INSTRUMENTATION AND ASSOCIATED TECHNIQUES FOR MINIMALLY INVASIVE VERTEBRAL ROD INSTALLATION

• US 20080312703A1
• Filed: 06/12/2007
• Published: 12/18/2008
• Est. Priority Date: 06/12/2007
• Status: Active Grant

• Current Assignee: Zimmer Biomet Spine, Inc. (Zimvie Incorporated)
• Original Assignee: Zimmer Spine, Inc. (Zimmer Biomet Holdings, Inc.)
• Inventors: Hestad, Hugh D., Kuester, W. Matthew
• Granted Patent: US 8,460,300 B2
• Time in Patent Office: Days
• US Class Current: 606/86A
• 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 17/7089 wherein insertion is along an arcuate path

Abstract

Spinal fixation systems may be installed utilizing instruments and techniques alone or in combination with selectively attached extension members mounted on vertebral anchors to extend percutaneously from the spine. The surgical procedures associated with this invention involve making small, discrete incisions for the placement of select vertebral anchors. The extension members retract soft tissue, muscle and the like to thereby provide visibility and access to the head of the anchor. Instrumentation is utilized to deliver and install components such as a spine rod, set screw and other required hardware to the anchors. Once a spine rod or other components are secured to the pedicle screws, the instrumentation and extension members are removed from the patient.

Claims

1. A tool for manipulating an connecting element into position relative to vertebral anchors as part of a spinal fixation construct being installed onto a patient'"'"'s spinal column, the tool comprising:

a first elongate member having a proximal end spaced from a distal end, the distal end being configured for insertion through an incision in a patient for placement proximate to a first vertebral anchor coupled to a vertebrae of the spinal column;

a first handle proximate the proximal end of the first elongate member and configured to be grasped by a surgeon; and

a connecting element retainer proximate the distal end of the first elongate member and configured to selectively retain the connecting element for insertion through the incision in an orientation generally perpendicular to the spinal column and subsequent subcutaneous re-orientation generally parallel to the spinal column.

2. The tool of claim 1 further comprising:

a connecting element pivoting mechanism on the first elongate member configured to re-orient the connecting element relative to a longitudinal axis of the first elongate member for installation of the connecting element onto the vertebral anchors.

3. The tool of claim 1 further comprising:

a second elongate element pivotally coupled to the first elongate element at a medial position between the distal and proximal ends of the first elongate element.

4. The tool of claim 3 further comprising:

a second handle proximate a proximal end of the second elongate member and configured to be grasped by a surgeon.

5. The tool of claim 3 further comprising:

a passage proximate a distal end of one of the elongate elements configured to be positioned proximate one of the vertebral anchors and to allow installation of the connecting element to the vertebral anchor by manipulation of the other one of the elongate members.

6. The tool of claim 1 wherein the connecting element retainer provides for subcutaneous pivotal movement of the connecting element relative to the first elongate member for positioning of the connecting element relative to the vertebral anchor.

7. The tool of claim 6 further comprising:

a lever coupled to the first elongate element and adapted to actuate pivotal movement of the connecting element via the connecting element retainer.

8. The tool kit of claim 6 wherein the connecting element retainer has an arcuate configuration.

9. The tool of claim 1 wherein the first elongate member includes a longitudinal lumen configured to percutaneously pass a component of the spinal fixation construct there through to one of the vertebral anchors.

10. A method for securing a connecting element as part of a spinal fixation construct being installed onto a patient'"'"'s spinal column, the method comprising the steps of:

establishing a percutaneous access path to a first vertebral anchor with an extension member configured to be coupled to the first vertebral anchor secured to an associated vertebrae, the extension member defining a lumen generally aligned coaxially with the first vertebral anchor when coupled thereto and a recess on the extension member offset from the lumen;

inserting a connecting element into the recess;

guiding the connecting member to the first vertebral anchor;

reorienting the connecting element into the first vertebral anchor;

visualizing the reorientation of the connecting element through the lumen; and

attaching a fastener to the first vertebral anchor after visualizing a proper location of the connecting element relative to the vertebral anchor to secure the connecting element to the first vertebral anchor.

11. The method of claim 10, wherein the connecting element includes a marking to allow for visualization of the proper location of the connecting element.

12. The method of claim 10, further comprising the step of attaching a fastener to a second vertebral anchor to secure the connecting element to the second vertebral anchor.

13. A tool kit for manipulating an connecting element into position relative to vertebral anchors as part of a spinal fixation construct being installed onto a patient'"'"'s spinal column, the tool kit comprising:

a first elongate member having a proximal end spaced from a distal end, the distal end being configured for insertion through an incision in a patient for placement proximate to a first vertebral anchor coupled to a vertebrae of the spinal column;

a first handle proximate the proximal end of the first elongate member and configured to be grasped by a surgeon;

a connecting element retainer proximate the distal end of the first elongate member and configured to selectively retain the connecting element for insertion through the incision in an orientation generally perpendicular to the spinal column and subsequent subcutaneous re-orientation generally parallel to the spinal column; and

an extension member configured to be selectively coupled to one of the vertebral anchors secured to an associated vertebrae and to provide percutaneous access to the vertebral anchor when coupled thereto.

14. The tool kit of claim 13 further comprising:

a primary lumen in the extension member generally aligned coaxially with the vertebral anchor when coupled thereto, the primary lumen providing percutaneous axial access to the vertebral anchor; and

a recess on the extension member offset from the primary lumen and configured to direct and guide the first elongate member and connecting member coupled thereto percutaneous off-axis access to the vertebral anchor.

15. The tool kit of claim 13 further comprising:

a deformation arrangement on the extension member permitting a portion of the extension member to deform during installation and removal of the extension member on to and from, respectively, the vertebral anchor.

16. The tool kit of claim 13 wherein the vertebral anchor is a pedicle screw having a threaded shaft adapted to be inserted into a pedicle of the vertebrae and an anchor head adapted to be positioned in a plurality of orientations relative to a longitudinal axis of the threaded shaft.

17. The tool kit of claim 16 further comprising:

a set screw adapted to pass through the primary lumen and threadably engage the anchor head and secure the connecting member relative to the vertebral anchor.

18. A tool for manipulating an element into position relative to vertebral anchors as part of a spinal fixation construct being installed onto a patient'"'"'s spinal column, the tool comprising:

a first elongate member having a proximal end spaced from a distal end, the distal end being configured for insertion through an incision in a patient for placement proximate to a first vertebral anchor coupled to a vertebrae of the spinal column;

a handle proximate the proximal end of the first elongate member and configured to be grasped by a surgeon; and

a retainer positioned proximate the distal end of the first elongate member and adapted to selectively retain the element for installation onto one of the vertebral anchors.

19. The tool of claim 18 wherein the retainer is adjustable to accommodate a range of sizes of the element.

20. The tool of claim 18 wherein the retainer further comprises:

a clamp configured to selectively retain one end of the element.

21. The tool of claim 20 wherein the clamp further comprises:

a jaw positioned proximate the distal end of the first elongate member and movable relative to the first elongate member.

22. The tool of claim 20 wherein the clamp further comprises:

a multi-bar linkage movably coupled to the first elongate member.