STABILIZING A SPINAL ANATOMICAL STRUCTURE

• US 20100106194A1
• Filed: 10/09/2009
• Published: 04/29/2010
• Est. Priority Date: 10/26/2004
• Status: Abandoned Application

• Current Assignee: P TECH, LLC
• Original Assignee: P TECH, LLC
• Inventors: Bonutti, Peter M., Phillips, Glen A.
• Application Number:
  US12/576,992
• Publication Number:
  US 20100106194A1
• Time in Patent Office: Days
• US Class Current: 606/279
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• 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 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0467 Instruments for cutting sutures surgical cutting instruments A61B17/32
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• 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 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/1615 Drill bits, i.e. rotating tools extending from a handpiece to contact the worked material
• CPC Class Codes: A61B 17/1637 Hollow drills or saws producing a curved cut, e.g. cylindrical A61B10/025, A61B17/1695 take precedence
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/17 Guides or aligning means for drills , mills, pins or wires
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/683 comprising bone transfixation elements, e.g. bolt with a distal cooperating element such as a nut
• CPC Class Codes: A61B 17/7053 with parts attached to bones or to each other by flexible wires, straps, sutures or cables
• CPC Class Codes: A61B 17/7064 Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
• CPC Class Codes: A61B 17/7067 Devices bearing against one or more spinous processes and also attached to another part of the spine; Tools therefor
• CPC Class Codes: A61B 17/842 Flexible wires, bands or straps A61B17/72, A61B17/82, A61B17/86 take precedence
• CPC Class Codes: A61B 17/8863 : Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• CPC Class Codes: A61B 17/8869 : Tensioning devices
• CPC Class Codes: A61B 2017/00004 : (bio)absorbable, (bio)resorbable, resorptive for implantable prostheses A61F2210/0004
• CPC Class Codes: A61B 2017/00398 : using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/00477 : Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2017/00818 : Treatment of the gastro-intestinal system
• CPC Class Codes: A61B 2017/00876 : magnetic
• CPC Class Codes: A61B 2017/00893 : pharmaceutically effective
• CPC Class Codes: A61B 2017/00898 : expandable upon contact with fluid
• CPC Class Codes: A61B 2017/00951 : adhesive
• CPC Class Codes: A61B 2017/0404 : Buttons
• CPC Class Codes: A61B 2017/0409 : Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0417 : T-fasteners
• CPC Class Codes: A61B 2017/0464 : for soft tissue
• CPC Class Codes: A61B 2017/0488 : Instruments for applying suture clamps, clips or locks for applying suture anchors A61B2017/0409; for applying wound clamps A61B17/10; for applying ligaturing clamps or clips A61B17/128
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2017/06176 : with protrusions, e.g. barbs
• CPC Class Codes: A61B 2017/2926 : Details of heads or jaws
• CPC Class Codes: A61B 2090/064 : for measuring force, pressure or mechanical tension
• CPC Class Codes: A61F 2/0063 : Implantable repair or support meshes, e.g. hernia meshes
• CPC Class Codes: A61F 2/08 : Muscles; Tendons; Ligaments sutures A61B17/04
• CPC Class Codes: A61F 2/0811 : Fixation devices for tendons or ligaments
• CPC Class Codes: A61F 2/28 : Bones joints A61F2/30
• CPC Class Codes: A61F 2/30749 : Fixation appliances for connecting prostheses to the body
• 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 2/442 : Intervertebral or spinal discs, e.g. resilient non-disc-shaped intervertebral inflatable pockets A61F2/441; non-disc-shaped intervertebral fusion implants A61F2/4455
• CPC Class Codes: A61F 2002/2817 : Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
• CPC Class Codes: A61F 2002/30062 : (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/30462 : retained or tied with a rope, string, thread, wire or cable
• CPC Class Codes: A61F 2002/30677 : Means for introducing or releasing pharmaceutical products, e.g. antibiotics, into the body
• CPC Class Codes: A61F 2002/4435 : Support means or repair of the natural disc wall, i.e. annulus, e.g. using plates, membranes or meshes
• CPC Class Codes: A61F 2002/444 : for replacing the nucleus pulposus
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2310/00293 : containing a phosphorus-containing compound, e.g. apatite
• CPC Class Codes: A61F 2310/00359 : Bone or bony tissue
• CPC Class Codes: A61L 27/58 : Materials at least partially resorbable by the body

Abstract

Methods and devices for stabilizing spinal anatomical structures. Some example methods may include introducing a curved segment of an elongate fastener placement rod adjacent to a spinal anatomical structure, providing a fastener at the leading end of the curved segment, and/or securing the fastener in place with respect to the spinal anatomical structure.

Claims

1. A method for stabilizing a spinal anatomical structure, comprising:

introducing, into a body, a curved segment of an elongate, fastener placement rod approximate to, adjacent to or on a spinal anatomical structure, the curved segment having a leading end;

providing, at the leading end of the curved segment of the fastener placement rod, a fastener approximate to, adjacent to or on the spinal anatomical structure; and

securing the fastener with respect to the spinal anatomical structure.

2. The method of claim 1, wherein the fastener is secured with respect to the spinal anatomical structure utilizing at least one flexible line.

3. The method of claim 2, wherein the at least one flexible line extends from the fastener, through at least a portion of the spinal anatomical structure to a separate securing point within the body.

4. The method of claim 3, further comprising securing the at least one flexible line at the separate securing point by a second fastener.

5. The method of claim 4, wherein the step of securing the at least one flexible line at the separate securing point by the second fastener comprises crimping the second fastener to the flexible line.

6. The method of claim 5, wherein the crimping step comprises introducing a crimping mechanism extending from an elongate rod of a crimping tool through an incision in the body and adjacent to the second fastener.

7. The method of claim 3, wherein the at least one flexible line comprises a suture.

8. The method of claim 3, wherein the at least one flexible line comprises a cable.

9. The method of claim 2, wherein the flexible line is provided attached to the fastener approximate to, adjacent to or on the spinal anatomical structure, and the method includes a step of passing the flexible line from the fastener and at least through the portion of the spinal anatomical structure to the separate securing point within the body.

10. The method of claim 9, wherein the passing step is performed utilizing a gripper at a leading end of an elongate gripper rod which pulls the flexible line from the fastener and at least through the portion of the spinal anatomical structure to the separate securing point within the body.

11. The method of claim 10, wherein the elongate fastener placement rod and elongate gripper rod extend from a hand-held guidance and positioning device.

12. The method of claim 11, further comprising forming a hole through the portion of the spinal anatomical structure prior to the pulling step.

13. The method of claim 12, wherein the hole forming step is performed by an elongate drill rod extending from the hand-held guidance and positioning device.

14. The method of claim 13, wherein the elongate gripper rod and elongate drill rod are guided by a guide tube extending from the hand-held guidance and positioning device.

15. The method of claim 10, wherein the elongate gripper rod extends from the hand-held guidance and positioning device along an axis that runs adjacent to or through the leading end of the curved segment of the fastener placement rod.

16. The method of claim 9, further comprising forming a hole through the portion of the spinal anatomical structure prior to the passing step.

17. The method of claim 2, wherein

the spinal anatomical structure is a first spinal anatomical structure;

the flexible line is provided attached to the fastener approximate to, adjacent to or on the spinal anatomical structure; and

the method includes a step of passing the flexible line from the fastener and at least through the portion of the first spinal anatomical structure, through at least a portion of a second anatomical structure to the separate securing point within the body, thereby stabilizing at least the first and second spinal anatomical structures with respect to each other.

18. The method of claim 17, wherein the first spinal anatomical structure is an intervertebral disc and the second spinal anatomical structure is a vertebra.

19. The method of claim 17, wherein the first spinal anatomical structure is a first vertebra and the second spinal anatomical structure is a second vertebra.

20. The method of claim 17, wherein the first spinal anatomical structure is a vertebra and the second spinal anatomical structure is an intevertebral disc.

21. The method of claim 17, wherein the first spinal anatomical structure is a first spinous process and the second spinal anatomical structure is a second spinous process.

22. The method of claim 17, wherein the first spinal anatomical structure is a first ligament segment and the second spinal anatomical structure is a second ligament segment.

23. The method of claim 22, wherein the first and second ligament segments are torn or severed segments of the same ligament.

24. The method of claim 17, wherein the first spinal anatomical structure is a ligament and the second spinal anatomical structure is a vertebra.

25. The method of claim 17, wherein the first spinal anatomical structure is a ligament and the second spinal anatomical structure is an intevertebral disc.

26. The method of claim 17, wherein the first spinal anatomical structure is a vertebra and the second spinal anatomical structure is a ligament.

27. The method of claim 17, wherein the first spinal anatomical structure is an intervertebral disc and the second spinal anatomical structure is a ligament.

28. The method of claim 17, wherein the method includes a step of passing the flexible line from the fastener and at least through the portion of the first spinal anatomical structure, through at least a portion of a second anatomical structure, and through at least a portion of a third anatomical structure to the separate securing point within the body, thereby stabilizing at least the first, second and third spinal anatomical structures with respect to each other.

29. The method of claim 28, wherein at least two of the first, second and third spinal anatomical structures comprise spinous processes.

30. The method of claim 28, wherein at least two of the first, second and third spinal anatomical structures comprise facets.

31. The method of claim 17, wherein the drawing step further comprises passing the flexible line through an implant.

32. The method of claim 31, wherein the implant comprises a graft.

33. The method of claim 31, wherein the implant comprises a disc implant.

34. The method of claim 31, wherein the implant comprises a scaffold.

35. The method of claim 17, wherein the first spinal anatomical structure is a spinous process and the second spinal anatomical structure is at least one of a pedicle and bone of a facet joint.

36. The method of claim 17, wherein the first spinal anatomical structure is at least one of a pedicle and bone of a facet joint and the second spinal anatomical structure is a spinous process.

37. The method of claim 17, wherein the first spinal anatomical structure is a first side of a cervical spine and the second anatomical structure is a second side of the cervical spine.

38. The method of claim 17, wherein the method further comprises passing the flexible line through a tubular implant positioned between the first and second spinal anatomical structures.

39. The method of claim 17, wherein the first spinal anatomical structure is a first facet and the second spinal anatomical structure is a second facet.

40. The method of claim 3, further comprising a step of tensioning at least a portion of the flexible line extending between the fastener and the separate securing point.

41. The method of claim 3, wherein the spinal anatomical structure comprises annulus fibrosus.

42. The method of claim 3, wherein the spinal anatomical structure comprises nucleus pulposus.

43. The method of claim 3, wherein the flexible line extends through an intervertebral disc and through an adjacent vertebra.

44. The method of claim 3, wherein the flexible line extends through adjacent vertebrae and an intervertebral disc between the adjacent vertebrae.

45. The method of claim 3, wherein the flexible line extends through two vertebrae and a disc positioned between but not adjacent to each of the two vertebrae.

46. The method of claim 3, wherein the flexible line extends through an upper spinous process and through a lower spinous process.

47. The method of claim 3, wherein the flexible line extends through a vertebra and to or though a disc implant.

48. The method of claim 3, wherein the flexible line extends through the spinal anatomical structure to or through a graft.

49. The method of claim 3, wherein the flexible line extends through the spinal anatomical structure and through or to a disc implant or a vertebral implant.

50. The method of claim 49, wherein the spinal anatomical structure comprises annulus fibrosus.

51. The method of claim 49, wherein the spinal anatomical structure comprises a vertebra.

52. The method of claim 49, wherein the spinal anatomical structure comprises a facet.

53. The method of claim 3, wherein the flexible line extends through two severed portions of a spinal ligament.

54. The method of claim 3, wherein the flexible line extends through two portions of a spinal ligament.

55. The method of claim 54, wherein the flexible line further extends through a vertebra adjacent to at least one of the two portions of the spinal ligament.

56. The method of claim 54, wherein the flexible line further extends through an intervertebral disc.

57. The method of claim 3, wherein the flexible line extends to or through a stabilization rod or plate.

58. The method of claim 57, wherein the spinal anatomical structure is a spinous process.

59. The method of claim 3, wherein the flexible line extends through at least one portion of a spinal ligament and through or to a ligament graft.

60. The method of claim 1, wherein at least a portion of the elongate fastener placement rod is hollow.

61. The method of claim 60, wherein the portion of the elongate fastener placement rod that is hollow opens onto the leading end of the curved segment of the fastener placement rod.

62. The method of claim 61, wherein the step of providing, at the leading end of the curved segment of the fastener placement rod, a fastener approximate to, adjacent to or on the spinal anatomical structure, includes a step of sending the fastener through the portion of the elongate faster placement rod that is hollow to the leading end of the curved segment.

63. The method of claim 62, wherein sending step further comprises sending a flexible line with the fastener through the portion of the elongate fastener placement rod that is hollow to the leading end of the curved segment, wherein the fastener is secured in place utilizing at least a portion of flexible line.

64. The method of claim 1, wherein the step of providing, at the leading end of the curved segment of the fastener placement rod, a fastener approximate to, adjacent to or on the spinal anatomical structure, is preceded by a step of engaging the fastener with the leading end of the curved segment of the fastener placement rod.

65. The method of claim 1, further comprising a step of engaging the fastener with the leading end of the curved segment of the fastener placement rod.

66. The method of claim 65, wherein the engaging step includes a step of disposing at least a portion of the fastener within the leading end of the curved segment of the fastener placement rod.

67. The method of claim 65, further comprising a step of disengaging the fastener from the leading end of the curved segment of the fastener placement rod while the fastener is approximate to, adjacent to or on the spinal anatomical structure.

68. The method of claim 1, wherein the introducing step comprises introducing the curved segment of an elongate, fastener placement rod through an incision in the skin as part of a minimally invasive procedure.

69. The method of claim 1, wherein the spinal anatomical structure comprises at least one of bone, vertebral body, nucleus pulposus, muscle, tendon and cartilage.

70. The method of claim 1, wherein the spinal anatomical structure comprises at least one bone taken from a group consisting of:

transverse process, pedicle, facet, spinous process, posterior arch, odontoid process, posterior tubercle, lateral articular process, uncinate process, anterior tubercle, carotid tubercle, odontoid process, lamina and vertebral body.

71. The method of claim 1, wherein the spinal anatomical structure comprises at least one ligament taken from a group consisting of:

anterior longitudinal ligament, posterior longitudinal ligament, interspinous ligament, supraspinous ligament, ligamentum flavum, intertransverse ligament, facet capsulary ligament, ligamentum nuchae, ligament of the sacrum and ligament of the coccyx spine.

72. A method for stabilizing a spinal anatomical structure, comprising:

connecting a flexible line and a fastener;

introducing, through an incision in the body, a curved segment of an elongate, fastener placement rod approximate to, adjacent to or on a spinal anatomical structure, the curved segment having a leading end;

providing, at the leading end of the curved segment of the fastener placement rod, the fastener and attached flexible line at a fastener placement point that is approximate to, adjacent to or on the spinal anatomical structure, the providing step including passing the fastener and attached flexible line through the curved segment of the elongate fastener placement rod to the leading end;

passing the connected flexible line from approximate the fastener placement point through at least a portion of the spinal anatomical structure to a securing point;

tensioning the flexible line between the fastener placement point and the securing point; and

securing the flexible line at the securing point.

73. The method of claim 72 wherein the step of securing the flexible line at the securing point comprises a step of tying the flexible line.

74. The method of claim 72 wherein the step of securing the flexible line at the securing point comprises a step of fastening the flexible line at the securing point using another fastener.

75. The method of claim 74 wherein the step of fastening the flexible line at the securing point using another fastener comprises crimping the other fastener to the flexible line.

76. The method of claim 72 wherein the flexible line comprises a suture.

77. The method of claim 72 wherein the flexible line comprises a cable.

78. The method of claim 72 wherein the passing step is performed utilizing a gripper at a leading end of an elongate gripper rod to pull the connected flexible line from approximate the fastener placement point through at least the portion of the spinal anatomical structure to the securing point.

79. The method of claim 78 wherein the elongate fastener placement rod and the elongate gripper rod extend from a hand-held guidance and positioning device.

80. The method of claim 79 further comprising forming a hole through the portion of the spinal anatomical structure prior to the pulling step.

81. The method of claim 80 wherein the hole forming step is performed by an elongate drill rod extending from the hand-held guidance and positioning device.

82. The method of claim 81 wherein the elongate gripper rod and the elongate drill rod are guided by a guide tube extending from the hand-held guidance and positioning device.

83. The method of claim 72, wherein the spinal anatomical structure comprises annulus fibrosus.

84. The method of claim 72, wherein the flexible line extends through an intervertebral disc and through an adjacent vertebra.

85. The method of claim 72, wherein the flexible line extends through adjacent vertebrae and an intervertebral disc between the adjacent vertebra.

86. The method of claim 72, wherein the flexible line extends through two vertebrae and a disc positioned between but not adjacent to each of the two vertebrae.

87. The method of claim 72, wherein the flexible line extends through an upper spinous process and through a lower spinous process.

88. The method of claim 72, wherein the flexible line extends through a vertebra and to or though a disc implant.

89. The method of claim 72, wherein the flexible line extends through the spinal anatomical structure to or through a graft.

90. The method of claim 72, wherein the flexible line extends through the spinal anatomical structure and through or to a disc implant or a vertebral implant.

91. The method of claim 90, wherein the spinal anatomical structure comprises annulus fibrosus.

92. The method of claim 90, wherein the spinal anatomical structure comprises a vertebra.

93. The method of claim 90, wherein the spinal anatomical structure comprises a facet.

94. The method of claim 72, wherein the flexible line extends through two severed portions of a spinal ligament.

95. The method of claim 72, wherein the flexible line extends through two portions of a spinal ligament.

96. The method of claim 95, wherein the flexible line further extends through a vertebra adjacent to at least one of the two portions of the spinal ligament.

97. The method of claim 95, wherein the flexible line further extends through an intervertebral disc.

98. The method of claim 72, wherein the flexible line extends to or through a stabilization rod or plate.

99. The method of claim 98, wherein the spinal anatomical structure is a spinous process.

100. The method of claim 72, wherein the flexible line extends through at least one portion of a spinal ligament and through or to a ligament graft.

101. The method of claim 72, wherein

the spinal anatomical structure is a first spinal anatomical structure;

and

the method comprises a step of passing the flexible line from approximate the fastener and at least through the portion of the first spinal anatomical structure, through at least a portion of a second anatomical structure to the securing point, thereby stabilizing at least the first and second spinal anatomical structures with respect to each other.

102. The method of claim 101, wherein the first spinal anatomical structure is an intervertebral disc and the second spinal anatomical structure is a vertebra.

103. The method of claim 101, wherein the first spinal anatomical structure is a first vertebra and the second spinal anatomical structure is a second vertebra.

104. The method of claim 101, wherein the first spinal anatomical structure is a vertebra and the second spinal anatomical structure is an intevertebral disc.

105. The method of claim 101, wherein the first spinal anatomical structure is a first spinous process and the second spinal anatomical structure is a second spinous process.

106. The method of claim 101, wherein the first spinal anatomical structure is a first ligament segment and the second spinal anatomical structure is a second ligament segment.

107. The method of claim 106, wherein the first and second ligament segments are torn or severed segments of the same ligament.

108. The method of claim 101, wherein the first spinal anatomical structure is a ligament and the second spinal anatomical structure is a vertebra.

109. The method of claim 101, wherein the first spinal anatomical structure is a ligament and the second spinal anatomical structure is an intevertebral disc.

110. The method of claim 101, wherein the first spinal anatomical structure is a vertebra and the second spinal anatomical structure is a ligament.

111. The method of claim 101, wherein the first spinal anatomical structure is an intervertebral disc and the second spinal anatomical structure is a ligament.

112. The method of claim 101, wherein the method includes a step of passing the flexible line from the fastener and at least through the portion of the first spinal anatomical structure, through at least a portion of a second anatomical structure, and through at least a portion of a third anatomical structure to the separate securing point within the body, thereby stabilizing at least the first, second and third spinal anatomical structures with respect to each other.

113. The method of claim 112, wherein at least two of the first, second and third spinal anatomical structures comprise spinous processes.

114. The method of claim 112, wherein at least two of the first, second and third spinal anatomical structures comprise facets.

115. The method of claim 101, wherein the passing step further comprises passing the flexible line through an implant.

116. The method of claim 115, wherein the implant comprises a graft.

117. The method of claim 115, wherein the implant comprises a disc implant.

118. The method of claim 115, wherein the implant comprises a scaffold.

119. The method of claim 101, wherein the first spinal anatomical structure is a spinous process and the second spinal anatomical structure is at least one of a pedicle and bone of a facet joint.

120. The method of claim 101, wherein the first spinal anatomical structure is at least one of a pedicle and bone of a facet joint and the second spinal anatomical structure is a spinous process.

121. The method of claim 101, wherein the first spinal anatomical structure is a first side of a cervical spine and the second anatomical structure is a second side of the cervical spine.

122. The method of claim 101, wherein the method further comprises passing the flexible line through a tubular implant positioned between the first and second spinal anatomical structures.

123. The method of claim 101, wherein the first spinal anatomical structure is a first facet and the second spinal anatomical structure is a second facet.

124. A method for stabilizing a spinal anatomical structure, comprising:

a step for introducing a fastener approximate to, adjacent to or on a spinal anatomical structure using a curved end of an introducer means;

a step for passing a flexible line attached to the fastener through at least a portion of the spinal anatomical structure to a securing point; and

a step for securing the flexible line at the securing point.

125. The method of claim 124 further comprising a step for tensioning the flexible line between the fastener and the securing point.