Method of inserting spinal implants with the use of imaging

• US 20030153916A1
• Filed: 02/21/2003
• Published: 08/14/2003
• Est. Priority Date: 06/10/1993
• Status: Active Grant

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Sofamor Danek Holdings, Inc
• Inventors: Michelson, Gary Karlin
• Granted Patent: US 6,875,213 B2
• Time in Patent Office: Days
• US Class Current: 606/61
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: Y10S 623/908 Bone
• CPC Class Codes: Y10T 407/1964 Arcuate cutting edge

Abstract

Apparatus and a method of inserting spinal implants is disclosed in which an intervertebral space is first distracted, a hollow sleeve having teeth at one end is then driven into the vertebrae adjacent that disc space. A drill is then passed through the hollow sleeve removing disc and bone in preparation for receiving the spinal implant which is then inserted through the sleeve.

Claims

1. A method for performing surgery on a spinal segment including a disc space and two vertebral bodies adjacent the disc space, the method comprising the steps of:

positioning at least a portion of one end of a hollow guard in contact with the adjacent vertebral bodies;

distracting the adjacent vertebral bodies relative to one another;

removing, through said guard, bone from the adjacent vertebral bodies to form an opening across the surgically corrected height of the disc space and into a portion of each of the two adjacent vertebral bodies;

inserting, through said guard and into the opening, an implant having opposed surfaces adapted to contact one each of the adjacent vertebral bodies, each of said opposed surfaces having at least one opening to permit for the growth of bone from adjacent vertebral body to adjacent vertebral body through said implant; and

utilizing at least in part radiologic imaging to visualize the position of at least a portion of at least one of said implant and said guard relative to the vertebral bodies during at least one of the planning and performing of the surgery.

2. The method of claim 1, wherein the utilizing step includes utilizing an x-ray.

3. The method of claim 1, wherein the utilizing step includes utilizing roentgenography.

4. The method of claim 1, wherein the positioning step includes the step of engaging said one end of said guard to the two adjacent vertebral bodies.

5. The method of claim 1, wherein the positioning step includes the substep of positioning said guard having at least one projection extending distally from a distal end of said guard, said distal end adapted to contact each of the vertebral bodies adjacent the disc space to be fused, said at least one projection adapted to penetrate the disc space so as to be located at least in part between the vertebral bodies where adjacent the disc space.

6. The method of claim 5, wherein said projection is at least in part co-linear with an outer perimeter of said guard.

7. The method of claim 5, wherein said projection is a tooth.

8. The method of claim 1, wherein the positioning step includes the substep of positioning said guard that is a tubular sleeve.

9. The method of claim 1, wherein the distracting step includes the step of using a distractor to distract the adjacent vertebral bodies relative to one another.

10. The method of claim 9, wherein the utilizing step includes visualizing the position of at least a portion of said distractor with said radiologic imaging relative to the vertebral bodies.

11. The method of claim 1, wherein the removing step includes the use of a bone removal device to form the opening and the utilizing step includes visualizing the position of at least a portion of said bone removal device with said radiologic imaging relative to the vertebral bodies.

12. The method of claim 1, wherein the removing step includes the substep of one of milling and drilling the opening.

13. The method of claim 1, further comprising the step of tapping the opening through said guard and the utilizing step includes visualizing the position of at least a portion of said tap with said radiologic imaging relative to the vertebral bodies.

14. The method of claim 1, wherein the inserting step includes the substep of screwing said implant into the opening through said guard.

15. The method of claim 1, wherein the inserting step includes using an insertion instrument to insert said implant into the opening and the utilizing step includes visualizing the position of at least a portion of said insertion instrument with said radiologic imaging relative to the vertebral bodies.

16. The method of claim 1, wherein the inserting step includes inserting said implant comprising a fusion-promoting substance.

17. The method of claim 1, wherein said implant includes at least in part one of bone and artificial material. 18. The method of claim 1, wherein said implant is in the shape of one of a cylinder, a partial cylinder, and a dowel.

19. The method of claim 1, further comprising the step of combining said implant with a fusion promoting substance.

20. The method of claim 19, wherein the fusion promoting substance includes bone.

21. The method of claim 19, wherein said implant is at least in part hollow, the step of combining including loading said implant with the fusion promoting substance.

22. The method of claim 19, wherein the step of combining includes coating said implant with the fusion promoting substance.

23. The method of claim 1, wherein the method is performed without distracting the adjacent vertebral bodies between the removing step and the inserting step.

24. The method of claim 1, wherein the method is performed without removing the guard between the positioning step and the inserting step.

25. The method of claim 1, wherein the inserting step includes the substep of providing said implant having upper and lower portions having at least one protrusion on said upper and lower portions for engaging the adjacent vertebral bodies.

26. The method of claim 25, wherein said protrusion is at least a portion of a thread.

27. A method for performing surgery on a spinal segment including a disc space and two vertebral bodies adjacent the disc space, the method comprising the steps of:

positioning at least a portion of one end of a hollow guard in contact with the adjacent vertebral bodies;

distracting the adjacent vertebral bodies relative to one another;

removing, through said guard, bone from the adjacent vertebral bodies to form an opening across the surgically corrected height of the disc space and into a portion of each of the two adjacent vertebral bodies;

inserting, through said guard and into the opening, an implant having rigid opposed surfaces adapted to contact one each of the adjacent vertebral bodies; and

utilizing at least in part magnetic resonance imaging to visualize the position of at least a portion of at least one of said implant and said guard relative to the vertebral bodies during at least one of the planning and performing of the surgery.

28. The method of claim 27, wherein the utilizing step includes utilizing an x-ray.

29. The method of claim 27, wherein the utilizing step includes utilizing roentgenography.

30. The method of claim 27, wherein the positioning step includes the step of engaging said one end of said guard to the two adjacent vertebral bodies.

31. The method of claim 27, wherein the positioning step includes the substep of positioning said guard having at least one projection extending distally from a distal end of said guard, said distal end adapted to contact each of the vertebral bodies adjacent the disc space to be fused, said at least one projection adapted to penetrate the disc space so as to be located at least in part between the of the vertebral bodies where adjacent the disc space.

32. The method of claim 31, wherein said projection is at least in part co-linear with an outer perimeter of said guard.

33. The method of claim 31, wherein said projection is a tooth.

34. The method of claim 27, wherein the positioning step includes the substep of positioning said guard that is a tubular sleeve.

35. The method of claim 27, wherein the distracting step includes using a distractor to distract the adjacent vertebral bodies relative to one another.

36. The method of claim 35, wherein the utilizing step includes visualizing the position of at least a portion of said distractor with said magnetic resonance imaging relative to the vertebral bodies.

37. The method of claim 27, wherein the removing step includes the use of a bone removal device to form the opening and the utilizing step includes visualizing the position of at least a portion of said bone removal device with said magnetic resonance imaging relative to the vertebral bodies.

38. The method of claim 27, wherein the removing step includes the substep of one of milling and drilling the opening.

39. The method of claim 27, further comprising the step of tapping the opening through said guard and the utilizing step includes visualizing the position of at least a portion of said tap with said magnetic resonance imaging relative to the vertebral bodies.

40. The method of claim 27, wherein the inserting step includes the substep of screwing said implant into the opening through said guard.

41. The method of claim 27, wherein the inserting step includes using an insertion instrument to insert said implant into the opening and the utilizing step includes visualizing the position of at least a portion of said insertion instrument with said magnetic resonance imaging relative to the vertebral bodies.

42. The method of claim 27, wherein the inserting step includes inserting said implant comprising a fusion-promoting substance.

43. The method of claim 27, wherein said implant includes at least in part one of bone and artificial material.

44. The method of claim 27, wherein said implant is in the shape of one of a cylinder, a partial cylinder, and a dowel.

45. The method of claim 27, further comprising the step of combining said implant with a fusion promoting substance.

46. The method of claim 45, wherein the fusion promoting substance includes bone.

47. The method of claim 45, wherein said implant is at least in part hollow, the step of combining including loading said implant with the fusion promoting substance.

48. The method of claim 45, wherein the step of combining includes coating said implant with the fusion promoting substance.

49. The method of claim 27, wherein the method is performed without distracting the adjacent vertebral bodies between the removing step and the inserting step.

50. The method of claim 27, wherein the method is performed without removing the guard between the positioning step and the inserting step.

51. The method of claim 27, wherein the inserting step includes the substep of providing said implant having upper and lower portions having at least one protrusion on said upper and lower portions for engaging the adjacent vertebral bodies.

52. The method of claim 51, wherein said protrusion is at least a portion of a thread.

53. A method for performing surgery on a spinal segment including a disc space and two vertebral bodies adjacent the disc space, the method comprising the steps of:

positioning at least a portion of one end of a hollow guard in contact with the adjacent vertebral bodies;

distracting the adjacent vertebral bodies relative to one another;

removing, through said guard, bone from the adjacent vertebral bodies to form an opening across the surgically corrected height of the disc space and into a portion of each of the two adjacent vertebral bodies;

inserting, through said guard and into the opening, an implant having opposed surfaces adapted to contact one each of the adjacent vertebral bodies, each of said opposed surfaces having at least one opening to permit for the growth of bone from adjacent vertebral body to adjacent vertebral body through said implant; and

utilizing at least in part magnetic resonance imaging to visualize the position of at least a portion of at least one of said implant and said guard relative to the vertebral bodies during at least one of the planning and performing of the surgery.

54. The method of claim 53, wherein the positioning step includes the step of engaging said one end of said guard to the two adjacent vertebral bodies.

55. The method of claim 53, wherein the positioning step includes the substep of positioning said guard having at least one projection extending distally from a distal end of said guard, said distal end adapted to contact each of the vertebral bodies adjacent the disc space to be fused, said at least one projection adapted to penetrate the disc space so as to be located at least in part between the vertebral bodies where adjacent the disc space.

56. The method of claim 55, wherein said projection is at least in part co-linear with an outer perimeter of said guard.

57. The method of claim 55, wherein said projection is a tooth.

58. The method of claim 53, wherein the positioning step includes the substep of positioning said guard that is a tubular sleeve.

59. The method of claim 53, wherein the distracting step includes using a distractor to distract the adjacent vertebral bodies relative to one another.

60. The method of claim 59, wherein the utilizing step includes visualizing the position of at least a portion of said distractor with said magnetic resonance imaging relative to the vertebral bodies.

61. The method of claim 53, wherein the removing step includes the use of a bone removal device to form the opening and the utilizing step includes visualizing the position of at least a portion of said bone removal device with said magnetic resonance imaging relative to the vertebral bodies.

62. The method of claim 53, wherein the removing step includes the substep of one of milling and drilling the opening.

63. The method of claim 53, further comprising the step of tapping the opening through said guard and the utilizing step includes visualizing the position of at least a portion of said tap with said magnetic resonance imaging relative to the vertebral bodies.

64. The method of claim 53, wherein the inserting step includes the substep of screwing said implant into the opening through said guard.

65. The method of claim 53, wherein the inserting step includes using an insertion instrument to insert said implant into the opening and the utilizing step includes visualizing the position of at least a portion of said insertion instrument with said magnetic resonance imaging relative to the vertebral bodies.

66. The method of claim 53, wherein the inserting step includes inserting said implant comprising a fusion-promoting substance.

67. The method of claim 53, wherein said implant includes at least in part one of bone and artificial material.

68. The method of claim 53, wherein said implant is in the shape of one of a cylinder, a partial cylinder, and a dowel.

69. The method of claim 53, further comprising the step of combining said implant with a fusion promoting substance.

70. The method of claim 69, wherein the fusion promoting substance includes bone.

71. The method of claim 69, wherein said implant is at least in part hollow, the step of combining including loading said implant with the fusion promoting substance.

72. The method of claim 69, wherein the step of combining includes coating said implant with the fusion promoting substance.

73. The method of claim 53, wherein the method is performed without distracting the adjacent vertebral bodies between the removing step and the inserting step.

74. The method of claim 53, wherein the method is performed without removing the guard between the positioning step and the inserting step.

75. The method of claim 53, wherein the inserting step includes the substep of providing said implant having upper and lower portions having at least one protrusion on said upper and lower portions for engaging the adjacent vertebral bodies.

76. The method of claim 75, wherein said protrusion is at least a portion of a thread.

77. A method for performing surgery on a spinal segment including a disc space and two vertebral bodies adjacent the disc space, the method comprising the steps of:

positioning at least a portion of one end of a hollow guard in contact with the adjacent vertebral bodies;

distracting the adjacent vertebral bodies relative to one another;

removing, through said guard, bone from the adjacent vertebral bodies to form an opening across the surgically corrected height of the disc space and into a portion of each of the two adjacent vertebral bodies;

inserting, through said guard and into the opening, an implant having rigid opposed surfaces adapted to contact one each of the adjacent vertebral bodies; and

utilizing at least in part magnetic resonance imaging to visualize the position of at least a portion of at least one of said implant and said guard relative to the vertebral bodies during at least one of the planning and performing of the surgery.

78. The method of claim 77, wherein the positioning step includes the step of engaging said one end of said guard to the two adjacent vertebral bodies.

79. The method of claim 77, wherein the positioning step includes the substep of positioning said guard having at least one projection extending distally from a distal end of said guard, said distal end adapted to contact each of the vertebral bodies adjacent the disc space to be fused, said at least one projection adapted to penetrate the disc space so as to be located at least in part between the vertebral bodies where adjacent the disc space.

80. The method of claim 79, wherein said projection is at least in part co-linear with an outer perimeter of said guard.

81. The method of claim 79, wherein said projection is a tooth.

82. The method of claim 77, wherein the positioning step includes the substep of positioning said guard that is a tubular sleeve.

83. The method of claim 77, wherein the distracting step includes using a distractor to distract the adjacent vertebral bodies relative to one another.

84. The method of claim 83, wherein the utilizing step includes visualizing the position of at least a portion of said distractor with said magnetic resonance imaging relative to the vertebral bodies.

85. The method of claim 77, wherein the removing step includes the use of a bone removal device to form the opening and the utilizing step includes visualizing the position of at least a portion of said bone removal device with said magnetic resonance imaging relative to the vertebral bodies.

86. The method of claim 77, wherein the removing step includes the substep of one of milling and drilling the opening.

87. The method of claim 77, further comprising the step of tapping the opening through said guard and the utilizing step includes visualizing the position of at least a portion of said tap with said magnetic resonance imaging relative to the vertebral bodies.

88. The method of claim 77, wherein the inserting step includes the substep of screwing said implant into the opening through said guard.

89. The method of claim 77, wherein the inserting step includes using an insertion instrument to insert said implant into the opening and the utilizing step includes visualizing the position of at least a portion of said insertion instrument with said magnetic resonance imaging relative to the vertebral bodies.

90. The method of claim 77, wherein the inserting step includes inserting said implant comprising a fusion-promoting substance.

91. The method of claim 77, wherein said implant includes at least in part one of bone and artificial material.

92. The method of claim 77, wherein said implant is in the shape of one of a cylinder, a partial cylinder, and a dowel.

93. The method of claim 77, further comprising the step of combining said implant with a fusion promoting substance.

94. The method of claim 93, wherein the fusion promoting substance includes bone.

95. The method of claim 93, wherein said implant is at least in part hollow, the step of combining including loading said implant with the fusion promoting substance.

96. The method of claim 93, wherein the step of combining includes coating said implant with the fusion promoting substance.

97. The method of claim 77, wherein the method is performed without distracting the adjacent vertebral bodies between the removing step and the inserting step.

98. The method of claim 77, wherein the method is performed without removing the guard between the positioning step and the inserting step.

99. The method of claim 77, wherein the inserting step includes the substep of providing said implant having upper and lower portions having at least one protrusion on said upper and lower portions for engaging the adjacent vertebral bodies.

100. The method of claim 99, wherein said protrusion is at least a portion of a thread.