Spinal fixation tool set and method

• US 20060111713A1
• Filed: 11/23/2004
• Published: 05/25/2006
• Est. Priority Date: 11/23/2004
• Status: Active Grant

• Current Assignee: Roger P. Jackson
• Original Assignee: Roger P. Jackson
• Inventors: Jackson, Roger P.
• Granted Patent: US 7,621,918 B2
• Time in Patent Office: Days
• US Class Current: 606/914
• CPC Class Codes: A61B 17/7002 Longitudinal elements, e.g. rods
• CPC Class Codes: A61B 17/7011 Longitudinal element being non-straight, e.g. curved, angled or branched adjustable length longitudinal elements A61B17/7014; A61B17/7019 takes precedence, e.g. coil springs
• CPC Class Codes: A61B 17/7032 Screws or hooks with U-shaped head or back through which longitudinal rods pass
• CPC Class Codes: A61B 17/7037 wherein pivoting is blocked when the rod is clamped
• CPC Class Codes: A61B 17/7082 for driving, i.e. rotating, screws or screw parts specially adapted for spinal fixation, e.g. for driving polyaxial or tulip-headed screws driving other bone screws A61B17/8875
• CPC Class Codes: A61B 17/7085 for insertion of a longitudinal element down one or more hollow screw or hook extensions, i.e. at least a part of the element within an extension has a component of movement parallel to the extension's axis
• 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

Abstract

A tool set for implanting bone screws in a human spine, followed by the implantation of a rod into the bone screws includes end guide tools having flexible back wall flaps that receive opposite ends of the rod and intermediate guide tools that hold the rod in intermediate locations between the end guide tools. Both the end and intermediate guide tools include an attachment structure for operably connecting the guide tool to a bone screw. For bone screw implantation, the end guide tools and intermediate guide tools are assembled with a multi-function installation tool and a bone screw driver. Both the installation tool and driver are coaxial with the guide tool and rotatingly mateable to the guide tool. The multi-function installation tool includes a sleeve that extends substantially about the guide tool providing stability during bone screw installation. The sleeve also operatively functions as a rod pusher that abuts the rod as the sleeve is translated along the guide tool and toward the bone screw. A method utilizing the tool set allows a surgeon to percutaneously implant the bone screws and the rod in the patient.

Claims

1. A tool set for implanting a rod in a patient, the tool set comprising:

a) first and second end guide tools, each guide tool further comprising;

i) an elongate body having a longitudinal axis, an outer surface and a channel with a lateral opening extending through the outer surface and along the longitudinal axis from a top to a bottom of the guide tool, at least a portion of the channel opening sized and shaped for side loading and receiving of an end of the rod;

ii) opposed spinal implant engaging structure near a bottom of the body; and

iii) a flexible holding structure disposed opposite the lateral opening and pressable laterally outwardly from the elongate body outer surface, the holding structure sized and shaped to closely receive and abut against the end of the rod.

2. The tool set of claim 1 wherein the flexible holding structure is sized and shaped to bias against the rod end at a location outside of the spinal implant.

3. The tool set of claim 1 wherein the flexible holding structure includes a back wall disposed opposite the lateral opening, the back wall having first and second elongate and parallel slits with a back wall flap portion disposed between the first and second slits, the back wall flap portion partially defining the channel and pushable to a location lateral with respect to a remainder of the back wall, the channel adapted to receive the rod end therein and the back wall flap portion adapted for lateral flexing to accommodate the rod.

4. The tool set of claim 1 further comprising an elongate installation tool having a translation nut and an attached sleeve, the translation nut coaxial and being freely rotatable with respect to the sleeve, the nut configured for rotatable attachment to at least one of the end guide tools, the sleeve having a rod pushing end, the installation tool being attachable to the end guide tool in a first bone screw implantation orientation and in a second rod pushing orientation, the first orientation with the sleeve being in a fixed, stationary position with respect to the end guide tool and the sleeve substantially surrounding the end guide tool, the second rod pushing orientation wherein the sleeve is in sliding relation along an axis of the end guide tool, the nut translating the rod pushing end between a first location spaced from the end guide tool bottom and a second location near the end guide tool bottom.

5. The tool set of claim 4 wherein the installation tool sleeve defines a second channel opening extending substantially along a length of the sleeve to an open end thereof opposite the translation nut, the installation tool being selectively attachable to the end guide tool in one of first and second positions, the first position being wherein the first channel opening and the second channel opening are fixed in adjacent relationship, the second position being wherein the flexible holding structure and the second channel opening are fixed in adjacent relationship with the flexible holding structure being outwardly protrudeable through the second channel opening.

6. The tool set of claim 1 further comprising at least one intermediate guide tool having first and second legs defining a longitudinal pass-through slot for receiving the rod therethrough.

7. The tool set of claim 6 further comprising:

a) an installation tool configured for rotatable attachment to at least one of the intermediate guide tool and the end guide tools, the sleeve having a rod pushing end; and

b) at least one driver having a handle, a guide tool attachment portion and a stem, the stem having an end configured for rotatable engagement with a spinal implant, the driver configured for coaxial relationship with at least one of the intermediate guide tool and the end guide tools when the stem is disposed within the respective guide tool and the respective guide tool is attached to an installation tool, the attachment portion configured for rigid attachment to the respective guide tool.

8. An end guide tool for use with a spinal implant bone screw and an associated rod, the guide tool comprising:

a) an elongate body having a lower attachment structure adapted for attachment to a respective bone screw, the body having an inner surface defining an elongate channel, the body further defining an elongate opening communicating with the channel; and

b) a back wall disposed opposite the opening, the back wall having first and second elongate and parallel slits with a back wall flap portion disposed between the first and second slits, the back wall flap portion partially defining the channel and pushable to a location lateral with respect to a remainder of the back wall, the channel adapted to receive a respective rod therein and the back wall flap portion adapted for lateral flexing to accommodate a respective rod.

9. The end guide tool of claim 8 further comprising a helically wound first guide and advancement structure located near a bottom of the end guide tool, the first guide and advancement structure providing a helical pathway adapted to rotatably and matingly receive a mating structure of a bone screw closure top and the first guide and advancement structure also being adapted to be aligned with a second guide and advancement structure on a bone screw so as to continue the helical pathway when the guide tool is attached to a bone screw and so as to be adapted to transfer the closure top between the end guide tool and the bone screw upon rotation of the closure top.

10. The end guide tool of claim 8 further comprising an outer surface having a first guide and advancement structure thereon adapted to rotatably and matingly receive a second guide and advancement structure disposed on a nut attachment of a rod pusher wherein rotation of the nut results in axial translation of the rod pusher with respect to the end guide tool.

11. The end guide tool of claim 10 wherein the end guide tool defines a slot adapted for receiving a spinal implant bone screw driver and the first guide and advancement structure is also adapted to rotatably and matingly receive a third guide and advancement structure disposed on the spinal implant bone screw driver.

12. A spinal rod implantation tool assembly comprising:

a) an elongate guide tool having an end configured for releaseable attachment to a spinal implant bone screw; and

b) an elongate installation tool having a sleeve with a rod pushing end, the installation tool attachable to the elongate guide tool in a first bone screw implantation orientation and a second rod pushing orientation, the first orientation with the sleeve being in a fixed, stationary position substantially surrounding the guide tool, the second rod pushing orientation wherein the rod pushing end is selectively advancement toward and away the elongate guide tool end.

13. The assembly of claim 12 wherein the installation tool includes a translation nut attached to the sleeve, the translation nut coaxial and freely rotatable with respect to the sleeve, the nut configured for rotatable attachment to the guide tool with rotation of the nut translating the rod pushing end with respect to the guide tool.

14. The assembly of claim 13 wherein:

a) the guide tool is an end guide tool having a body defining a first channel opening and a back wall defining first and second elongate and parallel slits with a back wall flap portion disposed between the first and second slits, the back wall flap portion disposed opposite the first channel opening; and

b) the installation tool sleeve defines a second channel opening extending substantially along a length of the sleeve to an open end thereof opposite the translation nut, the installation tool being attachable to the end guide tool in one of first and second positions, the first position wherein the first channel opening and the second channel opening are fixed in adjacent relationship, the second position wherein the back wall and the second channel opening are fixed in adjacent relationship with the back wall flap portion being rotatable into the second channel opening.

15. The assembly of claim 13 wherein the guide tool is an intermediate guide tool having first and second legs defining a longitudinal pass-through slot and wherein in the first orientation, the sleeve substantially surrounds the first and second legs and is in sliding engagement with the first and second legs.

16. The assembly of claim 13 wherein the guide tool further comprises:

a) first and second legs;

b) a first pin projecting from a first inner surface of the first leg, the first pin having a first body and a first lip, the first pin body, first lip and the first inner surface defining a first slot; and

c) a second pin smaller than the first pin, the second pin projecting from a second inner surface of the second leg, the second pin having a second body and a second lip, the second body, second lip, and second inner surface defining a second slot, the first and second slots for a twist-on insertion and releaseable attachment of a spinal bone screw head between the first and second legs.

17. The assembly of claim 16 further comprising:

a) a first nub disposed on the first inner surface and spaced from the first pin; and

b) a second nub disposed on the second inner surface and spaced from the second pin.

18. The assembly of claim 13 further comprising a driver having a handle, a guide tool attachment portion and a stem, the stem having an end configured for rotatable engagement with a spinal implant, the driver in coaxial relationship with both the guide tool and the installation tool when the stem is disposed within the guide tool and the guide tool is attached to the installation tool, the attachment portion configured for rigid and releaseable attachment to the guide tool.

19. The tool assembly of claim 18 wherein:

a) the guide tool has an outer surface having a first guide and advancement structure thereon;

b) the translation nut has a first inner surface having a second guide and advancement structure thereon, mateable with the first guide and advancement structure; and

c) the driver guide tool attachment portion has a second inner surface having a third guide and advancement structure mateable with the first guide and advancement structure.

20. The assembly of claim 18 wherein the driver guide tool attachment portion is a nut attachment freely rotatable with respect to the driver handle.

21. The assembly of claim 18 wherein:

a) the driver further comprises a pin projecting laterally from the stem; and

b) the guide tool has a slot, the pin slidable within the slot and preventing rotation of the guide tool with respect to the driver when the pin is disposed in the slot.

22. A spinal rod implantation tool assembly comprising:

a) an elongate guide tool having an end configured for releaseable attachment to a spinal implant bone screw;

b) an elongate installation tool having a translation nut and attached sleeve, the translation nut being coaxial and freely rotatable with respect to the sleeve, the nut configured for rotatable attachment to the guide tool, the sleeve partially extending around the guide tool and coaxial therewith when the nut and guide tool are attached; and

c) a driver having a handle, a guide tool attachment portion and a stem, the stem having an end configured for rotatable engagement with a spinal implant, the driver in coaxial relationship with both the guide tool and the installation tool when the stem is disposed within the guide tool and the guide tool is attached to the installation tool, the attachment portion being configured for rigid attachment to the guide tool.

23. The assembly of claim 22 wherein:

a) the guide tool is an end guide tool having a body defining a first channel opening and a back wall defining first and second elongate and parallel slits with a back wall portion disposed between the first and second slits, the back wall portion disposed opposite the first channel opening; and

b) the installation tool sleeve defines a second channel opening extending substantially along a length of the sleeve to an open end thereof opposite the translation nut, the installation tool being attachable to the end guide tool in one of first and second positions, the first position being wherein the first channel opening and the second channel opening are fixed in adjacent relationship, the second position being wherein the back wall and the second channel opening are fixed in adjacent relationship with the back wall portion being outwardly flexible at a lower end thereof through the second channel opening.

24. The tool assembly of claim 22 wherein:

a) the guide tool has an outer surface having a first guide and advancement structure thereon;

b) the translation nut has a first inner surface having a second guide and advancement structure thereon, mateable with the first guide and advancement structure; and

c) the driver guide tool attachment portion has a second inner surface having a third guide and advancement structure mateable with the first guide and advancement structure.

25. The assembly of claim 24 wherein the driver guide tool attachment portion is a nut attachment freely rotatable with respect to the driver handle.

26. The assembly of claim 22 wherein:

a) the driver further comprises a pin projecting laterally from the stem; and

b) the guide tool defines a slot, the pin slidable within the slot and prohibiting rotation of the guide tool with respect to the driver when the pin is disposed in the slot.

27. A vertebral support rod implantation kit adapted for use with a plurality of vertebrae, the kit comprising:

a) a plurality of polyaxial bone screws, each bone screw being adapted for implantation in one of the vertebrae, each of the bone screws having an attachment structure;

b) an elongate rod having first and second ends, the rod sized and shaped to extend between a pair of end bone screws of the plurality of bone screws;

c) a plurality of closure tops, each closure top sized and shape to mate with a respective bone screw and retain the elongate rod within a cavity defined by the respective bone screw;

d) a pair of end guide tools, each end guide tool having

i) an elongate body having a longitudinal axis, an outer surface and a channel with a lateral opening extending through the outer surface and along the longitudinal axis from a top to a bottom of the guide tool, at least a portion of the channel opening sized and shaped for side loading and receiving of an end of the rod;

ii) opposed spinal implant engaging structure near a bottom of the body; and

iii) a flexible holding structure disposed opposite the lateral opening and pressable laterally outwardly from the elongate body outer surface, the holding structure sized and shaped to closely receive and abut against the end of the rod.

28. The kit of claim 27 wherein the flexible holding structure includes a back wall disposed opposite the lateral opening, the back wall having first and second elongate and parallel slits with a back wall flap portion disposed between the first and second slits, the back wall flap portion partially defining the channel and pushable to a location lateral with respect to a remainder of the back wall, the channel adapted to receive the rod end therein and the back wall flap portion adapted for lateral flexing to accommodate the rod.

29. The kit of claim 28 further comprising a first helically wound guide and advancement structure located near the bottom of the end guide tool, the first guide and advancement structure providing a helical pathway to rotatably and matingly receive a mating guide and advancement structure of a respective bone screw closure top and the first guide and advancement structure also being operably alignable with a second guide and advancement structure located on a respective bone screw so as to continue the helical pathway when a respective guide tool is attached to a respective bone screw and so as to be adapted to transfer the closure top between a respective guide tool and the bone screw upon rotation of the closure top.

30. The kit of claim 27 further comprising at least one elongate installation tool having a translation nut and attached sleeve, the translation nut being coaxial and freely rotatable with respect to the sleeve, the nut being configured for rotatable attachment to the end guide tool, the sleeve having a rod pushing end, the installation tool being selectively attachable to the guide tool in a first bone screw implantation orientation and in a second rod pushing orientation, the first orientation being with the sleeve in a fixed, stationary position with respect to the guide tool, the sleeve substantially surrounding the guide tool, the second rod pushing orientation wherein the sleeve is in sliding relation along an axis of the guide tool, rotation of the nut translating the rod pushing end between a first location spaced from the guide tool end and a second location near the guide tool end.

31. The kit of claim 27 further comprising at least one intermediate guide tool having first and second legs extending to an end thereof, the first and second legs defining a longitudinal pass-through slot for receiving the rod therethrough.

32. The kit of claim 31 further comprising at least one elongate installation tool having a translation nut and attached sleeve, the translation nut being coaxial and freely rotatable with respect to the sleeve, the nut being configured for rotatable attachment with the intermediate guide tool, the sleeve having a rod pushing end, the installation tool being selectively attachable to the intermediate guide tool in a first bone screw implantation orientation and in a second rod pushing orientation, the first orientation being with the sleeve in a fixed, stationary position with respect to the intermediate guide tool, the sleeve substantially surrounding the first and second legs, the second rod pushing orientation being wherein the sleeve is in sliding relation along an axis of the intermediate guide tool, when rotated the nut translating the rod pushing end along the first and second legs between a first location spaced from the intermediate guide tool end and a second location near the intermediate guide tool end.

33. The kit of claim 27 further comprising at least one driver having a handle, a guide tool attachment portion and a stem, the stem having an end configured for rotatable engagement with a respective polyaxial bone screw, the driver being in coaxial relationship with the guide tool when the stem is disposed within the guide tool, the attachment portion being configured for rigid attachment to the guide tool.

34. In a guide tool having an elongate body with attachment structure at a lower end thereof adapted to be secured to an implant, the improvement comprising a laterally disposed flexible tang disposed opposite a laterally opening channel formed in the body and communicating with an interior of the body, the lateral opening extending from a top end of the body to the bottom end thereof so as to provide side access to the interior of the body along the entire length thereof, at least a portion of the opening sized to receive an end of a rod, the tang translatable by the rod to a location outside of the body.

35. A method of fastening a longitudinal member of a spinal fixation apparatus to a bone implant comprising the steps of:

a) providing a guide tool having a body with a laterally opening channel and an opposed flexible wall communicating with the channel, the laterally opening channel extending from a top end of the body to a bottom end thereof so as to provide side access to the interior of the body along an entire length thereof, at least a portion of the channel opening sized to receive the longitudinal member;

b) attaching the guide tool to the bone implant;

c) inserting the longitudinal member into the channel opening and into contact with the flexible wall;

d) inserting a fastener into the channel opening; and

e) connecting the fastener to the implant to securely attach the longitudinal member to the implant.

36. A spinal fixation assembly method comprising:

a) attaching a bone screw head of a spinal implant screw to a mating attachment structure disposed at an end of an elongate guide tool, the guide tool defining a channel and having a second attachment structure disposed near another end thereof;

b) inserting the guide tool and attached spinal implant screw into an elongate installation tool, the installation tool having a translation nut and a sleeve;

c) rotating the nut in a first direction to mate the installation tool with the second attachment structure and translate the sleeve to a location near the guide tool end; and

d) inserting a driver into the guide tool channel, the driver having a handle and a spinal implant screw engagement end; and

e) attaching the driver to the guide tool at the second attachment structure with the driver engagement end engaging the spinal implant screw.

37. The method of claim 36 further comprising the step of:

a) inserting the attached driver, installation tool, guide tool and spinal implant screw into an incision and into contact with a vertebra; and

b) turning the handle and thereby rotating the driver, installation tool, guide tool and spinal implant screw as one unit, so as to drive the spinal implant screw into the vertebra.

38. The method of claim 37 including the steps of:

a) detaching the driver from the guide tool after the spinal implant screw is inserted in the vertebra and sliding the driver out of the incision;

b) rotating the nut in a second direction to result in the sliding of the sleeve away from the guide tool end;

c) inserting a rod into the channel with the rod disposed between the vertebra and the sleeve; and

d) rotating the nut in the first direction with the sleeve pushing the rod toward the spinal implant screw.

39. The method of claim 37 including the steps of:

a) detaching the driver from the guide tool after the spinal implant screw is inserted in the vertebra and sliding the driver out of the incision;

b) rotating the nut in a second direction to result in the sliding of the sleeve away from the guide tool end and detaching the installation tool from the guide tool, and then sliding the installation tool out of the incision;

c) inserting a rod into the guide tool channel from a side thereof;

d) inserting a closure top into the channel from the side; and

e) pushing the closure top toward the bone screw, thereby pushing the rod toward the bone screw.

40. The method of claim 39 including the step of fixing the closure top to the spinal implant screw with the rod being captured between the spinal implant screw and the closure top.

41. A method of percutaneously implanting a spinal fixation apparatus, the method comprising:

a) providing at least first and second end guide tools, each end guide tool being releaseably attachable to a bone screw, each end guide tool having an elongate channel extending the length thereof and having a flexible wall near a lower end thereof;

b) attaching each end guide tool to a bone screw;

c) attaching an installation tool to each end guide tool, each installation tool having a sleeve defining an elongate opening, each installation tool being initially attached to a respective guide tool with the sleeve adjacent to the wall to retain the wall in a stationary position;

d) inserting a driver into each end guide tool and attached installation tool and rigidly attaching the driver to the end guide tool with an end of the driver in engagement with a respective bone screw;

e) making at least first and second incisions for the first and second end guide tools and respective bone screws to be implanted;

f) inserting each bone screw with attached guide tool, installation tool and driver combination into a respective incision and rotating the combination as a unit to drive the bone screw into a vertebra; and

g) detaching the driver from the guide tool and sliding the driver out of the incision.

42. The method of claim 41 further comprising the steps of:

a) detaching the installation tools from the guide tools;

b) replacing the installation tool on at least one of the guide tools, with the installation tool opening aligned with the guide flexible wall, the flexible wall being protrudeable through the support opening;

c) inserting a rod with first and second ends into each of the channels by first inserting the first end into the first incision and then inserting the rod first end into the channel of an opposed guide tool;

d) thereafter inserting the rod into all remaining channels with the first and second ends each in contact with a flexible wall of a respective end guide tool, the walls biasing against the rod ends; and

e) sliding the support sleeve toward the guide tool end, the sleeve contacting the rod and pushing the rod toward the bone screw.