of facilitating the machining of the parts because it is then possible to insert the locking means (3) in its conduit from a face of the implant, while providing the housing for its movement during the passage anchor, without requiring a larger conduit on the other side for its insertion, as required for example in the case of Figure 18E. In certain alternative embodiments, the retaining means (25, 32) may also comprise a thread on the periphery of the locking means (3), for example complementary to a tapping in the implant as explained above, to retain the locking means (3). Nevertheless, it will be noted that according to the orientation of the locking means (3) with respect to the anteroposterior axis of the implant, it is possible not to provide a means (25, 32) for retaining the locking means ( 3), or it is sufficient that it is fitted or hooked into a duct, since it is unlikely to be able to exit the implant (the retaining means then being formed by the fitting or the hooking, as for example on Figures 5E, 7G or 9F). Finally, in the example of the advantageous embodiments of the type of those of Figure 19D, it is possible to provide such a (thread, roughness, fitting) retaining means (32) of the locking means (3). However, in such examples, the need for threading or roughness or relief is less due to the path of the locking rod (3) relative to the passage of the anchors. Indeed, the locking rod of an anchor can for example partially cross the passage of the other anchor, slightly protruding inside, so that the other anchor, once inserted in its passage, press against the rod locking and thus locks in its conduit, as for example visible in Figure 19D. On the other hand, in embodiments where two rods intersect, it is possible to provide that the crossing is done on a portion where the ducts of the two rods are not yet flared (the flare allowing the bending of the rods) , and to then provide a cross path where the two rods come into contact with each other by a retaining portion (32) formed for example by a notch of complementary shape to a portion of the section of the other rod (Similar to the notches (32) of Figs. 14G and 15F, but the function of the pin or pin (25) retaining being here performed by the locking rod of the other anchor).
[0024] Spinal (Spinal / Intervertebral) Implant: In some embodiments, the spinal implant (2) is formed by at least one intersomatic cage, comprising a body forming a means for maintaining the height of the intervertebral space. This body comprises at least one passage therethrough from a peripheral wall to a vertebral contact surface of the cage. Examples of such embodiments are shown in most of the figures of the present application, with the exception of those of plate 26. The other characteristics of such cages are known from the prior art and therefore do not require be detailed, with the exception of those mentioned above on the passage and its shape, and on the arrangements of the locking means. In some embodiments, the spinal implant (2) is formed by at least one intervertebral disc prosthesis comprising at least two trays articulated to each other by at least one curved surface. In a manner known per se, such a curved surface is generally present on one of the trays and it cooperates in general with another curved surface, present either on the other tray, or on a movable core relative to at least one of the trays. At least one of the two trays has at least one passage therethrough, from a peripheral edge of the tray (or from an inner face of the prosthesis) to a vertebral contact surface of the prosthesis. Examples of such embodiments are shown in the figures of the plate 26. In some embodiments (not shown), the spinal implant (2) is formed by at least one osteosynthesis plate traversed by the passage from a outer face to a vertebral contact face of the osteosynthesis plate. In certain embodiments (not shown), the spinal implant (2) is formed by at least one corporectomy cage, for example comprising modular elements assembled together. At least a portion of these modular elements are intended to be in contact with the vertebrae and therefore comprise passages for the anchors and locking devices according to the present invention.
[0025] In some embodiments, particularly those where the implant is a prosthesis or a plate, the locking means (3) is machined directly into the thickness of said tray or said plate. Indeed, the trays and plates are often made of solid materials, such as titanium and it is therefore advantageous to provide the locking means directly in the material of these elements. In some embodiments, the spinal implant (2) has at least one attachment means (26, 27) for gripping it by a surgical instrument. It will be noted that the spinal implant (the interbody cage in particular) comprises at least one attachment means (26, 27) for its grip with the aid of an instrument, such as an implant holder (5) for example. This grip can be achieved by the cooperation of this means (s) of attachment (26, 27) of the implant (2) with at least one implant setting means (525) which equips the instrument . In some embodiments, the implant comprises a single attachment means, such as for example a hole in one of its walls, preferably the so-called posterior wall through which is inserted the anchor in the passage. This hole may be tapped to cooperate with a thread of the implant engaging means (525), formed for example by a threaded rod, the screwing of which in the hole (26) is controlled for example by means of a wheel (52) of the instrument (Figure 24C). In some embodiments, the implant comprises a second attachment means (27), as for example shown in Figures 1B, 2B, 3B, 4B, 5B and 6B. This second means may for example be formed by a groove in which is inserted a tongue of the instrument, or by a groove comprising a recess, as for example visible in Figure 5D, in which is inserted a pin of the instrument. This type of double attachment means allows a better grip of the implant and provides a lever arm to rotate the implant around the anteroposterior axis if necessary. Nevertheless, in the present application, it is possible to take advantage of the arrangement of the anchors and the implant by using the anchors preloaded in the implant to obtain this lever arm. Thus, only one attachment means can be provided since it is possible to use the anchors loaded in the instrument and at least partially engaged in the implant to stabilize the implant and allow possible rotation if necessary. Implantation The present invention also relates to surgical instrumentation, for the implantation of a spinal implant (2) according to various embodiments of the invention and for fixing this implant (2) in at least one vertebra by at least one anchoring device (1) according to various embodiments of the invention. This instrumentation preferably comprises: - an implant holder (5) of elongate shape along a longitudinal axis extending between a first end, called the gripping end of the implant (2), and a second end, called a push-piece, gripping end comprising a head (51) provided at its end with at least one means (525) for gripping the implant (2), the head (51) being traversed by a longitudinal passage opening on the implant (2 ) and adapted to receive said anchoring device (1), - at least one impactor (4) of elongated shape along a longitudinal axis extending between the two ends of the impactor, one end comprising at least one branch ( 41) adapted to penetrate into the implant holder (5) for pushing, directly or via another device (for example a rod inside the implant holder and extending the arm of the impactor, as for example detailed below). after), the posterior end of said anchoring device (1), while the other end of the impactor comprises a surface, said impaction, arranged to receive a thrust or shock to make penetrate the anterior end of said anchoring device (1) in a vertebra through the passage of the implant (2), - at least one guide surface of the anchoring device (1) for guiding the sliding of the latter in the implant holder (5) through the implant (2). Illustrative and nonlimiting examples of such an instrumentation are shown in FIGS. 23A, 23B, 23C, 23D, 24A, 24B, 24C and 25A. These examples represent the various elements in combination with each other, but it is clear that they may each constitute a particular element independently of each other and be claimed separately, particularly with respect to the charger (8), the impactor (4) or the implant holder (5). This instrumentation preferably comprises at least one means for actuating the locking means (3) to push back the locking means (3) during insertion of said anchoring device (1) into the passage of the implant (2). ), via at least one means of access to the locking means (3), for example a means of access to the abutments (14, 31) complementary to the anchoring device (1) and the locking means (3).
[0026] Indeed, as explained above, it is often provided in many embodiments, to access the locking means (3) to repel the stops the time to implement the anchors, so as to facilitate implantation. Thus, in certain preferred embodiments, the instrumentation comprises at least one means for actuating the locking means (3). In general, the implant engaging means (525) is configured to cooperate with at least one attachment means (26, 27) of said implant. This engagement means (525) can thus for example serve as an actuating means if it is used as detailed in FIG. 21F and explained above on the insertion of at least one pin into the attachment means ( 26) of the implant. On the other hand, in certain embodiments, the instrumentation 5 comprises at least one retaining means (84, FIG. 23C) capable of cooperating with said abutment (14) of the anchoring device (1) in order to retain the latter in the implant holder with the actuation of the impactor (4). In addition, in some embodiments, the surgical instrumentation comprises at least one loader (8) slidable in the head 10 of the implant holder (5) and provided with said guide surface. In these embodiments, it is on these chargers (8) that said retaining means (84) is provided. This type of loader (8) preferably comprises a housing or a cutout (85) forming a guide for the impaction of the anchors (guiding the passage of the branches of the impactor or extension rods as described below) . In addition, this charger preferably comprises a retaining means (86) for retaining it in the head of the implant holder (5), as for example visible in Figure 23A. In some embodiments, the magazine (8) also includes at least one attachment means (83) to be manipulated, in particular to slide it into the head of the implant holder (5), to engage it. or leave it for example. On the other hand, in some embodiments, the surgical instrumentation includes two chargers (8), each of which is provided on the one hand with a guide surface, preferably with a means of restraint. (84) and, on the other hand, slidable in the head of the implant holder (5). Preferably, the impactor (4) comprises two branches (41) able to push at the same time two anchoring devices (1) loaded on the two loaders (8) in the head of the implant holder (5). The impactor (4) then has a tuning fork shape whose two branches (41) are able to push at the same time, through the head of the implant holder (5), the two loaders (8) on which are loaded the two anchors (1). In certain variants, as for example shown in FIG. 24B, the impactor actually pushes on extension rods mounted sliding inside the implant door and transmitting the thrust to the anchors (1). In some embodiments, the surgical instrumentation includes a tool (9) for removing the anchor device comprising a hooking means (17) for an end (97) of the removal tool (9) which is configured to hang the anchoring device (1), so that traction on the tool can remove the latter from its passage in the implant. This tool is generally configured to access the anchoring means (17) of the anchoring device (1) via an access means of an implant (2) according to certain embodiments. The invention also relates to a spinal surgery system, characterized in that it comprises at least one anchoring device (1) according to various embodiments of the invention and at least one spinal implant (2) according to various modes of embodiment of the invention, at least one locking means (3) for locking said anchoring device (1) relative to the spinal implant (2) to ensure the stabilization of the latter in a vertebra.
[0027] In certain embodiments, the system comprises at least one instrument of an implantation instrumentation according to the invention. The present application describes various technical features and advantages with reference to the figures and / or various embodiments. Those skilled in the art will appreciate that the technical features of a given embodiment may in fact be combined with features of another embodiment unless the reverse is explicitly mentioned or it is evident that these characteristics are incompatible or that the combination does not provide a solution to at least one of the technical problems mentioned in this application. In addition, the technical features described in a given embodiment can be isolated from the other features of this mode unless the opposite 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 within the scope 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 (10)
[0001]
REVENDICATIONS1. Spinal implant bone anchoring device (1), arranged to be inserted through a through passageway of at least a portion of the implant (2), from an outer surface to a vertebral contact surface, the device (1) comprising a body comprising at least one plate (10) rigid and elongate along a longitudinal axis extending between an anterior end and a posterior end, the plate (10) being configured so that its anterior end penetrates into at least a vertebral surface while its posterior end remains in the passage of the implant (2), retaining said implant (2) against said vertebral surface, the device (1) being characterized in that said body comprises at least one stop ( 14) adapted to receive at least one locking means (3) of the device (1) relative to the implant (2), said stop (14) being oriented non-parallel to the longitudinal axis and complementary to at least one stop (31) of said locking means (3), said locking means (3), equipping the implant (2), being provided with at least one flexible portion (30) allowing, on the one hand, to repel said stop (31) of the locking means (3) for insertion of the anchoring device (1) in the passage, and secondly, the mutual engagement of the two stops (14, 31) when they meet again one opposite the other, by the elastic return of the flexible portion (30).
[0002]
2. Anchoring device (1) according to claim 1, characterized in that it comprises at least one attachment means (17), configured to hook the end of a tool for removal of the device (1) anchor.
[0003]
3. Anchoring device (1) according to the preceding claim, characterized in that said hooking means (17) is located near the rear end of the device (1).
[0004]
4. Device (1) for anchoring according to one of claims 1 to 3, characterized in that it comprises at least one access means to the locking means (3) for disengaging the respective stops (14, 31) of the device (1) anchoring and locking means (3).
[0005]
5. Device (1) for anchoring according to one of claims 1 to 4, characterized in that said abutment (14) of the device (1) comprises at least one abutment surface (141) oriented substantially facing the rear end of the anchoring device (1) for cooperating with at least one complementary abutment surface (311) of opposite orientation on the abutment (31) of the locking means (3) and thus opposing the withdrawal of the device from said passage.
[0006]
6. Anchoring device (1) according to claim 5, characterized in that said abutment surface (141) of the abutment (14) of the device (1) is oriented not perpendicular to the axis of insertion of the device ( 1) anchoring in the implant (2), to allow to push back the stop (31) of the locking means (3) and thus unlock the anchoring device (1) by a traction performed on a hooking means (17).
[0007]
7. Device (1) for anchoring according to one of claims 1 to 6, characterized in that said stop (14) of the device (1) comprises at least one abutment surface (142) facing the front end of the device (1) anchoring, to cooperate with at least one complementary abutment surface (312), of opposite orientation, on the abutment (31) of the locking means (3) and thus oppose an excessive advance of the device (1) in said passage.
[0008]
8. Anchoring device (1) according to one of claims 1 to 7, characterized in that said stop (14) of the device (1) is a female stop cooperating with a stop (31) male of the locking means (3) .
[0009]
9. Device (1) for anchoring according to one of claims 1 to 7, characterized in that said abutment (14) of the device (1) is a male abutment 30 cooperating with a stop (31) female locking means (3). ).
[0010]
10. Anchoring device (1) according to claim 8, characterized in that said abutment (14) of the device is a recess in a surface of the anchoring device (1), intended to cooperate with a projection forming the abutment ( 31) of the locking means (3). it Device (1) for anchoring according to claim 9, characterized in that said abutment (14) of the device (1) forms a projection protruding from a surface of the device (1) anchoring and intended to cooperate with a recess in a surface of the locking means (3). 12. Anchoring device (1) according to one of claims 1 to 11, characterized in that said rigid plate (10) is curved and complementary to the shape of the passage of the implant (2) so as to pass through the implant. without deformation and to be inserted along an axis not perpendicular to the vertebral surface into which the anterior end must penetrate. 13. Device (1) for anchoring according to one of the preceding claims, characterized in that the body describes at least one circular arc or elliptical having dimensions and at least one radius of curvature made such that the device (1) Anchor is implantable in a vertebral plateau along an approach axis forming with the vertical axis of the rachis an angle of approximately 90 °, having its longitudinal axis substantially in the plane of the intervertebral space. 14. Device (1) for anchoring according to one of the preceding claims, characterized in that the stop (14) of the device is formed by a surface of the rear end of the plate (10) which is arranged to penetrate sufficiently into the implant (2). 15. Device (1) for anchoring according to one of claims 1 to 14, characterized in that the body comprises a second plate (11) elongated along said longitudinal axis of the first plate (10) and extending between the end anterior and posterior end, the second plate (11) being integral with the first plate (10) and substantially perpendicular to the first plate (10), giving the device an L-shaped section complementary to the internal section of the passage in the implant (2). 16. Device (1) anchor according to one of the preceding claims, characterized in that the body comprises, at least at its anterior end, at least one chamfer or bevel (18) facilitating the penetration of the device (1) in said vertebral surface. 17. Anchoring device (1) according to one of the preceding claims, characterized in that the front end has at least one notch facilitating the penetration of the device (1) in said vertebral surface. 18. Device (1) for anchoring according to one of the preceding claims, characterized in that the body is provided with notches (16) oriented to oppose the withdrawal of the device (1) once implanted in a vertebra. 19. Device (1) for anchoring according to one of the preceding claims, characterized in that the body is provided at the portion intended to penetrate the vertebral surface, at least one hole (19) for bone growth through the anchoring device (1). 20. Spinal implant (2), comprising at least one external surface and at least one vertebral contact surface through which the implant (2) is intended to be placed in contact with at least one vertebral surface, said implant (2) spinal being configured to accommodate at least one anchoring device (1) according to one of the preceding claims, with at least one passage passing through at least a portion of the implant (2) along an insertion axis, from said outer surface to said vertebral contact surface, the implant (2) being characterized in that it comprises at least one locking means (3) of the device (1) with respect to the implant (2), said locking means (3) being provided with at least one flexible portion (30) and at least one stop (31) oriented non-parallel to the axis of insertion of the passage and complementary to said stop (14) of the device (1) to cooperate with it and thereby lock the device (1) relative to the implant (2), the flexibility of said flexible portion (30) for, on the one hand, to push said stop (31) of the locking means (3) for the insertion of the device (1) anchoring in the passage and, on the other hand, the reciprocal engagement of the two abutments (14, 31) when they meet one another, by the elastic return of the flexible portion (30). 21. Implant (2) spinal according to claim 20, characterized in that it comprises at least one means of access to the locking means (3) for disengaging the respective stops (14, 31) of the device (1) of anchoring and locking means (3). 22. Implant (2) spinal according to one of claims 20 and 21, characterized in that it comprises at least one access means, from outside the implant, to at least one attachment means (17) anchoring device (1) configured to hook the end of a tool for removal of the anchoring device. 23. Implant (2) spinal according to one of claims 20 to 22, characterized in that said stop (31) of the locking means (3) comprises at least one abutment surface (311) oriented substantially opposite the outlet of the passage, towards the vertebral contact surface, to cooperate with cooperating with at least one complementary abutment surface (141), of opposite orientation, on the abutment (14) of the anchoring device (1) and thus oppose its removal. outside said passage. 24. Implant (2) spinal according to claim 23, characterized in that said abutment surface (311) of the stop (31) of the locking means (3) is oriented not perpendicular to the axis of the passage of the device (1). ) anchoring in the implant (2), to allow pushing the stop (31) of the locking means (3) and thus unlocking the anchoring device (1) by a traction performed on a fastening means ( 17) of the anchoring device (1). 25. Implant (2) spinal according to one of claims 20 to 22, characterized in that said abutment (31) of the locking means (3) comprises at leasta abutment surface (312) facing the entrance of the passage, to the outer surface, to cooperate with at least one complementary abutment surface (142) of opposite orientation on the abutment (14) of the anchoring device (1) and to oppose an excessive advance of the device (1). ) in said passage. 26. Implant (2) spinal according to one of claims 20 to 25, characterized in that said abutment (31) of the locking means (3) is a male abutment cooperating with a stop (14) female device (1) of anchorage. 27. Implant (2) spinal according to one of claims 20 to 25, characterized in that said abutment (31) of the locking means (3) is a female stop cooperating with a stop (14) male of the device (1). 28. Implant (2) spinal according to claim 26, characterized in that said abutment (31) of the locking means (3) forms a projection for cooperating with the stop (14) of the device formed by a recess in a surface. the anchoring device (1). 29. Implant (2) spinal according to claim 27, characterized in that said stop (31) of the locking means (3) is a recess in a surface of the locking means (3), intended to cooperate with the stop (14). ) formed by a protrusion protruding from a surface of the anchoring device (1). 30. Implant (2) spinal according to one of claims 20 to 29, characterized in that said passage is rectilinear or curved and complementary to the shape of the device (1) curved anchoring so as to allow the passage of the device (1). ) anchoring through the implant without deformation, by insertion along an axis not perpendicular to the vertebral surface in which the anterior end must penetrate. 31. Implant (2) spinal according to one of claims 20 to 30, characterized in that the passage in the implant (2) has an inner section L-shaped, complementary to the shape of the device (1) anchoring which the body comprises a second plate (11) elongated along said longitudinal axis of the first plate (10) and extending between the lower end and the posterior end, the second plate (11) being integral with the first plate (10). ) and substantially perpendicular to the first plate (10). 32. Implant (2) spinal according to one of claims 20 to 31, characterized in that the locking means (3) is retained in a housing of the implant (2) and oriented in a direction not parallel to the axis insertion of the anchoring device (1). 33. Implant (2) spinal according to one of claims 20 to 32, characterized in that the locking means (3) is retained in the implant (2) by means of retaining means (32, 25) preventing the movement the abutment (31) in the direction of insertion and / or removal of the anchoring device (1). 34. Implant (2) spinal according to claim 33, characterized in that the retaining means (32, 25) are configured so that the locking means (3) is removable. 35. Implant (2) spinal according to one of claims 33 and 34, characterized in that the retaining means (32, 25) are formed by notches (32) on at least one surface of the locking means (3) for anchored in the walls of a housing of the implant (2) in which is inserted the locking means (3). 36. Implant (2) spinal according to one of claims 33 and 34, characterized in that the retaining means (32, 25) are formed by at least one shoulder (32) of the locking means (3) intended to come into abutment against the anchoring device (1), on either side of its abutment (14), so that the anchoring device (1) prevents movement of the locking means (3) in the implant (2) spinal. 37. Implant (2) spinal according to one of claims 33 and 34, characterized in that the retaining means (32, 25) are formed by a recess (32) in the locking means (3) for receiving a pin ( 25) or a staple (25) inserted through the spinal implant (2) to cooperate with this recess (32). Implant (2) spinal according to one of claims 33 and 34, characterized in that the retaining means (32, 25) are formed by a housing (32) in the locking means (3) for receiving a stick (25) inserted into this housing (32) through a conduit (250) of the spinal implant (2). 39. Implant (2) spinal according to one of claims 20 to 38, characterized in that said locking means (3) is formed by an elongated insert along a longitudinal axis not parallel to the axis of insertion. 40. Spinal implant (2) according to one of claims 20 to 38, characterized in that said locking means (3) is formed by a slotted ring-shaped insert inserted in a housing complementary to the spinal implant (2). ) near said passage. 41. Implant (2) spinal according to one of claims 20 to 38, characterized in that said locking means (3) is formed by a cylindrical insert 15 screwed into a housing of the implant (2) spinal and its abutment (31). ) is formed by at least one flexible tab opening into the passage to cooperate with the stop (14) of the device (1) for anchoring. 42. Implant (2) spinal device according to one of claims 20 to 41, characterized in that it is formed by at least one intersomatic cage, comprising a body forming a means for maintaining the height of the intervertebral space, said at least one passage passing through said body from a peripheral wall to a vertebral contact surface of the cage. 43. Implant (2) spinal according to one of claims 20 to 42, characterized in that it is formed by at least one intervertebral disk prosthesis, 25 comprising at least two plates articulated to each other by at least one curved surface, said at at least one passage passing through at least one of the two trays, from a peripheral edge of the tray or from an inner face of the prosthesis, to a vertebral contact surface of the prosthesis. 44. Implant (2) spinal according to one of claims 20 to 42, characterized in that it is formed by at least one osteosynthesis plate traversed by passing from an outer face to a vertebral contact face of the plate. osteosynthesis. 45. Implant (2) spinal according to one of claims 43 and 44, characterized in that said locking means (3) is machined directly in the thickness of said plate or said plate. 46. Implant (2) spinal according to one of claims 20 to 45, characterized in that it comprises at least one attachment means (26, 27) for its gripping by a surgical instrument. 47. Surgical instrumentation, for implanting a spinal implant (2) according to one of claims 20 to 46 and for fixing this implant (2) in at least one vertebra with at least one anchoring device ( 1) according to one of claims 1 to 19, the instrumentation comprising: an implant holder (5) of elongated shape along a longitudinal axis extending between a first end, said gripping of the implant (2), and a second end, said pusher, the gripping end comprising a head (51) provided at its end with at least one means (525) for gripping the implant (2), the head (51) being traversed by a longitudinal passage opening on the implant (2) and adapted to receive said anchoring device (1), at least one impactor (4) of elongate shape along a longitudinal axis extending between the two ends of the impactor, one of the ends comprising at least one branch (41) capable of penetrating into the implant holder (5) for p depressing the posterior end of said anchoring device (1), while the other end of the impactor comprises a so-called impaction surface, arranged to receive a thrust or shock to penetrate the anterior end of said device anchoring (1) in a vertebra through the passage of the implant (2), at least one guide surface of the anchoring device (1) for guiding the sliding of the latter in the implant holder (5) through the implant (2) the instrumentation being characterized in that it comprises at least one means of access to the abutments (14, 31) complementary to the anchoring device (1) and the locking means (3) for urging the locking means (3) upon insertion of said anchoring device (1) into the passage of the implant (2). 48. Surgical instrumentation according to the preceding claim, characterized in that it comprises at least one retaining means (84) adapted to cooperate with said stop (14) of the anchoring device (1) to retain the latter in the holder. implant before actuating the impactor (4). 49. Surgical instrumentation according to the preceding claim, characterized in that it comprises at least one loader (8) slidable in the head of the implant holder (5) and provided with said guide surface and said retaining means (84). ). 50. Surgical instrumentation according to one of claims 47 to 49, characterized in that it comprises two loaders (8), each of them being, on the one hand, provided with a guide surface and a means retainer (84) and, on the other hand, slidable in the head of the implant holder (5). 51. Surgical instrumentation according to claim 50, characterized in that the impactor (4) comprises two branches (41) able to push at the same time, in the head of the implant holder (5), two loaders (8) on which are loaded the two anchoring devices (1). 52. Surgical instrumentation according to one of claims 47 to 51, characterized in that the implant engaging means (525) is configured to cooperate with at least one attachment means (26, 27) of said implant. 53. Surgical instrumentation according to one of claims 47 to 52, characterized in that it comprises a tool (9) for removing the anchoring device according to one of claims 2 to 19 comprising a hooking means (17) for a end (97) of the removal tool (9) which is configured to hook the anchoring device (1), so that pulling on the tool allows removal of the latter from its passage in the implant .54. Surgical instrumentation according to claim 53, characterized in that the tool is configured to access the anchoring means (17) of the anchoring device (1) via an access means of an implant (2) according to the one of claims 30 to 46. 55. A spinal surgery system, characterized in that it comprises at least one anchoring device (1) according to one of claims 1 to 19 and at least one spinal implant (2) according to one of claims 20 to 46, wherein said at least one locking means (3) locks said anchoring device (1) relative to the spinal implant (2) to ensure the stabilization of the latter in a vertebra. 56. System according to claim 55, characterized in that it comprises at least one instrument of an implantation instrumentation according to one of claims 47 to 54.

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同族专利:

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公开号 | 公开日

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US10245157B2|2019-04-02|

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KR20160145538A|2016-12-20|

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US20170246007A1|2017-08-31|

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FR3016793B1|2021-05-07|

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JP2017507000A|2017-03-16|

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US20150209089A1|2015-07-30|

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CA2937451A1|2015-08-06|

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US20180296362A1|2018-10-18|

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EP3099272A1|2016-12-07|

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MX2016009873A|2016-10-28|

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US20180235771A1|2018-08-23|

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AU2015212759A1|2016-09-08|

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SG11201605740XA|2016-09-29|

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US9925059B2|2018-03-27|

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CN107072793A|2017-08-18|

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WO2015114122A1|2015-08-06|

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US9877842B2|2018-01-30|

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法律状态:
2016-01-29| PLFP| Fee payment|Year of fee payment: 3 |

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2017-01-24| PLFP| Fee payment|Year of fee payment: 4 |

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2017-12-11| PLFP| Fee payment|Year of fee payment: 5 |

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2019-12-05| PLFP| Fee payment|Year of fee payment: 7 |

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2020-12-16| PLFP| Fee payment|Year of fee payment: 8 |

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2021-12-23| PLFP| Fee payment|Year of fee payment: 9 |

优先权:

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申请号 | 申请日 | 专利标题

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FR1450749A|FR3016793B1|2014-01-30|2014-01-30|ANCHORING DEVICE FOR SPINAL IMPLANT, SPINAL IMPLANT AND IMPLANTATION INSTRUMENTATION|FR1450749A| FR3016793B1|2014-01-30|2014-01-30|ANCHORING DEVICE FOR SPINAL IMPLANT, SPINAL IMPLANT AND IMPLANTATION INSTRUMENTATION|

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