Minimally invasive Systems and Methods for Insertion of a Connecting Member Adjacent the Spinal Column

• US 20090264930A1
• Filed: 04/16/2008
• Published: 10/22/2009
• Est. Priority Date: 04/16/2008
• Status: Active Grant

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Inventors: McBride, Larry
• Granted Patent: US 8,226,656 B2
• Time in Patent Office: Days
• US Class Current: 606/250
• 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 17/7004 with a cross-section which varies along its length A61B17/7019 takes precedence
• 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 17/7085 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 2017/0256 for the spine
• CPC Class Codes: Y10S 606/914 Toolkit for installing or removing spinal positioner or stabilizer

Abstract

A spinal surgical system includes at least one extender mounted to an anchor engaged to the spinal column. The extender extends proximally away from the anchor to a proximal end outside the patient. The extender is configured to receive a connecting member from an approach that is generally parallel or along the longitudinal axis of the extender so that the connecting member can be positioned from the proximal end of the extender to the anchor at the distal end of the extender without requiring an additional incision or puncture to accommodate the connecting member insertion.

Claims

1. A spinal surgical system, comprising:

a first anchor engageable to the spinal column, said first anchor including a bone engaging portion and a receiver portion with a receptacle;

a first extender extending along a longitudinal axis between a proximal end and a distal end, said first extender including an elongated inner member releasably engaged to said receiver portion of said first anchor at said distal end, said inner member including a first passage extending from said proximal end to said receptacle of said receiver portion when said inner member is engaged to said receiver portion, said first extender further including an elongated outer member having an inner surface positioned around an outer surface of said inner member, wherein at least one of said inner surface of said outer member and said outer surface of said inner member includes a recessed portion therein that defines a second passage between said inner member and said outer member that extends along said first extender and opens at said proximal end of said first extender and opens into said receptacle of said receiver portion;

a second anchor engageable to the spinal column, said second anchor including a bone engaging portion and a receiver portion with a receptacle;

a second extender extending along a longitudinal axis between a proximal end and a distal end, said distal end being releasably engageable to said second anchor; and

a connecting member having a length sized to extend between said receiver portions of said first and second anchors when said first and second anchors are engaged to the spinal column, wherein said second passage is sized to receive said connecting member therein so that said connecting member is maneuverable through said second passage from said proximal end of said first extender toward said receiver portion of said first anchor and then from said first extender toward said receiver portion of said second anchor so that said connecting member is positioned to extend between said receptacles of said first and second anchors.

2. The system of claim 1, wherein said inner surface of said outer member and said outer surface of said inner member each include a recessed portion, said recessed portions being aligned with one another along said first extender to define said second passage.

3. The system of claim 2, wherein said recessed portion of said outer member includes a ramped surface portion that begins at a location proximal of a distal end of said outer member of said first extender and slopes from said location toward said inner member to said distal end of said outer member.

4. The system of claim 2, wherein said inner member includes a tubular body portion extending distally from said proximal end of said first extender and said inner member includes a pair of arms extending distally from said tubular body portion to said distal end of said first extender, said pair of arms being separated from one another by a slot therebetween, wherein said recessed portion of said inner member extends from said proximal end to said slot.

5. The system of claim 1, further comprising a retractor, said retractor including a shaft positioned in said first passage and a retracting blade at a distal end of said shaft, said retracting blade extending transversely to said shaft and projecting outwardly from said first extender adjacent said distal end of said first extender toward said second extender.

6. The system of claim 5, wherein said inner member includes a tubular body portion extending distally from said proximal end and a pair of arms extending distally from said tubular body portion to said distal end of said first extender, said pair of arms being separated from one another by a slot therebetween, wherein said outer member includes a notch extending from a distal end of said outer member toward said proximal end of said extender, said notch being located on a side of said first extender opposite said second passage and said retracting blade extends through said notch.

7. The system of claim 5, wherein said first extender includes a pinion mounted thereto that extends into said first passage and said shaft of said retractor includes a ratchet surface engaged to said pinion, said pinion being movable to move said shaft in said first extender to adjust a position of said retracting blade relative to said distal end of said first extender.

8. The system of claim 1, further comprising an orientation guide including first and second mounting portions mounted to said proximal ends of respective ones of said first and second extenders, said first and second mounting portions being adjustably connected to one another to vary a spacing therebetween to adapt to a distance between said proximal ends of said first and second extenders, said orientation guide engaging said first and second extenders so that said receptacles of said first and second anchors are aligned with one another to receive said connecting member therebetween.

9. The system of claim 1, wherein said first and second mounting portions are angled relative to one another to accommodate a non-parallel relationship between said first and second extenders.

10. A spinal surgical instrument, comprising:

an elongated extender for positioning in the body of a patient in a minimally invasive surgical procedure, said extender extending along a longitudinal axis between a proximal end and a distal end, said extender including an elongated inner member with a first passage extending from said proximal end of said extender to said distal end of said extender, said extender further including an elongated outer member extending between a distal end adjacent said distal end of said extender and a proximal end adjacent said proximal end of said extender, said outer member having an inner surface positioned around an outer surface of said inner member, wherein at least one of said inner surface of said outer member and said outer surface of said inner member includes a recessed portion therein that defines a second passage between said inner member and said outer member, said second passage extends along said extender and opens at said proximal end of said extender.

11. The instrument of claim 10, wherein said inner surface of said outer member and said outer surface of said inner member each include a recessed portion, said recessed portions being aligned with one another along said extender to define said second passage.

12. The instrument of claim 11, wherein said recessed portion of said outer member includes a ramped surface portion that begins at a location proximal of said distal end of said outer member and slopes from said location toward said inner member to said distal end of said outer member.

13. The instrument of claim 11, wherein said inner member includes a tubular body portion extending distally from said proximal end and a pair of arms extending distally from said tubular body portion to said distal end of said extender, said pair of arms being separated from one another by a slot therebetween, wherein said recessed portion of said inner member extends from said proximal end to said slot.

14. The system of claim 11, wherein said recessed portions are each U-shaped grooves.

15. The instrument of claim 10, wherein said inner member includes a tubular body portion extending distally from said proximal end of said extender and a pair of arms extending distally from said tubular body portion to said distal end of said extender, said pair of arms being separated from one another by a slot therebetween, wherein said outer member includes a notch extending from said distal end of said outer member toward said proximal end of said outer member, said notch being located on a side of said extender opposite said second passage and is aligned with said slot between said pair of arms.

16. A method for positioning a connecting member along a spinal column in a minimally invasive surgical procedure, comprising:

securing a first anchor to a first vertebra;

securing a second anchor to a second vertebra;

providing a first extender extending proximally from the first anchor away from the first vertebra;

providing a second extender extending proximally from the second anchor away from the second vertebra;

aligning receptacles of the first and second anchors relative to one another;

positioning a retractor in a first passage of the first extender and retracting tissue with the retractor in the first extender away from the first and second vertebrae to form a pathway from the first anchor to the second anchor without making an incision between the first and second extenders;

positioning the connecting member in a second passage of the first extender with a leading end of the connecting member oriented toward the first anchor and a trailing end of the connecting member oriented away from the first anchor;

moving the connecting member in the second passage along the first extender toward the receptacle of the first anchor;

pivoting the connecting member so its leading end is oriented toward the second anchor while moving the trailing end of the connecting member toward the receptacle of the first anchor;

moving the leading end of the connecting member along the pathway toward the second anchor; and

securing the trailing end of the connecting member in the receptacle of the first anchor and the leading end of the connecting member to the second anchor.

17. The method of claim 16, wherein aligning receptacles of the first and second anchors includes engaging an orientation guide to proximal ends of the first and second extenders to maintain the receptacles in alignment with one another.

18. The method of claim 16, wherein the first extender includes an inner member and an outer member positioned around the inner member, wherein the inner member includes a tubular body portion defining the first passage and the second passage is formed by a recessed portion in an inner surface of the outer member that is aligned with a recessed portion in an outer surface of the inner member.

19. The method of claim 18, wherein the recessed portion of the outer member includes a ramped surface portion beginning at a location proximal of a distal end of the outer member and sloping from the location toward the inner member to the distal end of the outer member.

20. The method of claim 16, wherein the first extender includes a pinion mounted thereto that extends into the first passage and the retractor includes an elongated shaft in the first passage, the elongated shaft including a ratchet surface engaged by the pinion and the pinion is rotatable to move the retractor along the first passage.

21. The method of claim 20, wherein the first extender includes a notch that opens into the first passage, the notch extending from a distal end of the first extender toward a proximal end of the first extender, and the retractor includes a retracting blade transversely oriented to the shaft that extends from the first passage through the notch.

22. The method of claim 16, wherein positioning the connecting member includes engaging the trailing end of the connecting member with an inserter so that the leading end of the connecting member is opposite the inserter, and orienting the connecting member so that the leading end enters the second passage followed by the trailing end.

23. The method of claim 22, wherein the connecting member includes an eyelet at the trailing end thereof and the inserter includes at least one protrusion extending into the eyelet when the connecting member is engaged to the inserter.

24. The method of claim 22, wherein the inserter includes a pair of arms pivotally coupled to one another about a first pivot axis to move end members at distal ends of the pair of arms toward and away from one another, the distal end members each being pivotally coupled to a respective one of the pair of arms about a second pivot axis that is orthogonally oriented to the first pivot axis.