METHODS AND APPARATUS FOR ACCESS TO AND/OR TREATMENT OF THE SPINE

• US 20070288026A1
• Filed: 06/08/2007
• Published: 12/13/2007
• Est. Priority Date: 06/09/2006
• Status: Active Grant

• Current Assignee: Zimmer Biomet Spine, Inc. (Zimvie Incorporated)
• Original Assignee: Endius Incorporated (Zimmer Biomet Holdings, Inc.)
• Inventors: Shluzas, Alan
• Granted Patent: US 8,123,751 B2
• Time in Patent Office: Days
• US Class Current: 606/86.A
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0482 Needle or suture guides guides for drills, pins or wire A61B17/17; for puncturing needles A61B17/3403
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/06109 Big needles, either gripped by hand or connectable to a handle
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 17/7002 Longitudinal elements, e.g. rods
• CPC Class Codes: A61B 17/7032 Screws or hooks with U-shaped head or back through which longitudinal rods pass
• CPC Class Codes: A61B 17/7035 Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
• CPC Class Codes: A61B 17/708 with tubular extensions coaxially mounted on the bone anchors
• 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 17/7083 Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements
• 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
• CPC Class Codes: A61B 17/8863 Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/3443 with means for adjusting the length of a cannula

Abstract

Systems, devices, and methods suitable for use with procedures performed at least partially percutaneously are provided. In some procedures, two or more access devices for providing access to adjacent surgical locations within a patient are used. Certain embodiments of the access device comprise an elongate body having a distal end with one or more cutouts. The cutouts on adjacent access devices are generally aligned with each other to permit passage of a portion of a fixation element from one access device to the other access device. A fastener with an elongated removable head may be delivered to the surgical site through the access device. After a distal end of the fastener is secured to the surgical site, a portion of the elongated housing is detached from the remainder of the fastener and removed from the patient.

Claims

1. A pedicle screw assembly comprising:

a threaded shaft;

a head including a housing and an elongated body integrally formed with the housing, the housing configured to receive a fixation element, the housing attached to the elongated body at a frangible neck, wherein the elongated body is adapted to be removed from the housing at the frangible neck and the elongated body has a length sufficient such that the elongated body extends above a patient'"'"'s skin when the screw is secured to the patient'"'"'s vertebra.

2. The pedicle screw assembly of claim 1, wherein the shaft and head are cannulated.

3. The pedicle screw assembly of claim 1, wherein the housing has one or more facets configured to couple with a removal device.

4. The pedicle screw assembly of claim 1, wherein the pedicle screw extends along a longitudinal axis, and the head includes a portion that is substantially “

U”

-shaped in a longitudinal cross-section relative to the longitudinal axis.

5. The pedicle screw assembly of claim 1, wherein the elongated body has one or more slots configured to allow passage of a fixation element to a target site.

6. The pedicle screw assembly of claim 1, wherein the elongated body extends along a longitudinal axis and has a proximal portion that is substantially “

C”

-shaped in a transverse cross section relative to the longitudinal axis.

7. The pedicle screw assembly of claim 1, wherein the elongated body extends along a longitudinal axis and has a distal portion that is substantially “

U”

-shaped in a longitudinal cross section relative to the longitudinal axis.

8. The pedicle screw assembly of claim 7, wherein the elongated body has a proximal portion that is substantially “

C”

-shaped in a transverse cross section relative to the longitudinal axis, wherein a first slot is defined in the substantially “

C”

-shaped proximal portion and a second slot is defined in the substantially “

U”

-shaped distal portion, and the first slot is aligned with the second slot.

9. The pedicle screw assembly of claim 7, wherein the housing includes a portion that is substantially “

U”

-shaped in a longitudinal cross-section relative to the longitudinal axis, and the substantially “

U”

-shaped distal portion of the elongate body is aligned with the substantially “

U”

-shaped portion of the housing.

10. The pedicle screw assembly of claim 6, wherein the substantially “

C”

-shaped proximal portion of the elongated body defines a guide for advancing a fixation element to a vertebral site, and for facilitating insertion of the fixation element into the housing.

11. The pedicle screw assembly of claim 1, wherein the elongated body has an outer surface configured to couple with a removal device.

12. The pedicle screw assembly of claim 1, wherein the neck includes a region of material having a reduced cross sectional area compared to the housing and elongated body.

13. The pedicle screw assembly of claim 1, wherein the neck includes one or more grooves in the elongated body.

14. The pedicle screw assembly of claim 1, wherein the housing has an inner threaded surface, wherein the assembly further comprises a screw cap configured to screw into the housing to secure a fixation element.

15. The pedicle screw assembly of claim 14, further comprising a removal device, the removal device including a first handle connected to an inner sleeve and a second handle connected to an outer sleeve, the inner sleeve configured to engage the elongated body, the outer sleeve configured to engage the housing, wherein the inner sleeve is configured to rotate within the outer sleeve such that forces applied to the first and second handles exert a shear stress on the neck, breaking the neck and allowing the elongate body to be removed.

16. A breakoff pedicle screw assembly comprising:

a threaded shaft; and

a breakoff head, the breakoff head having a distal portion attached to the shaft and configured to receive a fixation rod, a neck region, and an elongated proximal portion, wherein the neck region is configured such that application of a sufficient amount of torque to the proximal portion causes the proximal portion to be separated from the distal portion at the neck region and wherein the proximal portion has a length such that it extends beyond a patient'"'"'s skin when the shaft is inserted into a spinal location.

17. The breakoff pedicle screw of claim 16, wherein the neck region has a reduced cross-section compared to the distal and proximal portions.

18. The breakoff pedicle screw of claim 16, wherein the breakoff head has two opposing walls and a slot extending through both walls, the slot configured to receive the fixation rod, the slot extending from the distal portion through the neck region and at least part of the proximal portion.

19. The breakoff pedicle screw of claim 18, wherein the slot extends along a length of one of the opposing walls and along a portion of the length of the other of the opposing walls.

20. The breakoff pedicle screw of claim 19, wherein the threaded shaft and breakoff head are cannulated.

21. A method for coupling a spinal fixation assembly to a patient'"'"'s spine, the method comprising the steps of:

providing two pedicle screws, the pedicle screws comprising;

a head including a housing and an elongated body integrally formed with and extending from the housing, the housing configured to receive a fixation element, the housing connected to the elongated body at a frangible neck, wherein the elongated body is adapted to be removed from the housing at the frangible neck, wherein the elongated body has a length sufficient such that the elongated body extends above a patient'"'"'s skin when the pedicle screws are secured to the patient'"'"'s vertebrae;

securing the pedicle screws to the patient'"'"'s vertebra;

passing a fixation element through a slot in the elongate body of one of the pedicle screws toward the patient'"'"'s vertebra;

securing the fixation element to the pedicle screws; and

detaching the elongate body from each of the pedicle screws by breaking the connection of the housing and the elongate body at the frangible neck.