Curviliner spinal access method and device

• US 20080221586A1
• Filed: 02/11/2008
• Published: 09/11/2008
• Est. Priority Date: 02/09/2007
• Status: Active Grant

• Current Assignee: JGMG Bengochea, LLC
• Original Assignee: Alphatec Spine Incorporated (Alphatec Holdings Incorporated)
• Inventors: Garcia-Bengochea, Javier, Purcell, Thomas, Guyer, Jeffrey Allen
• Granted Patent: US 8,152,714 B2
• Time in Patent Office: Days
• US Class Current: 606/108
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/34 Trocars; Puncturing needles pointed biopsy instruments A61B10/0233; devices for piercing the ear-lobes A44C7/001; seals or hemostasis valves A61M39/06
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3468 for implanting or removing devices, e.g. prostheses, implants, seeds, wires devices for implanting seeds A61M37/0069
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61F 2/4611 of spinal prostheses
• CPC Class Codes: A61F 2002/302 toroidal, e.g. rings
• CPC Class Codes: A61F 2230/0065 toroidal, e.g. ring-shaped, doughnut-shaped

Abstract

A curvilinear spinal access device for performing a procedure on a spine of a patient is disclosed. The device includes a working portal configured to be advanced toward a surgical site located at the spine of the patient. The working portal includes a distal end and a proximate end, a working portal housing having an open interior channel disposed between the distal end and the proximate end, an exterior channel disposed on an outside surface of the working portal housing and between the distal end and the proximate end. The distal end is configured to be disposed at the surgical site and the proximate end is disposed away from the surgical site. The housing has a curved shape defined between the proximate end and the distal end, wherein the proximate end is disposed with respect to the distal end. The working channel is configured to allow advancement of at least one surgical tool and/or at least one implant toward the surgical site.

Claims

1. A device for performing a procedure on the spine of a patient, comprising:

a working portal configured to be advanced toward a surgical site of the spine of the patient;

said working portal comprising;

a distal end and a proximate end;

a working portal housing having an interior channel disposed between said distal end and said proximate end;

said distal end is configured to be disposed at the surgical site and said proximate end is disposed away from said surgical site;

said housing has a curved shape defined between said proximate end and said distal end;

said working channel is configured to allow advancement of at least one surgical tool and/or at least one implant toward the surgical site.

2. The device according to claim 1, further comprising an exterior channel disposed on an outside surface of said working portal housing and between said distal end and said proximate end.

3. The device according to claim 2, wherein said proximate end is disposed at an angle with respect to said distal end.

4. The device according to claim 3, further comprising a trocar guide configured to be advanced to the surgical site, wherein said trocar guide includes a trocar guide interior channel.

5. The device according to claim 4, further comprising a cutting trocar configured to be inserted into said trocar guide interior channel and further configured to create an opening in a wall of the vertebral disc or vertebral body at the surgical site.

6. The device according to claim 5, further comprising a barbed trocar configured to be inserted into said trocar guide interior channel subsequent to removal of said cutting trocar, wherein said barbed trocar is configured to be secured to the wall of the vertebral disc or vertebral body at the surgical site.

7. The device according to claim 6, further comprising a tissue separator instrument configured to be advanced along said barbed trocar to the surgical site subsequent to removal of said trocar guide and configured to remove tissue surrounding said barbed trocar.

8. The device according to claim 7, wherein said tissue separator instrument further includes a plurality of separators configured to remove tissue surrounding said barbed trocar.

9. The device according to claim 6, further comprising a plurality of distraction ramps configured to be advanced toward the surgical site along said barbed trocar subsequent to removal of said tissue separator.

10. The device according to claim 8, wherein at least one distraction ramp includes a distraction ramp channel.

11. The device according to claim 9, said plurality of distraction ramps includes an anterior distraction ramp and a dorsal tissue distraction ramp.

12. The device according to claim 9, further comprising a neuron monitoring ribbon.

13. The device according to claim 9, further comprising a distraction ramp alignment block configured to secure said plurality of said distraction ramps during advancement of said distraction ramps toward the surgical site.

14. The device according to claim 10, further comprising a small dilator having a small dilator interior channel configured to accommodate insertion of said barbed trocar, wherein said small dilator is configured to be advanced toward the surgical site along said barbed trocar subsequent to insertion of said distraction ramps and between said distraction ramps.

15. The device according to claim 14, further comprising a large dilator having a large dilator interior channel configured to accommodate insertion of said small dilator, wherein said large dilator is configured to be advanced toward the surgical site along said small dilator, having said barbed trocar disposed inside said small dilator, and between said distraction ramps.

16. The device according to claim 15, wherein said large dilator includes a large dilator housing and a rail disposed on an outside surface of said large dilator housing, wherein said rail is configured to slide inside said distraction ramp channel.

17. The device according to claim 16, further comprising an anterior awl configured to be advanced toward the surgical site along said working portal channel and further configured to anchor said working portal at the surgical site.

18. The device according to claim 17, wherein said small and large dilators and said barbed trocar are configured to be removed subsequent to insertion of said anterior awl.

19. The device according to claim 1, further comprising a holding arm configured to stabilize said working portal during the surgical procedure.

20. The device according to claim 18, wherein said working portal is advanced along said large dilator and between said distraction ramps;

wherein said working portal housing includes a working portal rail disposed on an outside surface of said working portal housing, said working portal rail is configured to interact with said distraction ramp channel to advance said working portal toward the surgical site.

21. The device according to claim 1, wherein the working portal has a width of in a range of 5 mm to 30 mm and a height in a range of 5 mm to 30 mm.

22. The device according to claim 1, wherein the working portal is configured to accommodate insertion of an implant having a height in the range of 8 mm to 18 mm, an anterior-posterior depth in a range of 8 mm to 30 mm, and a lateral width in the range of 20 mm to 70 mm.

23. The device according to claim 1, wherein the working portal has a cross-section selected from group consisting of:

square, rectangular, oval, polygonal.

24. The device according to claim 1, wherein the working portal further comprises an endoscope for viewing the surgical area.

25. The device according to claim 1, wherein the surgical procedure is selected from a group consisting of:

nucleus replacement, total disc replacement, interbody fusion, discectomy, neural decompression, implant delivery and any other spinal procedure.

26. The device according to claim 1, wherein the working portal is used to deliver an implant, wherein the implant is selected from a group consisting of:

a bone screw, a plate, an interbody device, an artificial disc, and any other spinal device.

27. A method for performing a surgical procedure on the spine of a patient, the method comprising:

advancing a working portal toward a surgical site located at the spine of the patient;

the working portal comprising;

a distal end and a proximate end;

a working portal housing having an open interior channel disposed between the distal end and the proximate end;

the distal end is configured to be disposed at the surgical site and the proximate end is disposed away from the surgical site;

the housing has a curved shape defined between the proximate end and the distal end, wherein the proximate end is disposed at an angle with respect to the distal end;

advancing at least one surgical tool and/or at least one implant toward the surgical site via the working channel to perform the procedure.

28. The method according to claim 27, wherein the working portal further comprises an exterior channel disposed on an outside surface of the working portal housing and between the distal end and the proximate end.

29. The method according to claim 28, further comprising advancing a trocar guide to the surgical site, wherein the trocar guide includes a trocar guide interior channel.

30. The method according to claim 29, further comprising inserting a cutting trocar into the trocar guide interior channel and further configured to create an opening in a wall of the vertebral disc or vertebral body at the surgical site.

31. The method according to claim 30, further comprising

removing the cutting trocar;

inserting a barbed trocar into the trocar guide interior channel subsequent to the removing of the cutting trocar; and

securing the barbed trocar to the wall of the vertebral disc or vertebral body at the surgical site.

32. The method according to claim 31, further comprising

removing the trocar guide;

advancing a tissue separator instrument along the barbed trocar to the surgical site subsequent to the removing of the trocar guide; and

removing tissue surrounding the barbed trocar.

33. The method according to claim 32, wherein the tissue separator instrument further includes a plurality of separators configured to remove tissue surrounding the barbed trocar.

34. The method according to claim 32, further comprising

removing the tissue separator;

and

inserting a plurality of distraction ramps toward the surgical site along the barbed trocar subsequent to the removing of the tissue separator.

35. The method according to claim 34, wherein at least one distraction ramp includes a distraction ramp channel.

36. The method according to claim 34, the plurality of distraction ramps includes an anterior distraction ramp and a dorsal tissue distraction ramp.

37. The method according to claim 34, further comprising a neuron monitoring ribbon.

38. The method according to claim 34, further comprising a distraction ramp alignment block configured to secure the plurality of the distraction ramps during advancement of the distraction ramps toward the surgical site.

39. The method according to claim 35, further comprising advancing a small dilator toward the surgical site along the barbed trocar subsequent to the inserting of the distraction ramps and between the distraction ramps, wherein the small dilator having a small dilator interior channel configured to accommodate insertion of the barbed trocar.

40. The method according to claim 39, further comprising advancing the large dilator toward the surgical site along the small dilator, having the barbed trocar disposed inside the small dilator, and between the distraction ramps, wherein the large dilator having a large dilator interior channel configured to accommodate insertion of the small dilator.

41. The method according to claim 40, wherein the large dilator includes a large dilator housing and a rail disposed on an outside surface of the large dilator housing, wherein the rail is configured to slide inside the distraction ramp channel.

42. The method according to claim 41, further comprising

advancing an anterior awl toward the surgical site along the working portal channel;

and

anchoring the working portal at the surgical site.

43. The method according to claim 42, further comprising removing the small and large dilators and the barbed trocar subsequent to the advancing of the anterior awl.

44. The method according to claim 28, further comprising stabilizing the working portal during the surgical procedure using a holding arm.

45. The method according to claim 43, wherein the working portal is advanced along the large dilator and between the distraction ramps;

wherein the working portal housing includes a working portal rail disposed on an outside surface of the working portal housing, the working portal rail is configured to interact with the distraction ramp channel to advance the working portal toward the surgical site.

46. The method according to claim 28, wherein the working portal has a cross-section selected from group consisting of:

square, rectangular, oval, polygonal.

47. The method according to claim 28, wherein the working portal further comprises an endoscope for viewing the surgical area.

48. The method according to claim 28, wherein the surgical procedure is selected from a group consisting of:

nucleus replacement, total disc replacement, interbody fusion, discectomy, neural decompression, implant delivery and any other spinal procedure.

49. The device according to claim 28, wherein the working portal is used to deliver an implant, wherein the implant is selected from a group consisting of:

a bone screw, a plate, an interbody device, an artificial disc, and any other spinal device.

50. A device for performing a procedure on the spine of a patient, comprising:

a working portal configured to be advanced toward a surgical site of the spine of the patient;

said working portal comprising;

a distal end and a proximate end;

a working portal housing having an interior channel disposed between said distal end and said proximate end;

an exterior rail/slot disposed on an outside surface of said working portal housing and between said distal end and said proximate end;

said distal end is configured to be disposed at the surgical site and said proximate end is disposed away from said surgical site;

said housing has a curved shape defined between said proximate end and said distal end;

said proximate end is disposed at an angle with respect to said distal end;

said working channel is configured to be advanced toward said surgical site and further configured allow advancement of at least one surgical tool and/or at least one implant toward the surgical site using said interior channel and/or said exterior rail/slot.

51. A method for performing a surgical procedure on the spine of a patient, the method comprising:

establishing an access pathway to a surgical site located at the spine of the patient;

advancing a working portal along said access pathway toward the surgical site;

the working portal comprising;

a distal end and a proximate end;

a working portal housing having an open interior channel disposed between the distal end and the proximate end;

an exterior rail/slot disposed on an outside surface of said working portal housing and between said distal end and said proximate end;

the distal end is configured to be disposed at the surgical site and the proximate end is disposed away from the surgical site;

the housing having a curved shape defined between the proximate end and the distal end, wherein the proximate end is disposed at an angle with respect to the distal end;

advancing at least one surgical tool and/or at least one implant toward the surgical site via the working channel to perform the procedure.