Instruments and methods for stabilization of bony structures

• US 20060111714A1
• Filed: 01/03/2006
• Published: 05/25/2006
• Est. Priority Date: 10/20/1999
• Status: Active Grant

• Current Assignee: Kevin T. Foley
• Original Assignee: Kevin T. Foley
• Inventors: Foley, Kevin T.
• Granted Patent: US 7,763,055 B2
• Time in Patent Office: Days
• US Class Current: 606/279
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/7038 to a different extent in different directions, e.g. within one plane only
• CPC Class Codes: A61B 17/7086 Rod reducers, i.e. devices providing a mechanical advantage to allow a user to force a rod into or onto an anchor head other than by means of a rod-to-bone anchor locking element; rod removers
• CPC Class Codes: A61B 17/7089 wherein insertion is along an arcuate path
• CPC Class Codes: A61B 17/88 Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices A61B17/7074 takes precedence
• CPC Class Codes: A61B 17/8872 Instruments for putting said fixation devices against or away from the bone A61B17/7074, A61B17/808 take precedence
• CPC Class Codes: A61B 17/8897 Guide wires or guide pins
• CPC Class Codes: A61B 17/90 Guides therefor
• CPC Class Codes: A61B 2017/681 Alignment, compression, or distraction mechanisms

Abstract

Systems and methods include positioning a device in a spinal disc space from a first approach and engaging a connecting element between anchors engaged to vertebrae from a second approach. The systems and methods minimize tissue dissection and retraction needed for stabilization of a vertebral level.

Claims

1. A minimally invasive surgical method, comprising:

accessing a spinal disc space of a patient from a first approach relative to a spinal midline;

distracting the spinal disc space through the first approach;

engaging anchors to vertebrae on each side of the spinal disc space from a second approach, the second approach being on a side of the spinal midline opposite the first approach;

engaging a connecting element between the anchors engaged to the vertebrae; and

positioning a device in the spinal disc space through the first approach.

2. The method of claim 1, wherein accessing the spinal disc space includes performing an annulotomy.

3. The method of claim 2, wherein accessing the spinal disc space includes performing a discectomy.

4. The method of claim 1, further comprising removing distraction from the first approach.

5. The method of claim 1, wherein positioning the device includes delivering the device to the spinal disc space through the first approach.

6. The method of claim 1, further comprising compressing the spinal disc space through the second approach.

7. The method of claim 1, further comprising percutaneously guiding the connecting element between the anchors before engaging the connecting element between the anchors.

8. The method of claim 7, wherein the anchors each include an extension extending proximally from the anchor through the second approach.

9. The method of claim 8, further comprising mounting an inserter instrument to the extensions with the connecting element coupled to the inserter instrument, and guiding the connecting element between the anchors includes guiding the connecting element by moving the inserter instrument relative to the extensions.

10. The method of claim 9, wherein moving the inserter instrument includes pivoting the inserter about proximal ends of the extensions.

11. The method of claim 1, wherein engaging anchors include positioning the anchors through a single incision forming the second approach.

12. The method of claim 1, wherein accessing the spinal disc space includes sequentially dilating paraspinous tissue along the first approach.

13. The method of claim 12, wherein accessing the spinal disc space includes positioning a retractor sleeve through the sequentially dilated tissue.

14. The method of claim 13, wherein positioning the device includes positioning the device through the retractor sleeve to the spinal disc space.

15. The method of claim 13, further comprising preparing the spinal disc space through the retractor sleeve before positioning the device.

16. The method of claim 1, wherein positioning the device includes positioning the device to bi-laterally support vertebrae on each side of the spinal midline.

17. The method of claim 1, wherein the first approach is a postero-lateral approach to the spinal disc space.

18. The method of claim 17, wherein the second approach is a posterior approach to pedicles of the vertebrae.

19. The method of claim 1, wherein each of the anchors is a multi-axial screw.

20. The method of claim 1, wherein the device is an interbody fusion device.

21. The method of claim 20, wherein the device is positioned in the spinal disc space to bi-laterally support the vertebrae.

22. The method of claim 21, wherein the device includes a pair of interbody fusion devices, and positioning the device includes positioning a first interbody fusion device at a at a second side of the spinal midline and positioning a second interbody fusion device at a first side of the spinal midline, the first side being offset from the spinal midline toward the first approach and the second side being offset from the spinal midline toward the second approach.

23. The method of claim 1, wherein the device is an artificial disc.

24. A minimally invasive surgical method, comprising:

accessing a spinal disc space of a patient from a first approach relative to a spinal midline;

engaging anchors to vertebrae on each side of the spinal disc space from a second approach, the second approach being on a side of the spinal midline opposite the first approach;

distracting the spinal disc space with extensions extending from respective ones of the anchors; and

positioning a device in the disc space through the first approach.

25. The method of claim 24, further comprising:

engaging a connecting element between the anchors engaged to the vertebrae.

26. The method of claim 24, wherein accessing the spinal disc space includes performing an annulotomy.

27. The method of claim 26, wherein accessing the spinal disc space includes performing a discectomy.

28. The method of claim 24, wherein positioning the device includes delivering the device to the spinal disc space through the first approach.

29. The method of claim 24, further comprising percutaneously guiding a connecting element between the anchors.

30. The method of claim 29, further comprising engaging the connecting element between the anchors after distracting the spinal disc space.

31. The method of claim 29, wherein the extensions extend proximally from the anchors through skin and tissue of the patient along the second approach.

32. The method of claim 31, further comprising mounting an inserter instrument to the extensions with connecting element extending from the inserter instrument, and guiding the connecting element between the anchors includes guiding the connecting element by moving the inserter instrument relative to the extensions.

33. The method of claim 32, wherein moving the inserter instrument includes pivoting the inserter instrument about proximal ends of the extensions.

34. The method of claim 31, wherein the extensions extend through a single incision forming the second approach.

35. The method of claim 24, wherein accessing the spinal disc space includes sequentially dilating paraspinous tissue along the first approach.

36. The method of claim 35, wherein accessing the spinal disc space includes positioning a retractor sleeve through the sequentially dilated tissue.

37. The method of claim 36, wherein positioning the device includes positioning the device through the retractor sleeve to the spinal disc space.

38. The method of claim 36, further comprising preparing the spinal disc space through the retractor sleeve before positioning the device.

39. The method of claim 24, wherein positioning the device includes positioning the device to bi-laterally support vertebrae on each side of the spinal midline.

40. The method of claim 39, wherein positioning the device includes positioning a single device in the spinal disc space.

41. The method of claim 39, wherein positioning the device includes positioning a pair of devices in the spinal disc space.

42. The method of claim 24, wherein the first approach is a postero-lateral approach.

43. The method of claim 42, wherein engaging the anchors includes engaging the anchors to pedicles of the vertebrae.

44. The method of claim 43, wherein the anchors are multi-axial screws.

45. A minimally invasive surgical method, comprising:

accessing a spinal disc space of a patient from a first approach relative to a spinal midline;

engaging anchors to vertebrae on each side of the spinal disc space from a second approach, the second approach being on a side of the spinal midline opposite the first approach;

distracting the spinal disc space from the anchors engaged to the vertebrae;

engaging a connecting element between the anchors; and

positioning a device in the disc space through the first approach.

46. The method of claim 45, wherein positioning the device includes delivering the device to the spinal disc space through the first approach.

47. The method of claim 45, wherein engaging the connecting element includes percutaneously guiding the connecting element between the anchors.

48. The method of claim 45, further comprising engaging the connecting element between the anchors after distracting the spinal disc space.

49. The method of claim 45, wherein extensions extend proximally from respective ones of the anchors through skin and tissue of the patient along the second approach.

50. The method of claim 49, further comprising mounting an inserter instrument to the extensions with connecting element extending from the inserter instrument, and guiding the connecting element between the anchors includes guiding the connecting element by moving the inserter instrument relative to the extensions.

51. The method of claim 50, wherein moving the inserter instrument includes pivoting the inserter instrument about proximal ends of the extensions.

52. The method of claim 49, wherein the extensions extend through a single incision forming the second approach.

53. The method of claim 45, wherein accessing the spinal disc space includes sequentially dilating paraspinous tissue along the first approach.

54. The method of claim 53, wherein accessing the spinal disc space includes positioning a retractor sleeve through the sequentially dilated tissue.

55. The method of claim 54, wherein positioning the device includes positioning the device through the retractor sleeve to the spinal disc space.

56. The method of claim 54, further comprising preparing the spinal disc space through the retractor sleeve before positioning the device.

57. The method of claim 45, wherein positioning the device includes positioning the device to bi-laterally support vertebrae on each side of the spinal midline.

58. The method of claim 45, wherein the first approach is a postero-lateral approach.

59. The method of claim 45, wherein engaging anchors to vertebrae includes engaging the anchors to pedicles of the vertebrae.

60. The method of claim 59, wherein the anchors are multi-axial screws.

61. The method of claim 45, wherein engaging anchors to vertebrae includes positioning the anchors through a single incision forming the second approach.