METHODS AND APPARATUS FOR ACCESSING AND TREATING THE FACET JOINT

• US 20090177205A1
• Filed: 01/08/2009
• Published: 07/09/2009
• Est. Priority Date: 01/09/2008
• Status: Active Grant

• Current Assignee: Providence Medical Technology, Inc.
• Original Assignee: Providence Medical Technology, Inc.
• Inventors: Maier, Nathan, McCormack, Bruce M.
• Granted Patent: US 9,005,288 B2
• Time in Patent Office: Days
• US Class Current: 606/90
• 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 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1659 Surgical rasps, files, planes, or scrapers
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/3211 Surgical scalpels, knives; Accessories therefor
• CPC Class Codes: A61B 17/7074 Tools specially adapted for spinal fixation operations other than for bone removal or filler handling A61B17/7062, A61B17/808, A61B17/8858 take precedence; for spinal image producing devices A61B90/36, A61B34/20; markers A61B90/39
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61F 2/28 Bones joints A61F2/30
• CPC Class Codes: A61F 2/4405 for apophyseal or facet joints, i.e. between adjacent spinous or transverse processes devices implanted between spinous or transverse processes A61B17/7062
• CPC Class Codes: A61F 2/441 made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
• CPC Class Codes: A61F 2/4455 for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages intervertebral discs A61F2/442
• CPC Class Codes: A61F 2/4601 for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• CPC Class Codes: A61F 2/4611 of spinal prostheses
• CPC Class Codes: A61F 2002/30616 Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2310/00359 Bone or bony tissue

Abstract

Methods and systems are disclosed for accessing and treating the interior of the facet joint for vertebral distraction and immobilization. The systems include a number of tools that facilitate access to the facet joint, distraction of the articulating decortication of the articulating surfaces, and delivery of implants and agents into the facet joint for fusion.

Claims

1. An apparatus for minimally invasively accessing an interior region of a facet joint, the facet joint comprising first and second articulating subchondral surfaces defining first and second boundaries of a facet cavity, the facet joint further comprising a facet capsule defining a third boundary of the facet cavity, the apparatus comprising:

an elongate handle having a proximal end and a distal end; and

a blade disposed at the distal end of the handle, the blade comprising a flat leading edge and configured so that placement of the blade through the facet capsule and into the facet cavity generates a slit-shaped aperture in the facet capsule, the slit-shaped aperture extending substantially parallel to the first and second articulating subchondral surfaces, the blade and distal end configured to be passable through a minimally invasive route leading to the facet capsule.

2. The apparatus as recited in claim 1, wherein the blade further comprises a planar lower surface extending from the leading edge, and extending proximally away from the leading edge;

wherein the planar surface is configured to provide a platform to guide a second instrument through the slit-shaped aperture for treatment of the facet joint.

3. The apparatus as recited in claim 2, wherein the blade further comprises an upper surface opposite the lower surface;

the upper surface and lower surface defining a thickness;

wherein the thickness is sized to be smaller than the distance between the first and second boundaries of a facet cavity.

4. The apparatus as recited in claim 3, further comprising:

a beveled surface defining at least a portion of said upper blade surface and extending proximally away from the leading edge;

wherein said thickness increases proximally along said beveled surface.

5. An apparatus as recited in claim 1, wherein said handle comprises a shaft extending from the distal end to the proximal end;

the shaft comprising a beveled surface at or near the leading edge and increasing in thickness proximally away from the leading edge.

6. An apparatus as recited in claim 5, wherein the beveled surface is configured to allow the blade to be inserted into the cavity at an angle not aligned with the first and second cavity boundaries.

7. An apparatus as recited in claim 5, wherein the shaft is disposed within a central channel running along the length of the handle, and

the shaft extends from the distal end of the handle.

8. An apparatus as recited in claim 5, wherein the shaft has a D-shaped cross section providing a flat planar surface in cooperation with said blade.

9. An apparatus for decorticating an interior region of a facet joint, the facet joint comprising first and second articulating subchondral surfaces defining first and second boundaries of a facet cavity, the facet joint further comprising a facet capsule defining a third boundary of the facet cavity, the apparatus comprising:

an elongate handle having a proximal end and a distal end; and

a rasp configured to decorticate at least one of the articulating subchondral surfaces and comprising a spatula-shaped member comprising a roughened planar surface, the spatula-shaped member extending distally outward from the distal end of the handle,

the rasp and distal end configured to be passable through a minimally invasive route leading to the facet capsule.

10. The apparatus as recited in claim 9, wherein the rasp further comprises a compliant, thin cross section that allows the rasp to bend while being delivered into the facet cavity from an angle out of alignment with a plane of the first and second articulating surfaces.

11. The apparatus as recited in claim 9, wherein the rasp further comprises a substantially planar lower surface extending proximally from a leading end of the rasp,

wherein said planar surface is configured to provide a platform for guiding the rasp in cooperation with a second instrument through an aperture in the facet capsule.

12. The apparatus as recited in claim 11, wherein the rasp comprises an upper surface opposite a lower surface;

said upper surface comprising the roughened planar surface;

said upper surface being substantially parallel with the lower surface to define a thickness;

wherein the thickness is sized to be smaller than the distance between the first and second boundaries of a facet cavity, and to dispose the rasp to bending under light to moderate pressure.

13. The apparatus as recited in claim 12, wherein the rasp further comprises:

a beveled surface adjacent said upper surface at a point proximally offset from the leading end of the rasp and extending proximally away from the leading edge.

14. The apparatus as recited in claim 13, wherein the rasp further comprises a shaft extending through the handle proximally from the beveled surface.

15. An apparatus for minimally invasively accessing an interior region of a facet joint, the facet joint comprising first and second articulating subchondral surfaces defining first and second boundaries of a facet cavity, the facet joint further comprising a facet capsule defining a third boundary of the facet cavity, the apparatus comprising:

an elongate handle having a proximal end and a distal end; and

a spatula-shaped tip disposed at the distal end of the handle, the tip comprising upper and lower parallel planar surfaces extending distally outward from the distal end of the handle;

wherein the spatula-shaped tip is configured to be delivered into the facet joint via a minimally invasive aperture in the joint capsule.

16. The apparatus as recited in claim 15, wherein the upper and lower parallel planar surfaces define a thickness that allows the tip to bend while being delivered into the facet from an angle out of alignment with a plane of the facet joint.

17. The apparatus as recited in claim 15, wherein the lower planar surface is configured to provide a platform for guiding a second instrument through the aperture for treatment of said facet joint.

18. The apparatus as recited in claim 16,

wherein the thickness is sized to be smaller than the distance between the first and second boundaries of a facet cavity, and to dispose the spatula-shaped tip to bending under light to moderate pressure.

19. The apparatus as recited in claim 15, further comprising:

a beveled surface adjacent said upper surface at a point proximal a leading end of the spatula-shaped tip and extending proximally away from the leading end.

20. The apparatus as recited in claim 15, wherein the spatula-shaped tip further comprises a shaft extending through the handle proximally from the beveled surface.

21. The apparatus as recited in claim 20, further comprising a second instrument, wherein the lower planar surface is configured to serve as a platform for guiding the second instrument to said aperture and introducing the second instrument into said cavity.

22. The apparatus as recited in claim 21, wherein the second instrument comprises a rasp configured to decorticate at least one of the articulating surfaces.

23. The apparatus as recited in claim 21, wherein the second instrument comprises a distracter for distracting the articulating surfaces.

24. The apparatus as recited in claim 21, wherein the second instrument comprises an injector for delivering an agent into the cavity.

25. The apparatus as recited in claim 21, wherein the second instrument comprises an introducer for delivering an implant into the cavity.

26. The apparatus as recited in claim 15, wherein the spatula-shaped tip further comprises a platform configured to receive an inflatable membrane and deliver the inflatable membrane to a location within the cavity.

27. An apparatus for distracting two adjacent vertebrae, the vertebrae separated by a facet joint comprising first and second articulating subchondral surfaces forming a facet cavity enclosed by a facet capsule, the apparatus comprising:

an elongate handle having a proximal end and a distal end; and

a wedge detachably disposed at the distal end of the handle;

the wedge having upper and lower beveled surfaces that converge toward a distal tip of the wedge;

wherein the wedge is configured to be delivered into the cavity through a minimally invasive aperture in the capsule so that the upper and lower beveled surfaces contact the first and second articulating subchondral surfaces and distract the surfaces as the wedge is driven into the cavity.

28. The apparatus as recited in claim 27, wherein the wedge comprises a recess on a proximal end of the wedge for detachably coupling the wedge to the handle.

29. The apparatus as recited in claim 27, further comprising a shaft extending from the distal end of said handle proximal to said wedge.

30. The apparatus as recited in claim 29, wherein the wedge is detachably coupled to the shaft.

31. The apparatus as recited in claim 29, wherein the shaft has a planar surface leading from the handle to the wedge, the planar surface configured to provide a platform for guiding the wedge in cooperation with a second instrument through the aperture.

32. The apparatus as recited in claim 27, wherein the upper and lower beveled surface extend proximally from the distal tip to parallel upper and lower distraction surfaces;

wherein the distraction surfaces are distanced from each other by a distraction thickness, wherein the distraction thickness correlates to a desired distraction of the articulating surfaces of the facet joint.

33. The apparatus as recited in claim 32, wherein the wedge comprises one of a plurality of detachable wedges;

each of the detachable wedges having an increasingly larger distraction thickness such that the plurality of detachable wedges may be delivered to the facet joint in series from thinnest to thickest to incrementally distract the facet joint.

34. The apparatus as recited in claim 27, wherein the upper and lower beveled surfaces converge to a nipple located at the distal end of the wedge;

wherein the nipple is configured to be received in the cavity between the articulating surfaces.

35. An apparatus for distracting two adjacent vertebrae, the vertebrae separated by a facet joint comprising first and second articulating subchondral surfaces forming a facet cavity enclosed by a facet capsule, the apparatus comprising:

an elongate handle having a proximal end and a distal end;

upper and lower pivoting members disposed at the distal end of the handle;

the upper and lower pivoting members coupled to the handle via a hinge located between proximal and distal ends of the upper and lower pivoting members;

wherein the distal ends of the upper and lower pivoting members extend past the distal end of the handle such that the distal ends of the upper and lower pivoting members may be pressed together to create a smaller profile for entry into the facet capsule and in between the first and second articulating subchondral surfaces;

said entry into the facet capsule resulting in displacement of the proximal ends of the upper and lower pivoting members away from the handle;

wherein the proximal ends of the upper and lower pivoting members are configured be pivoted toward the handle, the hinge acting as a fulcrum to separate the distal ends of the upper and lower pivoting members and distract the first and second articulating subchondral surfaces.

36. The apparatus as recited in claim 35, wherein the distal ends of the upper and lower pivoting members are configured to be delivered into the facet cavity through a minimally invasive aperture in the facet capsule.

37. The apparatus as recited in claim 35, wherein the handle comprises a hollow tube, the apparatus further comprising:

a shaft running through the tube to the distal end of the handle; and

a rasp coupled to the shaft at the distal end of the handle;

wherein the shaft may be reciprocated within the tube such that the rasp runs along a subchondral surface to decorticate the surface.

38. An introducer for delivering an implant to an interior region of a facet joint, the facet joint comprising first and second articulating subchondral surfaces forming facet cavity enclosed by a facet capsule, the introducer comprising:

an elongate handle having a proximal end and a distal end; and

a spatula-shaped tip disposed at the distal end of the handle, the tip comprising upper and lower parallel planar surfaces extending distally outward from the distal end of the handle;

wherein the tip is configured to be delivered into the facet joint via a minimally invasive aperture in the joint capsule;

wherein the tip comprises a platform configured to receive the implant and deliver the implant to a location within the cavity.

39. The introducer as recited in claim 38, wherein the upper and lower parallel planar surfaces define a thickness that allows the tip to bend while being delivered into the facet cavity from an angle out of alignment with a plane of the facet joint.

40. The introducer as recited in claim 38, wherein the lower planar surface is configured to provide a platform for guiding a second instrument through the aperture for treatment of said facet joint.

41. The introducer as recited in claim 38, further comprising:

a beveled surface adjacent said upper surface at a point proximal from a leading edge of the tip and extending proximally away from the leading edge.

42. The introducer as recited in claim 38, wherein the implant comprises an inflatable membrane.

43. The introducer as recited in claim 42, wherein the inflatable membrane comprises a pocket configured to slide over the distal tip of the introducer.

44. The introducer as recited in claim 43, further comprising a delivery line extending from the proximal end of the handle to the distal tip;

wherein the delivery line is configured to dispense an inflation medium to the inflatable membrane.

45. An apparatus for delivering an agent to an interior region of a facet joint, the facet joint comprising first and second articulating subchondral surfaces forming a facet cavity enclosed by a facet capsule, comprising:

an elongate handle having a proximal end and a distal end; and

a shaft extending from the distal end of said handle;

the shaft having a beveled surface at its distal tip; and

an agent delivery line extending from the proximal end of the handle to the distal tip of the shaft;

wherein the beveled distal tip of the shaft is configured to be delivered into the facet joint via a minimally invasive aperture in the joint capsule.

46. The apparatus as recited in claim 45, further comprising:

a blade on the distal end of the shaft, the blade configured to facilitate minimally invasive access into the facet joint.

47. The apparatus as recited in claim 45, wherein the shaft comprises a lower planar surface extending proximally from the distal tip;

wherein the lower planar surface is configured to provide a platform for guiding the apparatus in cooperation with a second instrument through said aperture.

48. A surgical system for treating a facet joint, the facet joint comprising first and second articulating subchondral surfaces forming a facet cavity enclosed by a facet capsule, the system comprising:

a first instrument configured to gain minimally invasive access to the joint and comprising;

an elongate handle having a proximal end and a distal end; and

a spatula-shaped tip disposed at the distal end of the handle, the tip comprising upper and lower parallel planar surfaces extending distally outward from the distal end of the handle, wherein the tip is configured to be delivered into the facet joint via a minimally invasive aperture in the joint capsule; and

a second instrument comprising a planar surface,

wherein the lower planar surface provides a platform for guiding the second instrument through the aperture for treatment of said facet joint,

and wherein the planar surface of the second instrument is configured to mate with the planar surface of the first instrument and slide distally along the first instrument to into the facet joint.

49. The surgical system as recited in claim 48, wherein the upper and lower parallel planar surfaces of the first instrument define a thickness that allows the tip to bend while being delivered into the facet joint from an angle out of alignment with the plane of the facet joint.

50. The surgical system as recited in claim 48, wherein the second instrument comprises a rasp configured to decorticate at least one of the articulating surfaces.

51. The surgical system as recited in claim 48, wherein the second instrument comprises a distracter configured to distract the articulating surfaces.

52. The surgical system as recited in claim 48, wherein the second instrument comprises an injector configured to deliver an agent into the cavity.

53. The surgical system recited in claim 48, wherein the second instrument comprises an introducer configured to deliver an implant into the cavity.

54. A surgical system for facet joint immobilization, the facet joint comprising first and second articulating subchondral surfaces forming a facet cavity enclosed by a facet capsule;

the surgical system comprising;

a facet access blade configured to pierce through the facet capsule and into the facet cavity to generate a minimally invasive slit-shaped aperture in the facet capsule, wherein said aperture extends substantially parallel to the first and second articulating subchondral surfaces;

a distraction apparatus configured to be delivered through the minimally invasive slit-shaped aperture in the facet capsule and into the facet cavity to distract the first and second articulating subchondral surfaces a predetermined distance;

a decortication apparatus configured to be delivered through the minimally invasive slit-shaped aperture in the facet capsule and into the facet cavity to decorticate at least one of the first and second articulating subchondral surfaces; and

an introducer configured to be delivered through the minimally invasive slit-shaped aperture in the facet capsule and into the facet cavity to deliver an implant between the first and second articulating subchondral surfaces to immobilize the joint at said predetermined distance.

55. The surgical system as recited in claim 54, wherein the decortication apparatus comprises a rasp configured to decorticate at least one of the articulating surfaces.

56. The surgical system as recited in claim 54, wherein the distraction apparatus comprises a pivoting distracter.

57. The surgical system as recited in claim 54, wherein the distraction apparatus comprises an inflatable membrane.

58. The surgical system as recited in claim 54, wherein the implant comprises an expandable implant.

59. The surgical system as recited in claim 54, wherein the implant comprises bone allograft.

60. The surgical system as recited in claim 54, further comprising a delivery system configured to deliver an agent to the facet joint.

61. A method for accessing the facet joint of a patient, the facet joint comprising first and second articulating subchondral surfaces forming a facet cavity enclosed by a facet capsule, the method comprising:

delivering a cutting blade to the facet joint capsule in a minimally invasive manner; and

piercing through the facet capsule and into the facet cavity with the cutting blade to generate a minimally invasive slit-shaped aperture in the facet capsule.

62. The method as recited in claim 61, wherein said aperture extends substantially parallel to the first and second articulating subchondral surfaces.

63. The method as recited in claim 61, further comprising:

delivering an introducer through the aperture and into the facet cavity.

64. The method as recited in claim 63, wherein the cutting blade is configured to guide delivery of the introducer.

65. A method for accessing the facet joint of a patient, the facet joint comprising first and second articulating subchondral surfaces forming a facet cavity enclosed by a facet capsule, the method comprising:

providing a first apparatus comprising;

an elongate handle having a proximal end and a distal end; and

a spatula-shaped tip disposed at the distal end of the handle, the tip comprising upper and lower parallel planar surfaces extending distally outward from the distal end of the handle,

forming a minimally invasive aperture in the joint capsule;

delivering the tip into the facet joint via the minimally invasive aperture in the joint capsule, the planar surfaces of the tip being oriented substantially parallel to a plane of the facet joint; and

delivering a second apparatus by guiding the second apparatus along the lower planar surface of the first apparatus and through the aperture.

66. The method as recited in claim 65, wherein the second apparatus comprises a planar surface that is configured to mate with the lower planar surface of the first apparatus and slide distally along the first apparatus into the facet joint.

67. The method as recited in claim 66, wherein the upper and lower parallel planar surfaces of the first apparatus define a thickness that allows the tip to bend while being delivered into the facet joint from an angle out of alignment with a plane of the facet joint.

68. A method for immobilizing the facet joint of a patient, the facet joint comprising first and second articulating subchondral surfaces forming a facet cavity enclosed by a facet capsule, the method comprising

delivering via a minimally invasive process a cutting blade to the facet joint capsule;

piercing through the facet capsule and into the facet cavity with the cutting blade to generate a minimally invasive aperture in the facet capsule

accessing the joint via the aperture with an introducer;

preparing the joint by sanding down cortical bone with a rasp, the rasp accessing the joint via the aperture; and

delivering a distraction device into the facet cavity via the aperture and distracting the first and second articulating subchondral surfaces.

69. The method as recited in claim 68, wherein the introducer facilitates delivery of the rasp.

70. The method as recited in claim 68, wherein the introducer facilitates delivery of the distraction device.

71. The method as recited in claim 68, wherein the distraction device comprises a wedge detachably disposed at the distal end of an elongate handle, the method further including:

delivering the wedge into the cavity through the aperture in the capsule so that the wedge contacts the first and second articulating subchondral surfaces and distract the surfaces as the wedge is driven into the cavity.

72. The method as recited in claim 68, wherein the distraction device comprises an inflatable membrane, and distracting the first and second articulating subchondral surfaces comprises inflating the membrane.

73. The method as recited in claim 68, wherein the distraction device comprises a pivoting introducer, and distracting the first and second articulating subchondral surfaces comprises inserting the introducer into the facet joint and pivoting a pair of distal pivoting members.

74. The method as recited in claim 68, further comprising:

delivering an implant into the facet cavity via the aperture.

75. The method as recited in claim 74, wherein the implant comprises bone allograft.

76. The method as recited in claim 75, further comprising:

delivering an injectable biomaterial into the facet cavity via the aperture.