Intervertebral implant

Abstract

The invention specifies in an intervertebral implant, which comprises at least two upper and at least two lower contact bodies (2.1-2.4) with contact surfaces (2.1.1-2.4.1), a drive (3) with a threaded body (4) with an extension axis (A), which is equipped with oppositely arranged threads (4.1, 4.2) arranged one after the other, wedges axially movably mounted on the threaded body (4) and movable along the threaded body by twisting the threaded body, which have at least one ramp (5.2.1, 5a.2.1) of at least one ramp body (5.2, 5a.2) of the wedges engaging on a corresponding surface of at least a portion of the contact bodies (2.1-2.4) and extending towards each other at a limited angle of less than 90°, the wedges are designed as double wedges with two ramp bodies arranged one after the other in the direction of the extension axis (A), and the ramps (5.1.1, 5.1.2; 5.2.1, 5.2.2) of one ramp body (5.1, 5.2) have a different orientation than the ramps (5a.1.1, 5a.1.2; 5a.2.1, 5a.2.2) of the other ramp body (5a.1, 5a.2), the ramps (5.2.1, 5.2.2; 5a.2.1, 5a.2.2) of the first ramp body (5.2, 5a.2) engage directly on the contact bodies (2.1-2.4) on the side, while the ramps (5.1.1, 5.1.2; 5a.1.1, 5a.1.2) of the second ramp body (5.1, 5a.1) engage directly on the contact bodies (2.1-2.4) in the vertical direction.

Description

TECHNICAL FIELD

[0001] The invention relates to an intervertebral implant comprising at least two upper and at least two lower contact bodies having contact surfaces, comprising an actuator having a threaded body with an axis of extension, which is provided with oppositely arranged threads, comprising wedges which are mounted axially movably on the threaded body and are movable along the threaded body by twisting the threaded body, the wedges having at least one ramp of the wedges which engages on a corresponding surface of at least a portion of the contact bodies and extends towards each other at a limited angle of less than 90°. BACKGROUND

[0002] US 2019 / 0269521 A1 shows an intervertebral implant of the same type, wherein the individual contact bodies of the intervertebral implant can be moved apart from each other laterally and in the vertical direction. The lateral mutual movement apart is effected by an actuator having a threaded rod with oppositely arranged threads via axially movable sliding bodies which are provided with ramps on the threads of the threaded rod, which sliding bodies engage on corresponding corresponding surfaces of the contact bodies.

[0003] The vertical mutual movement apart of the contact bodies is effected indirectly via intermediate bodies which are arranged between the wedges and the support bodies and are movable in obliquely extending grooves of the lower support bodies.

[0004] This construction is on the one hand costly due to the intermediate bodies which are provided as additional movable components in addition to the wedges and the support bodies and on the other hand is susceptible to disturbances, since by this tilting and jamming can occur. SUMMARY

[0005] It is therefore the task of the invention to create an intervertebral implant which is simple to construct while avoiding the above-mentioned disadvantages and which ensures reliable functioning while enabling a time-displaced movement of the support bodies in different directions.

[0006] According to the invention, the above-mentioned task is solved with an intervertebral implant of the same type, which is characterized in that the wedges are designed as double wedges having two successively arranged ramp bodies in the direction of the axis of extension, and the ramp of one of the ramp bodies has a different orientation than the ramp of the other ramp body, and the ramp of the first ramp body engages directly on the contact bodies laterally, while the ramp of the second ramp body engages directly on the contact bodies in the vertical direction.

[0007] The invention thus provides two ramp bodies arranged one after the other in the axial direction, the ramps of the different ramp bodies on one double wedge having different orientations, wherein the first ramp body serves for moving the support bodies laterally or laterally away from each other, and the second ramp body serves for moving the support bodies vertically or head-tailwise away from each other.

[0008] It is provided in particular that the differently oriented ramps are arranged on different ramp bodies of one double wedge.

[0009] A particularly preferred design of the invention provides that the ramps of the first ramp body are oriented in the vertical direction with a horizontal face normal, and the face normals of the ramps of the second ramp body are oriented at a different orientation relative to the vertical line, forming a limited angle of approximately 90°. It is provided in this case in a further development that the corresponding faces of the contact bodies, which interact with the differently oriented ramps in different orientations, have different spacings relative to the differently oriented ramp bodies in the direction of extension of the axis of the thread body of the actuator, in particular that the spacings of the differently oriented ramps relative to the spacings of the corresponding faces on the contact bodies are such that, upon twisting of the thread body, the contact bodies are moved laterally away from each other at least and only then are lifted relative to each other.

[0010] This can be achieved in a specific design in such a way that the spacings of the ramps relative to the spacings of the corresponding faces are such that the contact bodies are first engaged laterally on the corresponding faces of the contact bodies by the ramps of the first ramp body in order to move the contact bodies laterally away from each other and only then, upon further twisting, the ramps of the second ramp body are engaged on the corresponding faces of the contact bodies in order to lift the contact bodies. This in particular achieves a temporally staggered movement of the support bodies.

[0011] It can also be provided in accordance with the invention that the spacings of the differently oriented ramps of one double wedge having two ramp members are smaller than the spacings of the corresponding faces.

[0012] A further preferred design of the invention provides that the actuator has a radial disc or radial wheel fixedly connected to the thread body, which engages into a slot of the contact bodies oriented radially relative to the axis of the thread body in order to guide the contact bodies perpendicularly to the axis, and / or the contact bodies are guided relative to each other by a slidingly engaged guide rod in at least the upper contact body.

[0013] The contact surfaces of the outer part of the upper contact body and the lower contact body are not generally parallel to each other; rather, it is preferably provided that the contact surfaces of the outer part of the upper contact body and the outer part of the lower contact body enclose an angle of between 5° and 15°, preferably between 9° and 11°, in order to achieve a better fit to the natural lordosis of the lumbar spine in this way. Here, the proximal body- central region of the contact surface of each individual contact body initially begins with a surface that rises linearly at half the angle and then transitions into an opposite curvature in the distal region, in order to form an arch that also facilitates insertion into the intervertebral space.

[0014] In a preferred design it is provided that the ramp on one double wedge is formed in one piece with the double wedge.

[0015] In a particularly preferred design it is provided that the superimposed and / or side-by-side contact bodies are movably connected relative to each other by linear guides, in particular at least one linear guide is a slot-and-key guide, preferably a dovetail slot guide. By means of this linear guide, forces occurring under shear loading are guided through the contact bodies and do not or at least less load the internal (functional) structures, such as the displacement mechanism of the double screw. BRIEF DESCRIPTION OF DRAWINGS

[0016] Further advantages and features of the application result from the claims and from the following description, in which preferred embodiments of the application are explained with reference to the drawings. In the drawings:

[0017] Figure 1 An exploded view of a first intervertebral implant according to the application is shown;

[0018] Figure 2 A perspective view of a drive mechanism of an implant according to the application is shown; Figure 1

[0019] Figure 2a A side view of the drive mechanism of Figure 2

[0020] Figure 3 A perspective view of the drive mechanism of an embodiment of Figure 1

[0021] Figure 3a A side view of the drive mechanism according to Figure 3

[0022] Figure 4 A perspective view of a double wedge of an implant according to the application is shown; Figure 1

[0023] ​​​​​Figure 4a a top view of the double wedge of Figure 4 ;

[0024] Figure 4b a side view of the double wedge of Figure 4 ;

[0025] Figure 5 a view showing the complete implant in a compressed state;

[0026] Figure 5a a view showing the implant in a compressed state without the upper front contact body;

[0027] Figure 6 a view showing the implant in a state expanded only laterally (in the side) according to a first step;

[0028] Figure 6a a view showing the implant in a state expanded only laterally (in the side) according to a first step without the upper front contact body; Figure 6

[0029] Figure 7 a view showing the implant according to the application in a state expanded laterally and in the vertical direction after a second expansion step;

[0030] Figure 7a a view showing the implant according to the application in a state expanded laterally and in the vertical direction after a second expansion step without the upper front support body; Figure 7

[0031] Figure 8 an exploded view showing a further embodiment of an intervertebral implant according to the application;

[0032] Figure 9 a perspective view showing a further double wedge of the construction form of Figure 8 ;

[0033] Figure 10 a perspective view showing the implant of Figure 8 in a compressed state;

[0034] Figure 10a a side view showing the implant of Figure 8 , 10 in a compressed state;

[0035] Figure 11 an exploded view showing the implant of Figure 8 in a fully expanded state;

[0036] Figure 11a a side view showing the implant of Figure 8 in a fully expanded state; and​​

[0037] Figure 12 An embodiment of a modification of an intervertebral implant with linear guide according to the application is shown in a compressed state;

[0038] Figure 13 An embodiment of a modification of an intervertebral implant with linear guide according to the application is shown in a compressed state; Figure 12 An embodiment of a modification of an intervertebral implant with linear guide according to the application is shown in a compressed state;

[0039] Figure 14 An embodiment of a modification of an intervertebral implant with linear guide according to the application is shown in a compressed state; Figure 12 An embodiment of a modification of an intervertebral implant with linear guide according to the application is shown in a compressed state;

[0040] Figure 15 An embodiment of a modification of an intervertebral implant with linear guide according to the application is shown in a compressed state;

[0041] Figure 16 An embodiment of a modification of an intervertebral implant with linear guide according to the application is shown in a compressed state; DETAILED DESCRIPTION

[0042] A first embodiment of an intervertebral implant according to the application is shown in Figures 1 to 7a The implant 1 has two upper contact bodies 2.1 and 2.2 (2.2 is removed in Figure 5a , 6a , 7a) and two lower contact bodies 2.3, 2.4 opposite thereto. Between them centrally a drive or actuator mechanism 3 is provided (see also in particular Figure 3 , 3a ).

[0043] The contact bodies 2.1-2.4 have contact surfaces oriented upwards or downwards, which are oriented essentially horizontally in their middle region, for example 2.1.1, 2.2.1, 2.3.1, 2.4.1, or form or define a horizontal region, while the contact surfaces are curved or bent downwards on their ends in longitudinal direction and here the upper and lower contact surfaces opposite to each other extend towards each other.

[0044] The drive mechanism 3 has a central threaded body 4 with an axis A, which also determines the longitudinal direction of the implant. The threaded body 4 has two successive, oppositely oriented threads 4.1, 4.2. Thread 4.1 is a distally body- central thread, and thread 4.2 is a proximally body- central thread. The threaded body 4 is configured at the proximally body- central end with an engagement profile 4.4 for engaging a tool (not shown) with which the threaded body 4 can be twisted. Centrally on the threaded body 4, non- relatively twistably connected to the threaded body, a guide wheel 4.3 is provided, which engages into radially oriented cross grooves 2.5 of the contact bodies 2.1-2.4 and thus mutually determines and specifies the relative axial position of the contact bodies 2.1-2.4 and the threaded body 4, independent of lateral and vertical movements of the contact bodies 2.1-2.4 relative to one another.

[0045] On the threaded body 4, a double wedge 5, 5a with two ramp elements is supported, which is provided with an internal thread 5.3 that matches the threads 4.1, 4.2. These double wedges are mirror-symmetrically configured and arranged mirror-symmetrically on both sides of the wheel.

[0046] Each double wedge 5, 5a has a first and a second ramp body 5.1, 5a.1, 5.2, 5a.2, which are arranged successively in the direction of the axis A and are oriented outwardly from the wheel 4.3. The ramps 5.1.1 and 5.1.2 of the ramp body 5.1 narrow zulaufen outwardly from the wheel 4.3 towards one another, more precisely as follows: Figure 2 ) : The ramp body 5.1 has as upper and lower ramp faces respectively one ramp 5.1.1 and 5.1.2, which have a face normal F5 with a limited angle of approximately 90° with respect to a vertical line V about the axis A. Figure 2 , 2a ). The same applies to the other ramps of the ramp body.

[0047] The contact body 2.1 (and likewise the contact body 2.2) has for the ramp 5.1.1 a corresponding face 2.6, which has approximately or exactly the same inclination as the ramp 5.1.1, 5.1.2, which acts on the corresponding face if the double wedge 5 and the ramp body 5.1 and thus the ramps 5.1.1, 5.1.2 move outwardly from the wheel 4.3 along the axis A (to the left in the drawing) when the threaded body 4 is twisted.

[0048] The same applies essentially to ramp body 5a.1 and the ramps 5a.1.1, 5a.1.2 located thereon, wherein corresponding counter surfaces 2.1.3 are formed on the inner side of contact body 2.1. With respect to the corresponding ramp of contact body 2.2, the same applies to the lower ramp 5a.1.2 and the corresponding counter surfaces of the lower contact bodies 2.3 and 2.4.

[0049] Displaced inwardly in the axial direction A relative to the ramp body 5.1, as described above, the double wedge 5 has a ramp body 5.2 with ramps 5.2.1 and 5.2.2, which are oriented in the vertical direction (see also Figure 3 ), also extending outwardly from the wheel 4.3 at an angle to one another, each having a surface normal F5.2, which is oriented horizontally, ie perpendicular to the vertical line V and which defines a horizontal plane with the axis A ( Figure 3 ).

[0050] The ramp 5.2.1 cooperates with a corresponding surface 2.4.2 on the contact body 2.4, which is also oriented in the vertical direction and extends obliquely, and also with a corresponding corresponding surface on the front upper contact body 2.3, and when the double wedge 5 is moved outward from the wheel 4.3 by rotating the threaded body 4, the contact body 2.4 (and also the contact body 2.3) is moved outward until the ramp 5.2.1 is disengaged from the corresponding surface 2.4.2 (and the corresponding corresponding surface of the contact body 2.3), so that the double wedge 5 can then move along the contact body 2.4 and also together with the contact body 2.3 when the threaded body 4 is further screwed.

[0051] The corresponding contents apply to the ramp 5.2.2 and the corresponding counter surfaces on the contact bodies 2.1 and 2.2 as well as the corresponding ramps 5a.2.1, 5a.2.2 of the ramp body 5a.2 on the double wedge 5a ( Figure 3 、 3a ), wherein reference is made to the previous explanations regarding the interaction between the ramp 5.2.1 and the counter surface 2.4.2.

[0052] exist Figures 1-7a In a first constructional form, the ramp body 5.2 has upper and lower projections 5.2.1.2 (starting laterally from the ramp body and extending on the ramp 5.2.1). Figure 2 ), the lower projection engages in the slot 2.1.4 of the contact body 2.1 and guides the contact body horizontally when the contact bodies are moved laterally apart relative to one another due to the contact surface of the ramp body 5.2. The same applies to the second projections of the ramp bodies 5.2 and 5a.2 and the associated slots 2.3.4 of the contact bodies 2.1-2.4.

[0053] The slit 2.1.4 has a bevelled edge (Abkantung) in the region thereof which faces the end side. By this, when the contact bodies 2.1 and 2.3 or 2.2 and 2.4 are moved apart from one another in vertical direction under the action of the ramp body 5.1, 5a.1 as described above, guidance is ensured.

[0054] The corresponding content applies to the protrusion in the region of the ramp body 5a.2 and the configured slit, for example 2.3.4a, as can be seen from the figures, for which reference is made to the aforementioned explanations accordingly and for the corresponding protrusion on the respective side of the two mentioned ramp bodies and for the corresponding slit in the contact bodies 2.1 and 2.2.

[0055] Finally, guiding rods 6.1, 6.2 are also configured between the contact bodies 2.1 and 2.2, for example, which are movable in the two contact bodies 2.1, 2.2 and guide the two contact bodies relative to one another in their lateral movement apart and vertical lifting movement.

[0056] Corresponding guiding rods are provided in the lower contact bodies 2.3 and 2.4, which likewise guide the bodies relative to one another in the mentioned lateral movement and lowering movement.

[0057] From the figures, in particular Figure 1 It can be derived that the axial spacing of the ramp body 5.2 and thus of its ramp 5.2.1 relative to the ramp body 5.1 or its ramp 5.1.1 (and the corresponding invisible ramp) is smaller than the axial spacing between the counterface 2.4.2 and the counterface 2.6 or the corresponding counterface of the corresponding contact body. The corresponding content applies to the spacing of the ramp body 5a.2 and 5a.1 or its ramps compared to the corresponding counterface on the contact body.

[0058] With this, not only the upper contact bodies 2.1 and 2.2 but also the lower contact bodies 2.3 and 2.4 are first moved apart laterally in the side by the ramp bodies 5.2 and 5a.2 or their ramps in a first step and only then, i.e. temporally offset to the above-mentioned step, the contact bodies 2.1 and 2.3 as well as the contact bodies 2.2 and 2.4 are moved apart from one another in vertical or vertical direction by the ramp bodies 5.1 and 5a.1 or the ramps and thus the contact bodies 2.1-2.4 are only moved towards the upper and lower vertebral bodies in a laterally widened state, whereby the risk of damage to the vertebral bodies is reduced.

[0059] An embodiment of the intervertebral implant according to the invention is shown in Figures 8 to 11a The embodiment essentially and to a large extent has the features of the Figures 1 to 7aThe same applies to the first embodiment. In this regard, identical components are provided with identical reference numerals and reference is made to the above description of the first embodiment. The main difference in the slightly different configuration of the ramp bodies 5.2, 5.2a is the double wedge 5, 5a. The difference consists in that instead of the protrusions on both sides of the respective ramp body in the configuration of Figures 1 to 7a the protrusions 5.2.5 and 5.2.6 of the ramp body 5.2 and one of the protrusions 5a.2.6 and 5a.2.7 on the other side of the ramp body 5a.2 are shown on one side. The protrusions 5.2.5, 5.2.6 and 5a.2.6 are arranged at the middle height of the ramp body 5.2 or 5a.2. These protrusions are inlaid into the slits 2.1.5, 2.1.6, 2.2.5, 2.2.6, 2.3.5, 2.3.6, 2.4.5, 2.4.6 which extend first horizontally and then obliquely, wherein the oblique sections of the slits 2.1.5, 2.1.6, 2.2.5, 2.2.6 of the upper contact bodies 2.1, 2.2 extend outwardly downward and the oblique sections of the slits 2.3.5, 2.3.6, 2.4.5, 2.4.6 of the lower contact bodies 2.3, 2.4 extend outwardly upward.

[0060] This causes the lower contact bodies 2.3 and 2.4 to be pressed downward and the upper contact bodies 2.1 and 2.2 to be pressed upward when the protrusions 5.2.5 and 5.2.6 (and the corresponding protrusions of the ramp body 5a) enter into the oblique sections of the slits mentioned and thus causes a spreading in the vertical direction. The aforementioned horizontal spreading of the contact bodies 2.1 and 2.2 relative to each other and of the contact bodies 2.3 and 2.4 relative to each other takes place in the same way as described with reference to the first configuration.

[0061] In order for the protrusions 5.2.5 and 5.2.6 and 5a.2.6 (and the corresponding opposite protrusions of the ramp body 5a.2) to be able to inlay into the slits of the lower and upper contact bodies, respectively, at the same time in order to cause the respective vertical spreading, i.e. for example the protrusion 5.2.5 can inlay not only into the slit 2.3.5 of the contact body 2.3 but also into the slit 2.1.5 of the contact body 2.1, the slits must overlap in the compressed basic configuration Figure 10 , 10a ). Accordingly, the horizontal areas 2.1.7, 2.2.7 with the slits 2.1.5, 2.1.6 or 2.2.5, 2.2.6 are inlaid in the vertical direction inside the inside of the side walls of the respective lower contact body 2.3 or 2.4, whereby the overlap of the slits takes place in their horizontal areas, as in the hypothetical one-sided overlap Figure 8As can be easily seen when the contact bodies 2.1 and 2.3 are combined and the contact bodies 2.2 and 2.4 are combined.

[0062] Figures 12 to 16 Another modification of the intervertebral implant of the previous figures is shown. Identical parts are marked with the same reference numerals. Figures 12 to 16 The intervertebral implant also has upper contact bodies 2.1, 2.2 and lower contact bodies 2.3, 2.4. Figure 12 The intervertebral implant 1 is shown in a compressed state. Figure 13 It is shown in the state in which it is (only) expanded laterally or horizontally.

[0063] The implant 1 first has linear guides 7.1, 7.2 of the two upper contact bodies 2.1, 2.2 ( Figure 12 、 13 Furthermore, the implant comprises linear guides 7.3, 7.4 of the two lower contact bodies 2.3, 2.4 ( Figure 12 、 13 , 14, 16). The linear guides 7.1-7.4 serve to guide the upper contact bodies 2.1, 2.2 or the lower contact bodies 2.3, 2.4 laterally or horizontally relative to each other. In addition, corresponding (vertical) linear guides are provided for the directly superimposed contact bodies 2.1 and 2.3 or 2.2 and 2.4, wherein in the figures, more precisely Figure 13 FIG. 5 shows only one vertical linear guide 7 . 5 of the contact bodies 2 . 2 , 2 . 4 , which will be explained in more detail below.

[0064] Each linear guide 7.1-7.2 comprises a tongue and groove guide, in particular a dovetail guide with an undercut, as is particularly the case in Figure 12 、 13 、16 in the guide section 7.3、 Figure 13 Also Figure 15 The corresponding contents also apply to the guide parts 7.1 and 7.2. Figure 13 The guide portion is 7.5.

[0065] Each linear guide accordingly has a groove and a projection or protrusion engaging in the groove, usually referred to as a "tenon". In the linear guide 7.1, these are the groove 7.1.1 and the tenon 7.1.2, in the linear guide 7.2, the groove 7.2.1 and the tenon or projection 7.2.2 (in particular, respectively). Figure 13 In the linear guide 7.3, these are the groove 7.3.1 and the tongue 7.3.2, and in the linear guide 7.4, the groove 7.4.1 and the tongue 7.4.2 (correspondingly Figure 16 ).

[0066] exist Figure 13 In the (vertical) linear guide 7.5 shown in FIG, the groove is formed in the two downwardly directed guide projections 7.5.1 and 7.5.1a, and the corresponding tongue or projection of the guide 7.5 is formed by the side wall 7.5.2 of the lower support body on the right side (starting from the joint side). Here, the mutually cooperating side walls of the projection or tongue 7.5.2 and the guide projections 7.5.1, 7.5.1a are also configured as dovetails with undercuts, as shown in FIG. Figure 13 As shown in .

[0067] The vertical linear guides of the stacked supports 2.1, 2.3 are designed in the same way as the linear guides 7.5.

[0068] The linear guide achieves that the transverse forces that occur are absorbed by said linear guide and that, in particular, the twin screw 4 and the threads of the wedge that interact with it are relieved of or at least relieved of such forces.

[0069] The intervertebral implant 1 according to the invention is introduced and positioned in all embodiments essentially as follows:

[0070] First, access to the intervertebral opening is created, as described, for example, in WO 2014 / 146797.

[0071] Through the inlet sleeve, then guide it into the Figure 5 The intervertebral implant 1 is in a compressed state in the form of a structure. To this end, it is then achieved Figure 6 、 6a If the intervertebral implant 1 has reached its position between two vertebrae (i.e., one vertebra located below it and one vertebra located above it), a tool is inserted through the introduction sleeve to engage the manipulator at the end of the intervertebral implant 1 near the center of the body and the threaded body 4 is twisted by the tool. Since the two double wedges 5, 5a cannot be twisted together, the double wedges are advanced from the initial position in opposite directions apart from each other by means of the threaded connection between the double wedges and the opposite external threads of the threaded body, as in the case of Figures 2 to 3 As can be seen in the transition.

[0072] Here, first the ramp bodies 5.2 and 5a.2 engage on the respective counter surfaces of the contact bodies 2.1 - 2.4 and move the contact bodies laterally away from each other until the counter surfaces of the contact bodies, for example 2.4.2, release the respective ramp, so that the contact bodies can be moved along the support body upon further twisting of the thread body 4. At the same time, that is, after the support body has been moved completely laterally away, the ramp body 5.1 engages with its ramp on the respective counter surface of the contact body, for example 2.6, so that upon further twisting of the thread body, the contact bodies are lifted by the two mentioned surfaces until the configuration of Figure 7 , 7a is reached.

[0073] In this last method step, the contact bodies are moved with their outer side faces towards the vertebral body and thus at least one tension of the components reaches the vertebral body and the intervertebral implant.

[0074] By moving the contact bodies first in a laterally spread state towards the vertebral body, the danger of damaging the vertebral body is significantly reduced or excluded.

Claims

1. Intervertebral implants, - comprising at least two upper and at least two lower contact bodies (2.1-2.4), said contact bodies having contact surfaces (2.1.1-2.4.1); - comprises an actuator (3) having a threaded body (4) with an axis of extension (A), the threaded body being provided with opposing threads (4.1, 4.2) arranged one behind the other; - comprising wedges axially mounted on a threaded body (4) and movable along the threaded body by twisting the threaded body, the wedges having slopes (5.2, 5a.2) of at least one ramp body (5.2, 5a.2) of the wedge engaging at least on a corresponding face of at least a portion of the contact body, extending towards each other at a limited angle of less than 90° 5.2.1、5a.2.1)， It is characterized in that - the wedges are designed as double wedges, which have two ramp bodies arranged one after the other in the direction of the extension axis (A), - the slope of one of the slope bodies (5.1, 5.2) ( 5.1.1, 5.1.2; 5a.1.1, 5a.1.2) has a different orientation than the slope (5.2.1, 5.2.2, 5a.2.1, 5a.2.2) of another slope body (5a.1, 5a.2), - The ramps (5.2.1, 5.2.2; 5a.2.1, 5a.2.2) of the first ramp body (5.2, 5a.2) directly engage the contact body (2.1-2.4) laterally, while the ramps (5.1.1, 5.1.2; 5a.1.1, 5a.1.2) of the second ramp body (5.1, 5a.1) directly engage the contact body (2.1-2.4) in the vertical direction.

2. The intervertebral implant according to claim 1, characterized in that The slope (5.2.1, 5a.2.1) of the first ramp body (5.2, 5a.2) is oriented in the vertical direction with a horizontal surface normal (H), while the surface normal (F) of the slope (5.1.1, 5a.1.1) of the second ramp body (5.1, 5a.1) is oriented differently from this and encloses a limited angle of approximately 90° relative to the vertical line (V).

3. The intervertebral implant according to claim 1, characterized in that Differently oriented ramps (5.1.1, 5.2.1, 5a.1.1, 5a.2.1) are arranged on different ramp bodies (5.1, 5.2, 5a.1, 5a.2).

4. The intervertebral implant according to claim 1, characterized in that The contact bodies (2.1-2.4) have slopes with different orientations ( The corresponding surfaces (2.4.2, 2.6) of the actuator (5.1.1, 5.2.1; 5a.1.1, 5a.2.1) that cooperate with each other in different orientations have different spacings along the extension direction of the axis (A) of the threaded body (4) of the actuator relative to the spacings of the ramp bodies (5.1, 5.2, 5a.1, 5a.2) in different orientations.

5. The intervertebral implant according to claim 1, characterized in that The spacing of the differently oriented ramps (5.1.1, 5.2.1; 5a.1.1, 5a.2.2) relative to the spacing of the corresponding surfaces (2.4.2, 2.6) on the contact bodies (2.1-2.4) is such that when the threaded body (4) is rotated, the contact bodies (2.1-2.4) are moved apart from each other at least laterally and then lifted relative to each other.

6. The intervertebral implant according to claim 1, characterized in that The spacing of the ramps (5.1.1, 5.2.1; 5a.1.1, 5a.2.1) relative to the spacing of the corresponding surfaces (2.4.2, 2.6) is such that the contact bodies (2.1-2.4) first engage laterally on the corresponding surfaces (2.4.2) of the contact bodies (2.1-2.4) via the ramps (5.2.1, 5a.2.1) of the first ramp body (5.2, 5a.2) so that the contact bodies are moved laterally apart from each other and only upon further twisting does the ramps (5.1.1, 5a.1.1) of the second ramp body (5.1, 5a.1) engage on the corresponding surfaces (2.6) of the contact bodies (2.1-2.4) so ​​that the contact bodies are lifted.

7. The intervertebral implant according to claim 1, characterized in that The spacing between the differently oriented slopes (5.1.1, 5.2.1; 5a.1.1, 5a.2.1) of a double wedge (5, 5a) is smaller than the spacing between the associated counter surfaces (2.4.1, 2.6).

8. The intervertebral implant according to claim 1, characterized in that The actuator comprises a radial disk or radial wheel (4.3) fixedly connected to the threaded body, which engages in a slot (2.5) of the contact body (2.1-2.4) oriented radially relative to the axis (A) of the threaded body (4) in order to guide the contact body perpendicularly to the axis.

9. The intervertebral implant according to claim 1, characterized in that A guide rod is provided which is slidably engaged in at least the upper contact body (2.1, 2.2) in order to guide the contact bodies (2.1, 2.2) relative to one another.

10. The intervertebral implant according to claim 1, characterized in that The outer contact surface of the upper contact body (2.1, 2.2) encloses an angle of between 5° and 15° with the outer contact surface of the lower contact body (2.3, 2.4).

11. The intervertebral implant according to claim 1, characterized in that The ramp bodies (5.1, 5.2, 5a.1, 5a.2) on a double wedge are formed integrally with the double wedge.

12. The intervertebral implant according to claim 1, characterized in that The contact bodies (2.1, 2.3; 2.2, 2.4; 2.1, 2.2; 2.3, 2.4) arranged one above the other and / or side by side are connected so as to be movable relative to one another via linear guides.

13. The intervertebral implant according to claim 12, characterized in that At least one linear guide is a tongue and groove guide.

14. The intervertebral implant according to claim 10, characterized in that The outer contact surface of the upper contact body (2.1, 2.2) encloses an angle of between 9° and 11° with the outer contact surface of the lower contact body (2.3, 2.4).

15. The intervertebral implant according to claim 13, characterized in that The tongue and groove guide is a dovetail groove guide.

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