Instruments and methods for minimally invasive spine surgery

• US 20050080418A1
• Filed: 08/10/2004
• Published: 04/14/2005
• Est. Priority Date: 10/30/2001
• Status: Active Grant

• Current Assignee: Depuy Synthes Products Incorporated (Johnson & Johnson)
• Original Assignee: Depuy Spine Incorporated (Johnson & Johnson)
• Inventors: Bireley, Douglas S., Simonson, Robert E., Beardsley, Timothy A.
• Granted Patent: US 7,824,410 B2
• Time in Patent Office: Days
• US Class Current: 606/86.A
• 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 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3421 Cannulas
• 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 2017/0256 for the spine
• CPC Class Codes: A61B 2017/3443 with means for adjusting the length of a cannula
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61M 29/00 Dilators with or without means for introducing media, e.g. remedies instruments for performing visual medical inspections of cavities or tubes of the body A61B1/00
• CPC Class Codes: A61M 29/02 Dilators made of swellable material balloon catheters for angioplasty A61M25/104

Abstract

A minimally invasive surgical method includes inserting a first port that defines a first pathway to a first vertebra, advancing a first anchor through the first port to the first vertebra, inserting a second port that defines a second pathway to a second vertebra, advancing a second anchor through the second port to the second vertebra, positioning a first end of a fixation element in the first port, and advancing the first end of the fixation element subcutaneously through an opening in the first port and an opening in second port to the second anchor. A surgical access port includes a proximal end, a distal end, and a sidewall defining a lumen extending from the proximal end to the distal end. The port may include a first opening formed in the sidewall that defines a passageway for medical hardware from the lumen to external to the port.

Claims

1. A minimally invasive surgical method comprising:

making a first incision in a patient;

positioning a first port in the first incision, the first port defining a first pathway from the first incision to a first vertebra;

advancing a first anchor through the first pathway to a first anchor site on the first vertebra;

making a second incision in the patient;

positioning a second port in the second incision, the second port defining a second pathway from the second incision to a second vertebra;

advancing a second anchor through the second pathway to a second anchor site on the second vertebra;

positioning a first end of a fixation element in the first port;

advancing the first end of the fixation element subcutaneously through an opening in the first port and an opening in second port to the second anchor; and

coupling the fixation element to the first anchor and the second anchor.

2. The method of claim 1, further comprising expanding the first incision to facilitate positioning of the first port in the first incision.

3. The method of claim 2, wherein expanding the first incision includes dilating the first incision to the first vertebra.

4. The method of claim 3, wherein dilating the first incision comprises sequentially dilating the first incision to the first vertebra.

5. The method of claim 4, wherein the first port is positioned in the first incision by advancing the first port over a dilator.

6. The method of claim 2, wherein expanding the first incision comprises inserting a retractor into the first incision and expanding the retractor within the first incision.

7. The method of claim 6, wherein the port is positioned in the first incision through the retractor.

8. The method of claim 2, expanding the second incision to facilitate positioning of the second port in the second incision.

9. The method of claim 1, wherein the first and second anchors are polyaxial bone screws.

10. The method of claim 1, wherein the fixation element is a spinal rod.

11. The method of claim 1, further comprising creating a subcutaneous pathway between the first port and the second port to facilitate advancement of the fixation element to the second anchor.

12. The method of claim 11, further comprising positioning a first instrument in the first port and manipulating the first instrument to create the subcutaneous pathway from the first port to the second port.

13. The method of claim 12, wherein a distal tip of the first instrument is advanced through the opening in the first port to create the subcutaneous pathway.

14. The method of claim 13, wherein the distal tip of the first instrument is sharpened to facilitate the creation of the subcutaneous pathway.

15. The method of claim 12, further comprising positioning a second instrument in the second port and manipulating the second instrument in cooperation with the first instrument to facilitate the creation of the subcutaneous pathway.

16. The method of claim 15, wherein the second instrument includes a distal tip configured to guide the fixation element through the subcutaneous pathway.

17. The method of claim 12, wherein the subcutaneous pathway is created before advancing the first anchor through the first pathway and before advancing the second anchor through the second pathway.

18. The method of claim 12, wherein the subcutaneous pathway is created after advancing the first anchor through the first pathway and before advancing the second anchor through the second pathway.

19. The method of claim 12, wherein the subcutaneous pathway is created after advancing the first anchor through the first pathway and after advancing the second anchor through the second pathway.

20. The method of claim 12, wherein the fixation element has a tip configured to create a subcutaneous pathway and advancing the fixation element to the second anchor creates the subcutaneous pathway.

21. The method of claim 1, wherein the first incision is a percutaneous incision and the second incision is a percutaneous incision.

22. The method of claim 1, wherein the first and second vertebrae are adjacent vertebrae.

23. The method of claim 22, further comprising accessing a disk space between the first and second vertebrae though the first port or the second port and removing disk material from a disk space between the first and second vertebrae through the first pathway or the second pathway, respectively.

24. The method of claim 23, further comprising inserting bone graft into the disk space through the first pathway or the second pathway.

25. The method of claim 24, further comprising inserting an interbody fusion device into the disk space through the first pathway or the second pathway.

26. The method of claim 1, further comprising aligning the opening in the first port and the opening in the second port to facilitate advancement of the fixation element subcutaneously.

27. The method of claim 26, wherein a proximal end of the first port includes indicia indicating orientation of the opening in the first port and a proximal end of the second port includes indicia indicating orientation of the opening in the second port.

28. The method of claim 27, wherein aligning the opening of the first port and the opening of the second port comprises aligning the indicia on the first port and the indicia of the second port.

29. The method of claim 26, wherein the opening in the first port is positioned proximate a distal end of the first port and the opening in the second port is positioned proximate a distal end of the second port.

30. The method of claim 1, wherein the first port is a cannula and the second port is a cannula.

31. A minimally invasive surgical method comprising:

inserting a first port, the first port defining a first pathway to a first vertebra;

advancing a first anchor through the first port to the first vertebra;

inserting a second port, the second port defining a second pathway to a second vertebra;

advancing a second anchor through the second port to the second vertebra;

positioning a first end of a fixation element in the first port; and

advancing the first end of the fixation element subcutaneously through an opening in the first port and an opening in second port to the second anchor.

32. A minimally invasive surgical method comprising:

making a first percutaneous incision in a patient;

expanding the first percutaneous incision by inserting one or more dilators in the first percutaneous incision;

positioning a first port over a dilator in the first percutaneous incision, the first port defining a first pathway from the first percutaneous incision to the first vertebra;

advancing a first bone screw through the first pathway to the first vertebra;

making a second percutaneous incision in the patient;

expanding the second percutaneous incision by inserting one or more dilators in the second percutaneous incision;

positioning a second port over a dilator in the second percutaneous incision, the second port defining a second pathway from the second percutaneous incision to a second vertebra;

advancing a second bone screw through the second pathway to the second vertebra;

positioning a first end of a spinal rod in the first port;

advancing the first end of the spinal rod subcutaneously through a opening in the first port and a opening in second port to the second bone screw; and

coupling the spinal rod to the first bone screw and the second bone screw.

33. A minimally invasive surgical method comprising:

making an incision in a patient;

positioning a first port in the incision,

advancing a distal end of the port into proximity to a first vertebra and second vertebra;

manipulating a proximal end of the port to align the distal end of the port with the first vertebra;

advancing a first anchor through the port to the first vertebra;

manipulating a proximal end of the port to align the distal end of the port with the second vertebra;

advancing a second anchor through the port to the second vertebra;

positioning a first end of a fixation element in the port;

advancing the first end of the fixation element subcutaneously through an opening in the port from the second vertebra toward the first vertebra;

coupling the fixation element to the second anchor;

manipulating a proximal end of the port to align the distal end of the port with the first vertebra; and

coupling the fixation element to the first anchor.

34. A minimally invasive surgical method comprising:

making a first incision in a patient;

positioning a first port in the first incision,

advancing a distal end of the port into proximity to a vertebra, and

positioning an instrument through an opening proximate the distal end of the port.

35. The method of claim 34, wherein further comprising manipulating the instrument to perform a procedure proximate the vertebra.

36. The method of claim 35, wherein the procedure includes at least one a laminotomy, facetectomy, foraminotomy, nerve root retraction, and discectomy.

37. The method of claim 35, wherein the procedure includes placement of an implant.

38. The method of claim 37, wherein the implant is at least one of a bone anchor, a component of a bone anchor, a fixation element, an artificial disk, a nucleus replacement devices, and an interbody fusion device.

39. A minimally invasive surgical method comprising:

making a first incision in a patient;

positioning a first port in the first incision,

advancing a distal end of the port into proximity to a vertebra, and

positioning an implant through an opening proximate the distal end of the port.

40. The method of claim 39, wherein the implant is at least one of a bone anchor, a component of a bone anchor, a fixation element, and an interbody fusion device.

48. The port of claim 39, further comprising a second opening formed in the sidewall.

49. The port of claim 48, wherein the first opening is diametrically opposed to the second opening.

50. The port of claim 48, wherein the first opening has a length along a longitudinal axis that is approximately equal to a length of the second opening.

51. The port of claim 48, wherein the first opening has a length along a longitudinal axis that is greater than a length of the second opening.

52. The port of claim 48, wherein the port has a circular cross-section.

41. A surgical access port comprising:

a proximal end;

a distal end spaced apart a distance from the proximal end;

and a sidewall defining a lumen extending from the proximal end to the distal end, the lumen having a length sufficient to at least span from a skin incision to proximate a vertebra, and

a first opening formed in the sidewall, the first opening defining a passageway for medical hardware from the lumen to external to the port.

42. The port of claim 41, wherein the passageway is oriented generally perpendicular to the lumen.

43. The port of claim 41, wherein the first opening is sized to pass a spinal implant therethrough.

44. The port of claim 43, wherein the spinal implant is a spinal rod.

45. The port of claim 43, wherein the spinal implant is one or more components of a spinal anchor.

46. The port of claim 41, wherein the first opening extends proximally from the distal end.

47. The port of claim 41, wherein the first opening is interposed between the distal end and the proximal end.

53. The port of claim 41, wherein the port has an oval cross-section.

56. The system of claim 53, further comprising a first instrument for creating a subcutaneous pathway from the opening in the port.

57. The system of claim 56, wherein the first instrument for creating a subcutaneous pathway comprises

a proximal handle,

a shaft having a longitudinal axis, the shaft being sized to fit through the lumen of the port,

and a distal tip oriented at angle to the shaft.

58. The system of claim 57, wherein the distal tip is oriented approximately perpendicular to the longitudinal axis of the shaft.

59. The system of claim 58, wherein the distal tip is sharpened sufficiently to dissect tissue.

60. The system of claim 57, further comprising a second instrument, the second instrument having comprising:

a proximal handle,

a shaft having a longitudinal axis, the shaft being sized to fit through a lumen of a second surgical access port,

and a distal tip oriented at angle to the shaft, the distal tip being sized to receive at least a portion of the distal tip of the first instrument.

54. A system for minimally invasive spine surgery comprising:

a first dilator having a first diameter; and

a surgical access port comprising

a proximal end;

a distal end spaced apart a distance from the proximal end;

and a sidewall defining a lumen extending from the proximal end to the distal end, the lumen having a length sufficient to at least span from a skin incision to proximate a vertebra and a diameter greater than the first diameter; and

a first opening formed in the sidewall, the first opening defining a passageway for medical hardware from the lumen to external to the port.

55. The system of claim 54, further comprising a plurality of canullated dilators of varying lengths and diameters.

61. The system of claim 54, further comprising a spinal rod having a tip configured to dissect tissue.

62. A minimally invasive surgical method comprising:

inserting a first port, the first port defining a first pathway to a first vertebra;

advancing a first anchor through the first port to the first vertebra;

inserting a second port, the second port defining a second pathway to a second vertebra;

advancing a second anchor through the second port to the second vertebra;

inserting a third port, the third port defining a third pathway to a third vertebra;

advancing a third anchor through the third port to the third vertebra;

positioning a first end of a fixation element in the first port; and

advancing the first end of the fixation element subcutaneously through an opening in the first port, through an opening in the second port to the second anchor, and through an opening in the third port to the third anchor.