Minimally invasive method and apparatus for placing facet screws and fusing adjacent vertebrae

• US 20060085010A1
• Filed: 09/29/2004
• Published: 04/20/2006
• Est. Priority Date: 09/29/2004
• Status: Abandoned Application

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Lieberman, Isador H.
• Application Number:
  US10/952,650
• Publication Number:
  US 20060085010A1
• Time in Patent Office: Days
• US Class Current: 606/99
• CPC Class Codes: A61B 17/171 for external fixation
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/7064 Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/062 penetration depth

Abstract

The present invention provides a minimally invasive apparatus for placing screws across a facet joint between adjacent first and second vertebrae. The apparatus includes a first K-wire for inserting into the spinous process of the first vertebrae and a first fixation block removably connected to the first K-wire. The apparatus further includes a second K-wire for inserting into a transverse process of the second vertebrae and a second fixation block removably connected to the second K-wire. A rod member is removably connected to both of the first and second fixation blocks. A swivel block assembly includes relatively movable first and second block members. The rod member is removably connected to the first block member. A cannula extends from the second block member. The screws are insertable through the cannula for implantation across the facet joint. Methods for using the apparatus to place facet screws and fuse adjacent vertebrae are also provided.

Claims

1. An apparatus for placing translaminar screws across 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 the spinous process of the first vertebrae;

a second K-wire for inserting into a transverse process of the second vertebrae;

first and second fixation blocks having perpendicularly extending first and second passages, said first K-wire extending into said first passage in said first fixation block and said second K-wire extending into said first passage in said second fixation block;

a rod member extending through said second passage in said first fixation block and said second passage in said second fixation block;

a swivel block assembly comprising relatively movable first and second block members, said swivel block assembly including a third passage extending through said first block member and a fourth passage extending through said second block member, said rod member extending into said third passage; and

a cannula which extends into said fourth passage in said second block member and through which the translaminar screws are insertable for implantation across a facet joint between the first and second vertebrae.

2. The apparatus of claim 1 wherein said first and second K-wires include graduations for measuring axial length along said K-wires.

3. The apparatus of claim 1 wherein said rod member includes graduations for measuring axial length along said rod member.

4. The apparatus of claim 1 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.

5. The apparatus of claim 4 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.

6. The apparatus of claim 5 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.

7. The apparatus of claim 1 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.

8. The apparatus of claim 1 wherein said first block member includes securing means for securing said rod member to said first block member.

9. The apparatus of claim 8 wherein said second block member includes securing means for securing said cannula to said second block member.

10. The apparatus of claim 9 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.

11. The apparatus of claim 1 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.

12. The apparatus of claim 11 wherein said securing means on said first and second block members and said swivel block assembly comprises threaded fasteners.

13. The apparatus of claim 1 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.

14. The apparatus of claim 1 wherein said first and second passages in said first fixation block are offset from each other by a predetermined amount.

15. The apparatus of claim 14 wherein said first and second passages in said second fixation block are offset from each other by said predetermined amount.

16. A minimally invasive apparatus for placing screws across a facet joint between adjacent first and second vertebrae, said apparatus comprising:

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

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

a second K-wire for inserting into a transverse process of the 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 extending from said second block member and through which the screws are insertable for implantation across the facet joint.

17. The apparatus of claim 16 wherein each of said first and second K-wires includes means for measuring axial length along said K-wires.

18. The apparatus of claim 16 wherein said rod member includes means for measuring axial length along said rod member.

19. The apparatus of claim 16 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.

20. A minimally invasive surgical method for placing screws through the lamina and across the facet joints between 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 center of the spinous process of the upper vertebrae;

inserting the second K-wire into a transverse process on a first side of the lower vertebrae so that the second K-wire is parallel to the first K-wire in both the sagittal and coronal planes;

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

calculating a desired axial position for the swivel block assembly along the rod member;

calculating a desired angle for the centerline of the cannula to extend from a second side of the vertebrae toward the facet joint on the first side along a first axis;

securing the second block member of the swivel block assembly relative to the first block member to achieve the desired angle for the first axis;

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

obtaining percutaneous access to the junction of the lamina and the spinous process on the second side of the upper vertebrae via the cannula;

inserting a first screw through the cannula; and

implanting the first screw along the first axis across the facet joint on the first side to attach the upper and lower vertebrae.

21. The method of claim 20 further comprising the steps of:

inserting a drill bit into the cannula prior to said step of inserting the first screw; and

drilling a pilot hole for the first screw through the lamina and the facet joint on the first side with the drill bit to a predetermined depth along the first axis.

22. The method of claim 20 further comprising the steps of:

removing the cannula from its position over the lamina on the second side of the upper vertebrae;

releasing the first and second block members to allow relative movement;

swiveling the second block member to aim the centerline of the cannula along a second axis toward the facet joint on the second side;

obtaining percutaneous access 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.

23. The method of claim 22 further comprising the steps of:

inserting a burring bit into the cannula prior to said step of placing a bone graft material; and

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

24. The method of claim 20 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 so that the second K-wire is parallel to the first K-wire in both the sagittal and coronal planes;

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

releasing the first fixation block from the first K-wire;

rotating the first fixation block with the rod member extending across the K-wires;

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

calculating a desired axial position for the swivel block assembly along the rod member;

calculating a 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 a third axis;

securing the second block member of the swivel block assembly relative to the first block member to achieve the desired angle;

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

obtaining percutaneous access to the junction of the lamina and the spinous process on the first side of the upper vertebrae via the cannula;

inserting a second screw through the cannula; and

implanting the second screw along the third axis across the facet joint on the second side to attach the upper and lower vertebrae.

25. The method of claim 24 further comprising the steps of:

inserting a drill bit into the cannula prior to said step of inserting the second screw; and

drilling a pilot hole for the second screw through the lamina and the facet joint on the second side with the drill bit to a predetermined depth along the third axis.

26. The method of claim 24 further comprising the steps of:

removing the cannula from its position over the lamina on the first side of the upper vertebrae;

releasing the first and second block members to allow relative movement;

swiveling the second block member to aim the centerline of 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 into the facet joint on the first side around the previously implanted first screw to assist with fusion of the upper and lower vertebrae.

27. The method of claim 26 further comprising the steps of:

inserting a burring bit into the cannula prior to said step of placing a bone graft material; and

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

28. 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 center of 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;

inserting the first screw through the cannula; and

implanting the first screw along the first axis across the facet joint on the first side to attach the upper and lower vertebrae.

29. The method of claim 28 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.

30. The method of claim 28 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.

31. The method of claim 28 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;

inserting a second screw through the cannula; and

implanting the second screw along the third axis across the facet joint on the second side to attach the upper and lower vertebrae.

32. The method of claim 31 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.

33. The method of claim 31 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.