Methods and instrumentation for vertebral interbody fusion

• US 20040097932A1
• Filed: 10/20/2003
• Published: 05/20/2004
• Est. Priority Date: 04/09/1998
• Status: Active Grant

• Current Assignee: Eddie F. Ray III, James P. Duncan
• Original Assignee: Eddie F. Ray III, James P. Duncan
• Inventors: Duncan, James P., Ray, Eddie F. III
• Granted Patent: US 7,753,911 B2
• Time in Patent Office: Days
• US Class Current: 606/86.00A
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1615 Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material
• CPC Class Codes: A61B 17/1617 with mobile or detachable parts
• CPC Class Codes: A61B 17/1637 Hollow drills or saws producing a curved cut, e.g. cylindrical A61B10/025, A61B17/1695 take precedence
• CPC Class Codes: A61B 17/1655 for tapping
• 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: A61B 2017/3445 used as instrument channel for multiple instruments
• CPC Class Codes: A61B 2090/034 abutting on parts of the device itself
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61F 2/4611 of spinal prostheses
• CPC Class Codes: A61F 2002/4627 with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
• CPC Class Codes: A61F 2002/4687 Mechanical guides for implantation instruments

Abstract

Methods and instrumentation for vertebral interbody fusion are provided. Sleeve assemblies can be provided with a reduced width portion adjacent the distal end to limit the amount of retraction of the surrounding vascular and neural structures required for the procedure. A sleeve assembly can be provided with a guide sleeve removably engaged to a guide sleeve housing. The guide sleeve can be removed during surgery to improve the surgeon'"'"'s viewing of the operative site while the guide sleeve housing maintains disc space distraction. Methods and instruments for inserting and using the guide sleeve housing are also provided.

Claims

1. A spinal instrument assembly, comprising:

a guide sleeve housing including a proximal portion and a distal portion, said proximal portion including an inner wall defining a proximal chamber, said housing further including a first working channel port and a second working channel port extending through said distal portion and in communication with said proximal chamber; and

a central distractor in said chamber of said guide sleeve housing, said central distractor including a distractor tip movably positionable between said first and second working channel ports, said distractor tip including upper and lower distraction surfaces defining a distraction height therebetween to maintain distraction of a spinal disc space.

2. The instrument assembly of claim 1, wherein said proximal chamber is sized to receive a distal end of a guide sleeve.

3. The instrument assembly of claim 1, wherein said tip of said central distractor is centrally located in said housing.

4. The instrument assembly of claim 1, wherein said central distractor is rotatable from a reduced height configuration whereby said upper and lower distraction surfaces are oriented away from vertebral endplates of a spinal disc space to a distraction configuration whereby said upper and lower distraction surfaces are oriented toward vertebral endplates of the spinal disc space.

5. The instrument assembly of claim 1, wherein said guide sleeve housing is removably engageable to a housing inserter.

6. The instrument assembly of claim 5, wherein said central distractor includes a shaft extending proximally from said tip.

9. The instrument assembly of claim 1, wherein said inner wall defines a groove therein.

10. The instrument assembly of claim 9, wherein said central distractor includes a housing engaging portion having an actuatable finger for removably engaging said groove of said guide sleeve housing.

11. The instrument assembly of claim 10, wherein:

said central distractor tip includes a reduced height configuration whereby said upper and lower distraction surfaces are orientable away from vertebral endplates of a spinal disc space and said finger is not engaged to said guide sleeve housing; and

said central distractor tip is rotatable to a distraction configuration from said reduced height configuration whereby said upper and lower distraction surfaces are orientable toward vertebral endplates of a spinal disc space and said finger is actuated and received in said groove thereby coupling said guide sleeve housing to said central distractor.

12. The instrument assembly of claim 1, wherein said guide sleeve housing is removably engageable to a housing inserter, said housing inserter having an actuatable finger positionable to engage said housing inserter to said guide sleeve housing.

13. The instrument assembly of claim 12, wherein said housing inserter and said guide sleeve housing are positionable over a proximal end of said shaft of said central distractor and movable therealong to position said guide sleeve housing in an operative position adjacent the spinal disc space.

14. The instrument assembly of claim 1, wherein said central distractor is withdrawable from said guide sleeve housing.

15. The instrument assembly of claim 1, further comprising a guide sleeve engageable to said proximal portion of said guide sleeve housing.

16. The instrument assembly of claim 1, wherein said first working channel port and said second working channel port of said guide sleeve housing are in communication with one another through said guide sleeve housing.

17. The instrument assembly of claim 1, wherein said guide sleeve housing includes a pair of lateral flanges extending distally therefrom on opposite lateral sides of said guide sleeve housing.

18. The instrument assembly of claim 17, wherein each of said lateral flanges has a non-distracting height between upper and lower surfaces thereof.

19. The instrument assembly of claim 1, wherein in an operative position said proximal portion of said guide sleeve housing includes a first width transverse to the spinal column axis and said distal portion includes a second width transverse to the spinal column axis, said first width being greater than said second width.

8. The instrument assembly of claim 7, wherein said housing inserter and said guide sleeve housing are positionable over a proximal end of a shaft of said central distractor and movable therealong to position said guide sleeve housing in said operative position.

20. A method for accessing a spinal disc space between adjacent vertebrae, comprising:

providing a guide sleeve housing and a central distractor;

inserting the central distractor into the disc space between the adjacent vertebrae;

positioning the guide sleeve housing in an operative position with respect to the disc space and about the central distractor with the central distractor in the disc space; and

performing surgical procedures through the guide sleeve housing.

21. The method of claim 20, further comprising withdrawing the central distractor from the disc space.

22. The method of claim 21, further comprising engaging a distal end of a guide sleeve to the guide sleeve housing.

23. The method of claim 20, wherein positioning the guide sleeve housing includes guiding the guide sleeve housing into position with the central distractor.

24. The method of claim 20, further comprising rotating the central distractor to a reduced height orientation before removing the central distractor.

25. The method of claim 20, further comprising:

removably engaging the guide sleeve housing to a housing inserter; and

advancing the guide sleeve housing with the housing inserter over a proximal shaft of the central distractor.

26. The method of claim 20, further comprising removably engaging the guide sleeve housing to the central distractor.

27. A spinal surgical instrument, comprising:

a shaft;

an engaging portion at a distal end of said shaft releasably engageable with a member positioned about said engaging portion; and

a distractor tip extending distally of said engaging portion, wherein said engaging portion includes an enlarged configuration relative to said shaft and said distractor tip.

28. The instrument of claim 27, wherein said distractor tip is rotatable relative to said engaging portion between a distraction configuration and a reduced height configuration.

29. The instrument of claim 28, wherein said distractor tip includes an upper distracting surface and an opposite lower distracting surface.

30. The instrument of claim 29, wherein at least one of said upper and lower distracting surfaces includes a vertebral endplate engaging surface.

31. The instrument of claim 27, wherein said engaging portion includes a receptacle and a finger movable into and out of said receptacle between an engagement position for engaging said member positioned about said engaging portion and a release position for releasing said member from said engaging portion.

32. The instrument of claim 31, wherein said distractor tip is rotatable relative to said engaging portion with said shaft, said distractor tip being movable between a distraction configuration wherein said finger engages said member and a reduced height configuration wherein said finger is released from said member.

33. The instrument of claim 27, wherein said member is a guide sleeve housing defining first and second access ports therethrough for accessing a spinal disc space with said engaging portion removed therefrom.

34. The instrument of claim 33, wherein said guide sleeve housing includes a pair of lateral flanges extending distally therefrom on opposite lateral sides of said guide sleeve housing.

35. The instrument assembly of claim 34, wherein each of said lateral flanges has a non-distracting height between upper and lower surfaces thereof.