Method and system for fusing a spinal region

• US 20050038514A1
• Filed: 09/08/2004
• Published: 02/17/2005
• Est. Priority Date: 05/07/1999
• Status: Active Grant

• Current Assignee: University of Virginia Patent Foundation (University of Virginia)
• Original Assignee: University of Virginia Patent Foundation (University of Virginia)
• Inventors: Helm, Gregory A., Hankins, Gerald R., Kallmes, David F., Jensen, Mary E.
• Granted Patent: US 7,947,079 B2
• Time in Patent Office: Days
• US Class Current: 623/17.120
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2090/3945 Active visible markers, e.g. light emitting diodes
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61F 2/44 for the spine, e.g. vertebrae, spinal discs
• CPC Class Codes: A61F 2/441 made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
• 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 2/4601 for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• 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 2002/3008 radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: A61F 2002/30583 filled with hardenable fluid, e.g. curable in-situ
• CPC Class Codes: A61F 2002/30677 : Means for introducing or releasing pharmaceutical products, e.g. antibiotics, into the body
• 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 2002/4632 : using computer-controlled surgery, e.g. robotic surgery
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2002/4687 : Mechanical guides for implantation instruments
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2210/0085 : hardenable in situ, e.g. epoxy resins
• CPC Class Codes: A61F 2250/0098 : radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: A61F 2310/00293 : containing a phosphorus-containing compound, e.g. apatite
• CPC Class Codes: A61F 2310/00353 : Bone cement, e.g. polymethylmethacrylate or PMMA
• CPC Class Codes: A61F 2310/00365 : Proteins; Polypeptides; Degradation products thereof

Abstract

A method and system for fusing a region in the spine involve the use of at least one guide tube to pass instruments and substances into the spinal region in a minimally invasive manner. In the preferred practice of the method, a guide tube is anchored to a vertebra and the guide tube is moved to thereby position the vertebra. A steerable drilling tool is passed through the guide tube and steered into position to abrade at least a portion of an intervertebral disc and thereby create a cavity in the disc. A flowable substance is passed into the cavity and permitted to solidify to establish fusion in the cavity. Optionally, an uninflated balloon is inserted into the cavity and the balloon is filled with the flowable substance to contain the flowable substance.

Claims

1-28. -28. (cancelled)

29. A method of fusing a spinal region, the method comprising:

removing at least a nucleus of an intervertebral disc to form a cavity extending in at least the disc;

inserting a balloon into the cavity;

inflating the balloon with a contrast agent;

viewing the balloon with imaging equipment to evaluate the cavity;

removing the contrast agent from the balloon; and

flowing a flowable fusion substance into the cavity, the fusion substance being configured to solidify to provide fusion in the cavity.

30. The method of claim 29, wherein the balloon is an inflatable implant and wherein the flowing includes passing the fusion substance into the inflatable implant to inflate the implant in the cavity.

31. The method of claim 29, wherein the flowable substance includes a solidifying agent comprising polymethacrylate.

32. The method of claim 29, wherein the flowable substance includes material for inducing bone growth.

33. The method of claim 32, wherein the bone growth inducing material is chosen from morphogenic protein, fibroplast growth factor, genetically modified cells, and stem cells.

34. The method of claim 29, wherein the method further comprises removing the balloon from the cavity prior to flowing the flowable substance into the cavity.

35. The method of claim 34, wherein the method further comprises inserting an inflatable implant into the cavity and wherein the flowing includes passing the fusion substance into the inflatable implant to inflate the implant in the cavity.

36. The method of claim 29, wherein the removing does not remove any circumferential segment of the annulus fibrosis of the disc.

37. The method of claim 29, wherein the removing includes removing material from the medullary area of at least one vertebra adjacent to the disc.

38. A method of fusing a spinal region, the method comprising:

contacting a guide tube against at least one vertebra;

inserting a steerable drilling tool through the guide tube;

steering the steerable drilling tool toward a disc;

abrading at least a portion of the disc with the drilling tool;

removing at least the abraded portion of the disc and a nucleus of the disc to form a cavity extending in at least the disc; and

placing an implant in the cavity, the implant being configured to provide fusion in the cavity.

39. The method of claim 38, wherein the implant is inflatable and wherein the placing of the implant includes inserting the balloon in the cavity in an uninflated state and inflating the balloon in the cavity.

40. The method of claim 38, wherein the abrading includes abrading vertebral material in the medullary area of the at least one vertebra such that the cavity extends into the at least one vertebra.

41-52. -52. (cancelled)

53. A steerable drilling tool comprising:

a flexible tubular body having a proximal end portion and a distal end portion;

a flexible, rotatable drive member in the tubular member;

a bit on the end of the rotatable drive member, the bit being rotated during rotation of the drive member and being located at the distal end portion of the tubular body; and

a steering element configured such that movement of the steering element varies position of the distal end portion of the tubular member with respect to the remainder of the tubular member.