Minimally invasive method and apparatus for fusing adjacent vertebrae

• US 20060084977A1
• Filed: 09/29/2004
• Published: 04/20/2006
• Est. Priority Date: 09/29/2004
• Status: Active Grant

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Lieberman, Isador H.
• Granted Patent: US 7,396,360 B2
• Time in Patent Office: Days
• US Class Current: 606/60
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/7053 with parts attached to bones or to each other by flexible wires, straps, sutures or cables
• CPC Class Codes: A61B 17/7064 Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
• CPC Class Codes: A61B 17/863 with thread interrupted or changing its form along shank, other than constant taper
• CPC Class Codes: A61B 17/8863 Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• CPC Class Codes: A61B 2090/037 with a frangible part, e.g. by reduced diameter
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/062 penetration depth

Abstract

The present invention is a minimally invasive surgical method for fusing adjacent vertebrae. A first K-wire is inserted into the spinous process of an upper vertebrae. A second K-wire is inserted into a transverse process of a lower vertebrae. A first fixation block is secured to the first K-wire and a second fixation block is secured to the second K-wire. A rod member extends across the K-wires. A swivel block assembly is secured to achieve a desired angle for a first axis along which a first screw will be implanted into a facet joint. The swivel block assembly is secured at a desired axial position on the rod member. Percutaneous access to the upper vertebrae along the first axis is then obtained via a cannula. A removable screw having a threaded section for implantation across the facet joint and an elongated shank section that is shearable subcutaneously is inserted through the cannula. The threaded section is implanted along the first axis across the facet joint to attach the upper and lower vertebrae. A shearing tool is inserted percutaneously over the shank section and the shank section is sheared off immediately above the lamina.

Claims

1. A minimally invasive surgical method for fusing adjacent upper and lower vertebrae, said method comprising the steps of:

providing an apparatus comprising first and second K-wires, first and second fixation blocks, a swivel block having relatively movable first and second block members, a rod member extending between the fixation blocks and the first block member, and a cannula extending from the second block member;

inserting the first K-wire into the spinous process of the upper vertebrae;

inserting the second K-wire into the transverse process on a first side of the lower vertebrae;

securing the first fixation block to the first K-wire and the second fixation block to the second K-wire with the rod member extending across the K-wires;

securing the second block member of the swivel block assembly relative to the first block member to achieve a desired angle for a first axis along which a first screw will be implanted into the facet joint on the first side;

securing the swivel block assembly at a desired axial position on the rod member;

obtaining percutaneous access along the first axis to a second side of the upper vertebrae via the cannula;

providing a first one removable screw for insertion into the cannula, the first screw having a threaded section for implantation across the facet joint to promote fusion of the adjacent vertebrae and an elongated shank section that is shearable subcutaneously following implantation;

inserting the first screw through the cannula;

implanting the threaded section of the first screw along the first axis across the facet joint on the first side to attach the upper and lower vertebrae;

percutaneously inserting a shearing tool over the elongated shank section of the first screw; and

shearing the elongated shank section of the first screw with the shearing tool to form an accessible head portion of the shank section that lies above the surface of the lamina of the upper vertebrae.

2. The method of claim 1 wherein prior to said step of securing the second block member of the swivel block assembly relative to the first block member to achieve a desired angle for the first axis, said method further comprising the steps of:

moving the cannula to aim the cannula toward the facet joint on the second side of the vertebrae along a second axis;

obtaining percutaneous access along the second axis to the facet joint on the second side via the cannula; and

placing a bone graft material into the facet joint on the second side through the cannula to assist with fusion of the upper and lower vertebrae.

3. The method of claim 2 further comprising the steps of:

inserting a burring bit into the cannula; and

burring the articular surfaces of the facet joint on the second side to widen the said facet joint for accepting a bone graft material.

4. The method of claim 1 further comprising the steps of:

removing the cannula from percutaneous insertion on the second side;

removing the second K-wire from the transverse process on the first side of the lower vertebrae;

inserting the second K-wire into the transverse process on the second side of the lower vertebrae;

securing the second fixation block to the second K-wire;

releasing the first fixation block from the first K-wire and rotating the first fixation block with the rod member extending across the K-wires;

securing the first fixation block to the first K-wire;

securing the second block member of the swivel block assembly relative to the first block member to achieve a desired angle for a third axis on which a second screw will be implanted into the facet joint on the second side;

securing the swivel block assembly at a desired axial position along the rod member;

obtaining percutaneous access to the first side of the upper vertebrae via the cannula;

providing a second removable screw for insertion into the cannula, the second screw having a threaded section for implantation across the facet joint to promote fusion of the adjacent vertebrae and an elongated shank section that is shearable subcutaneously following implantation;

inserting the second screw through the cannula;

implanting the threaded section of the second screw along the third axis across the facet joint on the second side to attach the upper and lower vertebrae;

percutaneously inserting the shearing tool over the elongated shank section of the second screw; and

shearing the elongated shank section of the second screw with the shearing tool to form an accessible head portion of the shank section that lies above the surface of the lamina of the upper vertebrae.

5. The method of claim 4 further comprising the steps of:

moving the cannula to aim the cannula along a fourth axis toward the facet joint on the first side previously secured with the first screw;

obtaining percutaneous access to the facet joint on the first side via the cannula; and

placing a bone graft material through the cannula and into the facet joint on the first side around the previously implanted first screw to assist with fusion of the upper and lower vertebrae.

6. The method of claim 5 further comprising the steps of:

inserting a burring bit into the cannula; and

burring the articular surfaces of the facet joint on the first side to widen said facet joint around the first screw for accepting a bone graft material.

7. The method of claim 4 wherein said steps of shearing the first screw and shearing the second screw are completed consecutively.

8. The method of claim 4 wherein prior to said step of placing a bone graft material, said method further comprises the step of temporarily backing the threaded section of the first screw out of the facet joint on the first side of the vertebrae.

9. The method of claim 4 wherein said step of securing the second block member of the swivel block assembly relative to the first block member to achieve a desired angle for the third axis along which the second screw is implanted includes the step of calculating the desired angle for the centerline of the cannula to extend from the first side of the vertebrae toward the facet joint on the second side along the third axis.

10. The method of claim 4 wherein said step of securing the swivel block assembly at a desired axial position on the rod member includes the step of calculating the desired axial position for the swivel block assembly along the rod member.

11. The method of claim 4 wherein said step of securing the second block member of the swivel block assembly relative to the first block member to achieve a desired angle for the first axis along which the first screw is implanted includes the step of calculating the desired angle for the centerline of the cannula to extend from the second side of the vertebrae toward the facet joint on the first side along the first axis.

12. The method of claim 4 wherein said step of securing the swivel block assembly at a desired axial position on the rod member includes the step of calculating the desired axial position for the swivel block assembly along the rod member.

13. An apparatus for fusing a facet joint between adjacent first and second vertebrae in a minimally invasive surgical procedure, said apparatus comprising:

a first K-wire for inserting into one of the first and second vertebrae;

a first fixation block removably connected to said first K-wire;

a second K-wire for inserting into the other of the first and second vertebrae;

a second fixation block removably connected to said second K-wire;

a rod member removably connected to both of said first and second fixation blocks;

a swivel block assembly comprising relatively movable first and second block members, said rod member being removably connected to said first block member; and

a cannula for obtaining percutaneous access to the vertebrae, said cannula extending from said second block member; and

at least one removable screw for insertion into the cannula, said at least one screw having a threaded section for implantation across the facet joint to promote fusion of the adjacent vertebrae and an elongated shank section that is shearable subcutaneously following implantation.

14. The apparatus of claim 13 wherein said first and second K-wires include graduations for measuring axial length along said K-wires.

15. The apparatus of claim 13 wherein said rod member includes graduations for measuring axial length along said rod member.

16. The apparatus of claim 13 wherein said first fixation block includes a first securing means for securing said first K-wire to said first fixation block and a second securing means for securing said rod member to said first fixation block.

17. The apparatus of claim 16 wherein said second fixation block includes a first securing means for securing said second K-wire to said second fixation block and a second securing means for securing said second fixation block to said rod member.

18. The apparatus of claim 17 wherein said first and second securing means on said first fixation block and said first and second securing means on said second fixation block comprise threaded fasteners.

19. The apparatus of claim 13 wherein said second fixation block includes a first securing means for securing said second K-wire to said second fixation block and a second securing means for securing said second fixation block to said rod member.

20. The apparatus of claim 13 wherein said first block member includes securing means for securing said rod member to said first block member.

21. The apparatus of claim 20 wherein said second block member includes securing means for securing said cannula to said second block member.

22. The apparatus of claim 21 wherein said swivel block assembly includes securing means for securing said first and second block members in a desired angular position relative to each other.

23. The apparatus of claim 13 wherein said swivel block assembly includes securing means for securing said first and second block members in a desired angular position relative to each other.

24. The apparatus of claim 23 wherein said securing means on said first and second block members and said swivel block assembly comprises threaded fasteners.

25. The apparatus of claim 13 wherein said swivel block assembly includes positioning means for controllably adjusting the angular position of the first and second block members relative to each other.

26. The apparatus of claim 13 wherein said first and second passages in said first fixation block are offset from each other by a predetermined amount.

27. The apparatus of claim 26 wherein said first and second passages in said second fixation block are offset from each other by said predetermined amount.