Percutaneous access devices and bone anchor assemblies

• US 20050131408A1
• Filed: 12/16/2003
• Published: 06/16/2005
• Est. Priority Date: 12/16/2003
• Status: Active Grant

• Current Assignee: Medos International Sarl (Johnson & Johnson)
• Original Assignee: Depuy Spine Sarl (Johnson & Johnson)
• Inventors: Lopez, Erasmo, Sicvol, Christopher W.
• Granted Patent: US 7,179,261 B2
• Time in Patent Office: Days
• US Class Current: 606/86.A
• CPC Class Codes: A61B 17/70 Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
• CPC Class Codes: A61B 17/7032 Screws or hooks with U-shaped head or back through which longitudinal rods pass
• CPC Class Codes: A61B 17/7034 characterised by a lateral opening
• CPC Class Codes: A61B 17/7035 Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
• CPC Class Codes: A61B 17/7037 wherein pivoting is blocked when the rod is clamped
• CPC Class Codes: A61B 17/7076 for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
• CPC Class Codes: A61B 17/708 with tubular extensions coaxially mounted on the bone anchors
• CPC Class Codes: A61B 17/7091 for applying, tightening or removing longitudinal element-to-bone anchor locking elements, e.g. caps, set screws, nuts or wedges
• CPC Class Codes: A61B 17/8605 Heads, i.e. proximal ends projecting from bone
• CPC Class Codes: A61B 2017/564 Methods for bone or joint treatment
• CPC Class Codes: A61B 2090/037 with a frangible part, e.g. by reduced diameter

Abstract

A percutaneous access device includes an inner tube and an outer tube disposed about at least a portion of the inner tube. The outer tube may be sized to span from a skin incision in a patient to a site proximate the spine of the patient. The distal end of the outer tube may be adapted to releasably engage a bone anchor. The inner tube may be adjustable relative to the outer tube between a first position and a second position in which the distal end of the inner tube contacts the bone anchor. A bone anchor assembly includes a bone anchor having a distal bone engaging portion and a receiving member having a recess for receiving a spinal fixation element. The proximal end of the receiving member may have an arcuate groove formed on an exterior surface thereof to facilitate connection of an instrument to the receiving member.

Claims

1. A percutaneous access device comprising:

an inner tube having a proximal end, a distal end, and a lumen extending between the proximal end; and

an outer tube disposed about at least a portion of the inner tube, the outer tube having a proximal end, a distal end, and a lumen extending between the proximal end and the distal end, the outer tube being sized to span from at least a skin incision in a patient to a predetermined site proximate the spine of the patient, the distal end of the outer tube being adapted to releasably engage a bone anchor, the inner tube being adjustable relative to the outer tube along the longitudinal axis of the outer tube between a first position and a second position in which the distal end of the inner tube contacts the bone anchor.

2. The percutaneous access device of claim 1, wherein the lumen of the inner tube has an inner diameter proximate the distal end of the inner tube that is greater than or equal to an inner diameter of a bore formed in a receiving portion of the bone anchor.

3. The percutaneous access device of claim 1, wherein the outer tube has an outer diameter proximate the distal end of the outer tube that is less than or equal to an outer diameter of a receiving portion of the bone anchor.

4. The percutaneous access device of claim 1, wherein the inner tube and the outer tube are coaxial.

5. The percutaneous access device of claim 1, wherein the inner tube has a first slot formed therein, the first slot having an opening at the distal end of the inner tube and extending a first slot length toward the proximal end of the inner tube.

6. The percutaneous access device of claim 5, wherein the outer tube has a second slot formed therein, the second slot having an opening at the distal end of the outer tube and extending a second slot length toward the proximal end of the outer tube.

7. The percutaneous access device of claim 6, wherein the first slot is aligned with the second slot.

8. The percutaneous access device of claim 6, wherein the first slot length is sized to be accessible external to the skin incision.

9. The percutaneous access device of claim 6, wherein the first slot and the second slot each has a width that is approximately equal to the width of a recess formed in the receiving member of the bone anchor.

10. The percutaneous access device of claim 1, wherein the distal end of the outer tube includes a pair of opposed tabs, each tab having a radially inward projection that is sized and shaped to seat within a groove formed in a receiving member of a bone anchor.

11. The percutaneous access device of claim 10, wherein each tab has a tab width that is less than or equal to the width of a slot formed in the receiving member of the bone anchor.

12. The percutaneous access device of claim 1, wherein the distal end of the inner tube defines a plurality of contact surfaces, each contact surface contacting a proximal surface of a receiving member of the bone anchor when the inner tube is in the second position.

13. The percutaneous access device of claim 12, wherein an extension extends axially from at least one of the contact surfaces, the extension engaging the bone anchor to inhibit rotation of the inner tube relative to the bone anchor when the inner tube is in the second position.

14. A bone anchor assembly, comprising:

a bone anchor having a proximal head and a distal bone engaging portion; and

a receiving member coupled to the bone anchor, the receiving member having a proximal end, a distal end and a recess for receiving a spinal fixation element, the proximal end of the receiving member having at least one arcuate groove formed on an exterior surface thereof to facilitate connection of an instrument to the receiving member.

15. The bone anchor assembly of claim 14, wherein the proximal end has a first bore defining a first bore axis, the recess is in communication with the first bore, the distal end has a second bore opposite the first bore and defining a second bore axis, and the second bore is sized to receive the head of the bone anchor.

16. The bone anchor assembly of claim 15, wherein the first bore axis and the second bore axis are coaxial.

17. The bone anchor assembly of claim 15, wherein the second bore axis is at an angle other than 0 degrees relative to the first bore axis.

18. The bone anchor assembly of claim 15, wherein the bone anchor is adjustable relative to the receiving member.

19. The bone anchor assembly of claim 15, wherein the receiving member has a substantially U-shaped cross-section defined by two legs separated by the recess, each leg being free at the proximal end of the receiving member.

20. The bone anchor assembly of claim 19, wherein the at least one arcuate groove is formed on an exterior surface of the proximal end of one of the legs.

21. The bone anchor assembly of claim 19, wherein a first arcuate groove is formed on an exterior surface of the proximal end of a first one of the legs and a second arcuate groove is formed on an exterior surface of the proximal end of a second one of the legs.

22. The bone anchor assembly of claim 14, wherein the arcuate groove has a proximal surface and a distal surface.

23. The bone anchor assembly of claim 22, wherein the proximal surface is oriented at angle greater than 0°

relative to an orthogonal line that is oriented perpendicular to a longitudinal axis of the receiving member.

24. The bone anchor assembly of claim 22, wherein the proximal surface is oriented at angle between approximately 5°

and approximately 30°

relative to an orthogonal line that is oriented perpendicular to a longitudinal axis of the receiving member.

25. The bone anchor assembly of claim 22, wherein the proximal surface is oriented at angle of approximately 20°

relative to an orthogonal line that is oriented perpendicular to a longitudinal axis of the receiving member.

26. The bone anchor assembly of claim 22, wherein the distal surface is oriented parallel to the groove plane.

27. The bone anchor assembly of claim 22, wherein the distal surface is oriented at angle greater than 0°

relative to an orthogonal line that is oriented perpendicular to a longitudinal axis of the receiving member.

28. The bone anchor assembly of claim 14, wherein the bone anchor is fixed relative to the receiving member.

29. The bone anchor assembly of claim 14, wherein the bone anchor is at least one of a bone screw or a bone hook.

30. A bone anchor assembly, comprising:

a bone anchor having a proximal head and a distal bone engaging portion; and

a receiving member having a proximal end having a first bore, a distal end opposite the proximal end and having a second bore, and a recess for receiving a spinal fixation element in communication with the first bore, the second bore being sized to receive the head of the bone anchor, the receiving member having a substantially U-shaped cross-section defined by two legs separated by the recess, each leg being free at the proximal end of the receiving member,

wherein a first arcuate groove is formed on an exterior surface of the proximal end of a first one of the legs and a second arcuate groove is formed on an exterior surface of the proximal end of a second one of the legs.

31. The bone anchor assembly of claim 30, wherein the first arcuate groove has a proximal surface and a distal surface opposite the proximal surface and

the second arcuate groove has a proximal surface and a distal surface opposite the proximal surface.

32. The bone anchor assembly of claim 31, wherein the proximal surface of the first groove and the proximal surface of the second groove are co-planar.

33. The bone anchor assembly of claim 31, wherein the proximal surface of the first groove and the proximal surface of the second groove each are oriented at angle greater than 0°

relative to an orthogonal line that is oriented perpendicular to a longitudinal axis of the receiving member.

34. The bone anchor assembly of claim 31, wherein the proximal surface of the first groove and the proximal surface of the second groove each are oriented at angle between approximately 5°

and approximately 30°

relative to an orthogonal line that is oriented perpendicular to a longitudinal axis of the receiving member.

35. The bone anchor assembly of claim 31, wherein the proximal surface of the first groove and the proximal surface of the second groove each are oriented at angle of approximately 20°

relative to an orthogonal line that is oriented perpendicular to longitudinal axis of the receiving member.

36. The bone anchor assembly of claim 31, wherein the distal surface of the first groove and the distal surface of the second groove each are oriented at angle greater than 0°

relative to an orthogonal line that is oriented perpendicular to a longitudinal axis of the receiving member.

37. A percutaneous access device comprising:

an inner tube having a proximal end, a distal end, and a lumen extending between the proximal end and the distal end, the inner tube having a first slot formed therein, the first slot having an opening at the distal end of the inner tube and extending a first slot length toward the proximal end of the inner tube; and

an outer tube coaxially disposed about at least a portion of the inner tube, the outer tube having a proximal end, a distal end, and a lumen extending between the proximal end and the distal end;

the outer tube being sized to span from at least a skin incision in a patient to a predetermined site proximate the spine of the patient, the distal end of the outer tube being adapted to releasably engage a bone anchor, the outer tube having a second slot formed therein aligned with the first slot, the second slot having an opening at the distal end of the outer tube and extending a second slot length toward the proximal end of the outer tube.

38. The percutaneous access device of claim 37, wherein inner tube is movable along the longitudinal axis of the outer tube.

39. The percutaneous access device of claim 37, wherein the inner tube is movable between a between a first position and a second position in which the distal end of the inner tube contacts the bone anchor.

40. The percutaneous access device of claim 37, wherein the first slot length and the second slot length are approximately equal.

41. The percutaneous access device of claim 40, wherein the first and second slots lengths are selected to span from at least a skin incision in patient to the proximal end of the inner tube and the outer tube, respectively.

42. A medical device comprising:

a percutaneous access device comprising

an inner tube having a proximal end, a distal end, and a lumen extending between the proximal end and the distal end; and

an outer tube disposed about at least a portion of the inner tube, the outer tube having a proximal end, a distal end, and a lumen extending between the proximal end and the distal end;

the outer tube being sized to span from at least a skin incision in a patient to a predetermined site proximate the spine of the patient; and

a bone anchor assembly comprising;

a bone anchor having a proximal head and a distal bone engaging portion; and

a receiving member coupled to the bone anchor, the receiving member having a proximal end, a distal end and a recess for receiving a spinal fixation element, the proximal end of the receiving member having at least one arcuate groove formed on an exterior surface thereof, wherein the distal end of the outer tube is adapted to releasably engage the arcuate groove in the receiving member.

43. The medical device of claim 42, wherein the inner tube is adjustable relative to the outer tube along the longitudinal axis of the outer tube between a first position and a second position in which the distal end of the inner tube contacts the proximal end of the receiving member.

44. A medical device comprising:

a percutaneous access device comprising

an inner tube having a proximal end, a distal end, and a lumen extending between the proximal end and the distal end, the inner tube having a first slot formed therein, the first slot having an opening at the distal end of the inner tube and extending toward the proximal end of the inner tube, and

an outer tube coaxially disposed about at least a portion of the inner tube, the outer tube having a proximal end, a distal end, and a lumen extending between the proximal end and the distal end, the outer tube being sized to span from at least a skin incision in a patient to a predetermined site proximate the spine of the patient, the outer tube having a second slot formed therein aligned with the first slot, the second slot having an opening at the distal end of the outer tube and extending toward the proximal end of the outer tube; and

a bone anchor assembly comprising

a bone anchor having a proximal head and a distal bone engaging portion, and

a receiving member having a proximal end having a first bore, a distal end opposite the proximal end and having a second bore, and a recess for receiving a spinal fixation element and in communication with the first bore, the second bore being sized to receive the head of the bone anchor, wherein the distal end of the outer tube is adapted to releasably engage the receiving member and the first and second slots are aligned with the recess in the receiving member when the outer tube is releasably engaged to the receiving member.

45. The medical device of claim 44, wherein the receiving member has a substantially U-shaped cross-section defined by two legs separated by the recess and each leg is free at the proximal end of the receiving member.

46. The medical device of claim 45, wherein a first arcuate groove is formed on an exterior surface of the proximal end of a first one of the legs and a second arcuate groove is formed on an exterior surface of the proximal end of a second one of the legs and the distal end of the outer tube is configured to releasably engage the first and second grooves.