Method and apparatus for performing spine surgery

• US 10,327,750 B1
• Filed: 04/29/2016
• Issued: 06/25/2019
• Est. Priority Date: 04/16/2009
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Pimenta, Luiz, Serra, Michael, Morris, Andrew, Lovell, Nathan, Oi, Nelson, Shoshtaev, Eugene
• Primary Examiner(s): Fowler, Daniel W
• Application Number:
  US15/143,242
• Time in Patent Office: 1,152 Days
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/320036 adapted for use within the carpal tunnel
• CPC Class Codes: A61B 17/3209 Incision instruments
• CPC Class Codes: A61B 17/3211 Surgical scalpels, knives; Accessories therefor
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• CPC Class Codes: A61B 17/8863 Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/0262 with a provision for protecting nerves
• CPC Class Codes: A61B 2017/320052 Guides for cutting instruments
• CPC Class Codes: A61B 2018/00601 Cutting
• CPC Class Codes: A61B 2090/08021 of the patient or his organs
• CPC Class Codes: A61B 2090/0817 Spatulas or spatula like extensions
• CPC Class Codes: A61F 2/30771 applied in original prostheses, e.g. holes or grooves
• CPC Class Codes: A61F 2/442 Intervertebral or spinal discs, e.g. resilient non-disc-shaped intervertebral inflatable pockets A61F2/441; non-disc-shaped intervertebral fusion implants A61F2/4455
• CPC Class Codes: A61F 2/4455 for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages intervertebral discs A61F2/442
• CPC Class Codes: A61F 2/447 : substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
• CPC Class Codes: A61F 2/4611 : of spinal prostheses
• CPC Class Codes: A61F 2002/2817 : Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
• CPC Class Codes: A61F 2002/2835 : Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30062 : (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/30176 : V-shaped
• CPC Class Codes: A61F 2002/30266 : wedge-shaped parallelepipeds
• CPC Class Codes: A61F 2002/30281 : wedge-shaped
• CPC Class Codes: A61F 2002/30433 : using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/30576 : with extending fixation tabs
• CPC Class Codes: A61F 2002/30578 : having apertures, e.g. for receiving fixation screws
• CPC Class Codes: A61F 2002/30593 : hollow
• CPC Class Codes: A61F 2002/30607 : Kits of prosthetic parts to be assembled in various combinations for forming different prostheses
• CPC Class Codes: A61F 2002/30616 : Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2002/30774 : internally-threaded
• CPC Class Codes: A61F 2002/30777 : Oblong apertures
• CPC Class Codes: A61F 2002/30784 : Plurality of holes
• CPC Class Codes: A61F 2002/30785 : parallel
• CPC Class Codes: A61F 2002/30787 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30828 : parallel
• CPC Class Codes: A61F 2002/30904 : serrated profile, i.e. saw-toothed
• CPC Class Codes: A61F 2002/3093 : for promoting ingrowth of bone tissue
• CPC Class Codes: A61F 2250/0098 : radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: A61F 2310/00011 : Metals or alloys
• CPC Class Codes: A61F 2310/00179 : Ceramics or ceramic-like structures
• CPC Class Codes: A61F 2310/00359 : Bone or bony tissue

Abstract

Systems and methods are described for correcting sagittal imbalance in a spine including instruments for performing the controlled release of the anterior longitudinal ligament through a lateral access corridor and hyper-lordotic lateral implants.

Claims

1. A method for correcting sagittal imbalance of a lumbar spine, comprising the steps of:

a) creating a lateral operative corridor to access a targeted spinal disc via a lateral approach by inserting an access system along a lateral, trans-psoas path to the targeted spinal disc;

b) inserting a cutting device through the lateral operative corridor and severing the Anterior Longitudinal Ligament (ALL);

c) connecting an insertion instrument to a first retractor blade forming a portion of a border of the lateral operative corridor, the insertion instrument having an implant for positioning between the adjacent vertebral bodies bordering the targeted disc coupled thereto; and

d) advancing the insertion instrument along the first retractor blade to position the implant between the adjacent vertebral bodies.

2. The method of claim 1, wherein the cutting device includes a blade.

3. The method of claim 2, wherein the blade is situated between two finger extensions.

4. The method of claim 1, wherein the cutting device includes an anode electrode.

5. The method of claim 4, wherein an insulated retractor is positioned between the ALL and the great vessels prior to activating electrical current that cuts the ALL.

6. The method of claim 1, wherein the implant is angled between 20 and 40 degrees from an anterior to posterior direction.

7. The method of claim 1, wherein the access system comprises at least one dilator and a retractor that slides over the at least one dilator in a first configuration, and thereafter adjusts to a second configuration to form the operative corridor, wherein the retractor includes the first retractor blade.

8. The method of claim 7, further comprising:

monitoring the proximity of nerve tissue to at least one component of the access system.

9. The method of claim 8, wherein the retractor includes a plurality of blades, one of the plurality of blades being a posterior blade, and wherein monitoring the proximity of nerve tissue comprises determining a proximity and directionality to a nerve located in the psoas muscle, the method further comprising:

fixing the position of the posterior blade just anterior to the nerve prior to adjusting to the second configuration such that adjusting to the second configuration comprises moving at least one of the plurality of blades away from the posterior blade.

10. The method of claim 9, wherein the first retractor blade is the posterior retractor blade.

11. The method of claim 10, wherein connecting the insertion instrument to the first retractor blade includes slideably engaging a guide piece of the insertion instrument into a track of the first retractor blade.

12. The method of claim 11, wherein the guide piece rotates in two axes relative to a longitudinal axis of the insertion instrument such that the anterior-posterior position and cephalad-caudal position of the implant is adjustable relative to the first retractor blade.

13. A method for correcting sagittal imbalance of a lumbar spine, comprising:

creating a lateral operative corridor to access a targeted spinal disc by inserting an access system along a lateral, trans-psoas path extending into a retroperitoneal space and through a psoas muscle to the targeted spinal disc, wherein the access system comprises at least one dilator and a retractor that slides over the at least one dilator in a first configuration, and wherein the retractor thereafter adjusts to a second configuration to form the lateral operative corridor;

inserting a cutting device through the lateral operative corridor and severing the Anterior Longitudinal Ligament (ALL);

inserting an insertion instrument into the lateral operative corridor, the insertion instrument having an implant coupled thereto for positioning between the adjacent vertebral bodies bordering the targeted disc; and

advancing the insertion instrument through the lateral operative corridor to position the implant between the adjacent vertebral bodies.

14. The method of claim 13, further comprising:

monitoring the proximity of nerve tissue to at least one component of the access system.

15. The method of claim 14, wherein the retractor includes a plurality of blades, one of the plurality of blades being a posterior blade, and wherein monitoring the proximity of nerve tissue comprises determining a proximity and directionality to a nerve located in the psoas muscle, the method further comprising:

fixing the position of the posterior blade just anterior to the nerve prior to adjusting to the second configuration such that adjusting to the second configuration comprises moving at least one of the plurality of blades away from the posterior blade.

16. The method of claim 14, wherein the retractor includes a first retractor blade, wherein inserting the insertion instrument into the lateral operative corridor comprises slideably engaging a guide piece of the insertion instrument into a track of the first retractor blade.

17. The method of claim 16, wherein the guide piece rotates in two axes relative to a longitudinal axis of the insertion instrument such that the anterior-posterior position and cephalad-caudal position of the implant is adjustable relative to the first retractor blade.