Minimally invasive instruments and methods for inserting implants

• US 20030208203A1
• Filed: 07/25/2002
• Published: 11/06/2003
• Est. Priority Date: 05/06/2002
• Status: Active Grant

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Inventors: Sherman, Michael C., Lim, Roy
• Granted Patent: US 7,572,276 B2
• Time in Patent Office: Days
• US Class Current: 606/61
• 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 17/7059 Cortical plates A61B17/7007, A61B17/7058 take precedence
• CPC Class Codes: A61B 17/7065 Devices with changeable shape, e.g. collapsible or having retractable arms to aid implantation; Tools therefor
• CPC Class Codes: A61B 17/7083 Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements
• CPC Class Codes: A61B 17/808 Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
• CPC Class Codes: A61B 2017/00238 Type of minimally invasive operation A61B2017/00805 takes precedence

Abstract

Instruments and methods for inserting one or more implants to a surgical site in a patient in a surgical procedure, including minimally invasive surgical procedures are provided. The implant is mountable to the instrument in a reduced profile orientation and after insertion is manipulated with the insertion instrument to the desired orientation.

Claims

1. A system, comprising

an implant positionable adjacent a surgical space associated with a spinal column of a patient;

and

an insertion instrument including an articulating implant holder adjacent a distal end thereof releasably engageable to said implant, wherein said implant is moveable with said implant holder between a reduced profile orientation relative to said insertion instrument and an increased profile orientation relative to said insertion instrument, said implant holder being adapted to release said implant from said implant holder in the increased profile orientation when said implant is positioned adjacent to and substantially unconstrained in the surgical space.

2. The system of claim 1, wherein said implant is a bone plate.

3. The system of claim 1, wherein said implant is a rod.

4. The system of claim 1, wherein said insertion instrument comprises:

a control system;

a connector system extending distally from said control system and including said implant holder pivotally coupled adjacent a distal end thereof; and

a manipulator system associated with said implant holder.

5. The system of claim 1, wherein said implant holder includes an articulating member pivotally mounted to a distal end of said insertion instrument and a pair of clamping members mounted along opposite sides of said articulating member, said clamping members being moveable from a released position wherein said elongated connecting element is positionable therebetween to an engaged position wherein said pair of clamping members engage said elongated connecting member therebetween.

6. The system of claim 5, wherein said implant holder includes a pair of engagement members actuatable from said articulating member to move said clamping members to said engaged position.

7. The system of claim 5, wherein said articulating member includes a pair of opposite distally extending fingers and said clamping members extend between and are pivotally coupled to each of said distally extending fingers.

8. The system of claim 5, wherein insertion instrument comprises:

a shaft assembly including an outer shaft and an intermediate shaft extending through said outer shaft;

said articulating member is pivotally mounted to said intermediate shaft; and

a linkage mechanism extending between and pivotally coupled to each of said articulating member and said outer shaft.

9. The system of claim 8, further comprising:

a cam member extending through said intermediate shaft; and

a pair of engagement members in said articulating member engageable with a distal end of said cam member, said cam member moveable from a first position wherein said pair of engagement members are recessed in said articulating member to a second position wherein said cam member biases said pair of engagement members outwardly from said articulating member into contact with said pair of clamping members to move said pair of clamping members to said engaged position.

10. The system of claim 9, wherein said cam member includes a lever at a proximal end thereof operable to move said cam member between said first position and said second position.

11. The system of claim 8, further comprising a mounting member on a distal end of said intermediate shaft and said articulating member is pivotally mounted to said mounting member.

12. The system of claim 11, wherein said implant holder includes a pair of engagement members movably captured in said mounting member and actuatable from said articulating member to move said clamping members to said engaged position.

13. The system of claim 1, wherein said insertion instrument includes a handle assembly having a distal handle portion pivotally coupled to a proximal handle portion.

14. The system of claim 13, wherein said insertion instrument includes an outer shaft coupled to said distal handle portion and an intermediate shaft coupled to said proximal handle portion and said implant holder is pivotally coupled to a distal end of said intermediate shaft, wherein in said increased profile orientation a distal end of said outer shaft is positioned more proximally relative to said distal end of said intermediate shaft than when in said reduced profile orientation.

15. The system of claim 14, wherein said outer shaft and said intermediate shaft are biased relative to one another so that said implant holder normally assumes said reduced profile orientation.

16. The system of claim 14, further comprising a linkage mechanism extending between and pivotally coupled to said articulating member to said outer shaft.

17. The system of claim 16, wherein upon movement of said outer shaft and said inner shaft relative to one another said linkage mechanism causes said articulating member to pivot relative to said intermediate shaft.

18. The system of claim 17, wherein in said reduced profile orientation said linkage mechanism extends transversely to said outer shaft and in said increased profile orientation said linkage mechanism extends generally along said outer shaft.

19. The system of claim 1, wherein said implant includes a receptacle and said implant holder is releasably engageable in said receptacle.

20. The system of claim 19, wherein said implant holder includes an articulating member pivotally mounted adjacent a distal end of said insertion instrument.

21. The system of claim 20, wherein said implant holder further includes a pair of engagement members actuatable from said articulating member to releasably engage said implant in said receptacle.

22. The system of claim 21, wherein said insertion instrument includes a cam member extending therethrough engageable with said pair of opposite engagement members, said cam member moveable from a first position wherein said pair of engagement members are recessed in said articulating member to a second position wherein said cam member biases said pair of engagement members outwardly from said articulating member to releasably engage said implant.

23. The system of claim 20, wherein said articulating member includes a pair of distally extending fingers and a lip extending about a proximal end of said fingers, said lip positionable against a proximal surface of said implant with said pair of fingers positioned in said receptacle.

24. A system, comprising

an implant positionable adjacent a surgical space associated with a spinal column of a patient;

and

an insertion instrument including an articulating implant holder at a distal end thereof releasably engageable to said implant, wherein said implant holder is normally biased to a first position wherein said implant has a reduced profile orientation relative to said insertion instrument and said implant holder is moveable from said biased first position to a second position wherein said implant has an increased profile relative to said insertion instrument.

25. A system, comprising

an elongated implant having a first end and a second end and a central axis extending therebetween;

a control system;

a connector system having a proximal end portion adjacent said control system, a distal end portion, and a longitudinal axis extending therebetween; and

an implant holder adjacent said distal end portion of said connector system releasably engageable with said implant between said first and second ends, wherein said implant holder is movable between a reduced profile orientation wherein said central axis of said implant extends generally along said longitudinal axis of said connector system and an increased profile orientation wherein said central axis of said implant extends generally transverse to said longitudinal axis of said implant.

26. The system of claim 25, wherein in said reduced profile orientation said first end of said implant is positioned proximally of said distal end portion of said connector system and said second end is positioned distally of said distal end portion of said connector system.

27. The system of claim 26, wherein in said increased profile orientation said first and second ends are each positioned distally of said distal end portion of said connector system.

28. A system, comprising

a bone plate having a receptacle therein;

and

an insertion instrument comprising an articulatable implant holder adjacent a distal end thereof releasably engageable in said receptacle of said bone plate, wherein said implant holder is movable from a first position wherein said bone plate has a reduced profile orientation relative to said insertion instrument for insertion of said bone plate to a surgical space in a patient to a second position wherein said bone plate has an enlarged profile relative to said insertion instrument for engagement of said bone plate at the surgical space.

29. The system of claim 28, wherein said implant holder is adapted to release said bone plate from said implant holder in said second position when said bone plate is positioned adjacent to and substantially unconstrained relative to the surgical space.

30. The system of claim 28, wherein said implant holder includes an articulating member pivotally mounted to a distal end of said insertion instrument.

31. The system of claim 30, wherein said implant holder further includes a pair of engagement members actuatable from said articulating member to engage said bone plate in said receptacle.

32. The system of claim 30, wherein said articulating member includes a pair of distally extending fingers and a lip extending about a proximal end of said fingers, said lip positionable against a proximal surface of said bone plate with said pair of fingers positioned in said receptacle.

33. The system of claim 30, wherein said insertion instrument comprises a shaft assembly including an outer shaft and an intermediate shaft extending through said outer shaft and said articulating member is pivotally mounted to said intermediate shaft.

34. The system of claim 33, wherein said insertion instrument includes a linkage mechanism extending between and pivotally coupled to said articulating member and to said outer shaft.

35. The system of claim 33, further comprising a cam member extending through said intermediate shaft and engageable with a pair of opposite engagement members, said cam member moveable from a first position wherein said pair of engagement members are recessed in said articulating member to a second position wherein said cam member biases said pair of engagement members outwardly from said articulating member into engagement with said bone plate in said receptacle.

36. The system of claim 35, wherein said cam member includes a lever at a proximal end thereof operable to move said cam member between said first position and said second position.

37. The system of claim 35, wherein said engagement members are movably captured in a mounting member positioned at a distal end of said intermediate shaft.

38. A system, comprising

an elongated spinal rod;

and

an insertion instrument comprising an articulatable implant holder adjacent a distal end thereof releasably clampable about said spinal rod, wherein said implant holder is movable from a first position wherein said spinal rod has a reduced profile orientation relative to said insertion instrument for insertion of said spinal rod to a surgical space in a patient to a second position wherein said spinal rod has an enlarged profile relative to said insertion instrument for positioning said spinal rod at the surgical space.

39. An insertion instrument for positioning an implant at a surgical site in a patient, comprising:

a control system;

a connector system extending distally from said control system;

an implant holder adjacent a distal end of said connector system;

a locking system associated with said implant holder and remotely actuatable between an unlocked position wherein said implant holder is released from the implant to a locked position wherein said implant holder is engaged with the implant; and

a manipulator system associated with said implant holder, wherein said implant holder is movable with said manipulator system between a first position wherein the implant has a reduced profile orientation for insertion to the surgical site and a second position providing an enlarged profile.

40. The instrument of claim 39, wherein said implant holder includes an articulating member pivotally mounted to a distal end of said connector system and a pair of clamping members pivotally mounted to said articulating member.

41. The instrument of claim 40, wherein in said locked position said locking system biases said pair of clamping members toward one another and in said unlocked position said clamping members are moveable move away from one another.

42. The instrument of claim 40, wherein said implant holder includes a pair of engagement members actuatable from said articulating member into contact with respective ones of said pair of clamping members with said locking system in said locked position.

43. The instrument of claim 42, wherein said locking system includes a cam member in said implant holder, said cam member movable from a first position wherein said pair of engagement members are recessed in said articulating member to a second position wherein said cam member biases said pair of engagement members outwardly from said articulating member into contact with said pair of clamping members.

44. The instrument of claim 43, wherein said cam member includes a lever adjacent a proximal end of said control system operable to move said cam member between said first position and said second position.

45. The instrument of claim 40, wherein said articulating member includes a pair of opposite distally extending fingers and each of said pair of clamping members extends between and is pivotally coupled to said distally extending fingers on opposite sides of said articulating member.

46. The instrument of claim 40, wherein:

said connector system includes a shaft assembly including an outer shaft and an intermediate shaft extending through said outer shaft;

said articulating member is pivotally mounted to said intermediate shaft; and

said manipulator system includes a linkage mechanism extending between and pivotally linking said articulating member to said outer shaft.

47. The instrument of claim 46, further comprising a mounting member on a distal end of said intermediate shaft and said articulating member is pivotally mounted to said mounting member.

48. The instrument of claim 39, wherein said implant holder includes an articulating member pivotally mounted to a distal end of said connector system and a pair of engagement members actuatable from said articulating member with said locking system to engage the implant.

49. The instrument of claim 48, wherein said articulating member includes a pair of distally extending fingers and a lip extending about a proximal end of said fingers, said lip positionable against a proximal surface of the implant with said pair of fingers positionable in a receptacle of the implant.

50. The instrument of claim 48, wherein:

said connector system includes a shaft assembly including an outer shaft and an intermediate shaft extending through said outer shaft;

said articulating member is pivotally mounted to said intermediate shaft; and

a linkage mechanism extending between and pivotally coupled to said articulating member and to said outer shaft.

51. The instrument of claim 50, wherein said locking system comprises a cam member extending through said intermediate shaft and engageable with each of said pair of engagement members, said cam member being moveable from a first position wherein said pair of engagement members are recessed in said articulating member to a second position wherein said cam member biases said pair of engagement members outwardly from said articulating member.

52. The instrument of claim 39, wherein said control system comprises a handle assembly.

53. An insertion instrument for positioning an implant at a surgical space in a patient, comprising:

a handle assembly;

a shaft assembly extending distally from said handle assembly, said shaft assembly including a first shaft axially translatable relative to a second shaft; and

an implant holder adjacent a distal end of one of said first and second shafts, said implant holder releasably engageable with the implant, wherein said implant holder has a reduced profile orientation for insertion of the implant to the surgical site and is movable to an enlarged profile orientation for positioning the implant at the surgical space upon axial translation of said first and second shafts relative to one another.

54. The instrument of claim 53, wherein said shaft assembly includes a longitudinal axis and the implant has a central axis extending generally along the longitudinal axis in the reduced profile orientation and generally transverse to the longitudinal axis in the enlarged profile orientation.

55. The instrument of claim 53, wherein said first shaft includes an outer shaft and said second shaft includes an intermediate shaft extending through said outer shaft.

56. The instrument of claim 55, wherein said implant holder includes an articulating member pivotally mounted to said intermediate shaft and further comprising a linkage mechanism extending between and pivotally coupled to said articulating member and to said outer shaft.

57. The instrument of claim 56, further comprising:

a cam member extending through said intermediate shaft;

a pair of engagement members in said articulating member engageable with a distal end of said cam member, said cam member moveable from a first position wherein said pair of engagement members are recessed in said articulating member to a second position wherein said cam member biases said pair of engagement members outwardly from said articulating member.

58. The instrument of claim 53, wherein said control system includes a handle assembly having a distal handle portion pivotally coupled to a proximal handle portion.

59. The instrument of claim 58, wherein:

said first shaft is coupled to one of said distal handle portion and said proximal handle portion; and

said second shaft is coupled to the other of said distal handle portion and said proximal handle portion.

60. An insertion instrument for positioning an implant at a surgical space in a patient, comprising:

a handle assembly;

a shaft assembly extending distally from said handle assembly; and

an implant holder adjacent a distal end of said shaft assembly, said implant holder releasably engageable to the implant, wherein said implant holder is moveable between a reduced profile orientation relative to said shaft assembly and an increased profile orientation relative to said shaft assembly, said implant holder being adapted to release the implant when the implant is positioned adjacent to and substantially unconstrained in the surgical space.

61. A method for positioning a bone plate along a spinal column of a patient, comprising:

accessing the spinal column through a minimally invasive access path through skin and tissue of the patient;

securing the bone plate on an insertion instrument with a longitudinal axis of the bone plate extending generally in the direction of the path through the skin and tissue;

positioning the bone plate through the path with the insertion instrument to a location adjacent the spinal column; and

remotely manipulating the bone plate relative to the insertion instrument to a desired orientation along the spinal column.

62. The method of claim 61, wherein in the desired orientation the longitudinal axis of the bone plate extends transversely to the path through the skin and tissue.

63. The method of claim 61, wherein the accessing the spinal column includes inserting a sleeve through skin and tissue of the patient to form the path.

64. The method of claim 61, wherein the path has a transverse dimension that is less than a length of the bone plate.

65. The method of claim 61, further comprising securing the bone plate to first and second vertebrae of the spinal column with bone engaging fasteners.

66. A method for positioning a spinal rod along a spinal column of a patient, comprising:

accessing the spinal column through a minimally invasive access path through skin and tissue of the patient;

securing the spinal rod on an insertion instrument with a longitudinal axis of the spinal rod extending generally in the direction of the path through the skin and tissue;

positioning the spinal rod through the path with the insertion instrument to a location adjacent the spinal column; and

remotely manipulating the spinal rod relative to the insertion instrument to a desired orientation along the spinal column.

67. The method of claim 66, wherein in the desired orientation the longitudinal axis of the spinal rod extends transversely to the path through the skin and tissue.

68. The method of claim 66, wherein the path has a transverse dimension that is less than a length of the spinal rod.

69. The method of claim 66, further comprising securing the spinal rod to first and second vertebrae of the spinal column.