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

• US 20080015582A1
• Filed: 06/08/2007
• Published: 01/17/2008
• 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: Anderson, Stephen, DiPoto, Gene
• Granted Patent: US 7,892,238 B2
• Time in Patent Office: Days
• US Class Current: 606/61
• 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 method for treating the spine of a patient, the method comprising:

advancing a first access device including a first passage into the patient such that a distal end of the first access device is adjacent a first spinal location;

advancing a second access device including a second passage into the patient such that a distal end of the second access device is adjacent a second spinal location;

providing a flexible puller member coupled to a spinal fixation element;

inserting the flexible puller member through the first passage and into the second passage; and

pulling the spinal fixation element into position adjacent the first and second spinal locations using the flexible puller member.

2. The method of claim 1, wherein the flexible puller member comprises suture material.

3. The method of claim 1, wherein the flexible puller member comprises a wire or cable.

4. The method of claim 1, wherein the spinal fixation element includes an eyelet, and the flexible puller member is attached to the eyelet.

5. The method of claim 1, wherein the flexible puller member is attached to the spinal fixation element with a flexible cap.

6. The method of claim 1, wherein the spinal fixation element is cannulated, and the flexible puller member extends through at least a portion of the spinal fixation element.

7. A method for treating the spine of a patient, the method comprising:

advancing a first access device including a first passage into the patient such that a distal end of the first access device is adjacent a first spinal location;

advancing a second access device including a second passage into the patient such that a distal end of the second access device is adjacent a second spinal location;

inserting a first spinal fastener through the first passage into a vertebra at the first spinal location;

inserting a second fastener through the second passage into second vertebrae at the second spinal location;

providing a flexible puller member coupled to a spinal fixation element;

inserting a flexible puller member down through the first passage and up into and through the second passage;

pulling the spinal fixation element into position adjacent the first and second fasteners using the flexible puller member; and

coupling the fixation element to the first and second fasteners.

8. The method of claim 7, wherein the flexible puller member comprises suture material.

9. The method of claim 7, wherein the flexible puller member comprises a flexible wire or cable.

10. The method of claim 7, wherein the spinal fixation element includes a receiving element for coupling of the flexible puller member.

11. The method of claim 10, wherein the receiving element is an eyelet and the flexible puller member is coupled to the eyelet.

12. The method of claim 7, wherein the flexible puller member is coupled to the spinal fixation element with a flexible cap.

13. The method of claim 7, wherein the flexible puller member is coupled to the spinal fixation element with a clamp.

14. The method of claim 7, wherein the spinal fixation element is cannulated, and the flexible puller member extends through at least a portion of the spinal fixation element.

15. The method of claim 7, wherein flexible puller member is inserted down through the first passage and into the second passage using a passing member.

16. The method of claim 15, wherein the passing member includes a curved distal end, a proximal end and a length such that when the distal end is inserted through the first passage, the proximal end extends outside the patient.

17. The method of claim 15, wherein the passing member includes an advancing component configured to cause the flexible puller member to be advanced through the passing member.

18. The method of claim 17, wherein the advancing component is a thumbwheel for advancing the flexible puller member.

19. A spinal fixation assembly for use in a spinal fixation procedure, the fixation assembly comprising:

an elongated rigid spinal fixation member including a first end and a second end, the spinal fixation member sized and configured for attachment to one or more spinal fasteners in a spinal fixation procedure;

a flexible pulling member attached to the fixation member, the pulling member configured to allow the fixation member to be pulled into a desired position during the spinal fixation procedure.

20. The spinal fixation assembly of claim 19, wherein the flexible pulling member comprises suture material.

21. The spinal fixation assembly of claim 19, wherein the flexible pulling member comprises a wire or cable.

22. The spinal fixation assembly of claim 19, wherein the first end of the spinal fixation member includes an eyelet, and the flexible pulling member is attached to the eyelet.

23. The spinal fixation assembly of claim 19, wherein the flexible puller member is attached to the spinal fixation element with a flexible cap releasably attached to the first end of the spinal fixation element.

24. The spinal fixation assembly of claim 19, wherein the spinal fixation element is cannulated, and the flexible puller member extends through at least a portion of the spinal fixation element.

25. The spinal fixation assembly of claim 19, wherein the flexible puller member is attached to the spinal fixation element with a clamp.

26. The spinal fixation assembly of claim 19, further comprising a passing member configured to pass the flexible puller member through a passage in a spinal access assembly during the spinal fixation procedure.

27. The spinal fixation assembly of claim 26, wherein the passing member includes a curved distal end, a proximal end and a length such that when the distal end is inserted through the passage during the spinal fixation procedure, the proximal end extends outside the patient.

28. The spinal fixation assembly of claim 26, wherein the passing member includes an advancing component configured to cause the flexible puller member to be advanced through the passing member.

29. The spinal fixation assembly of claim 28, wherein the advancing component is a thumbwheel for advancing the flexible puller member.