Vertebral joint implants and delivery tools

• US 20100191241A1
• Filed: 12/10/2009
• Published: 07/29/2010
• Est. Priority Date: 06/06/2008
• Status: Active Grant

• Current Assignee: Providence Medical Technology, Inc.
• Original Assignee: Providence Medical Technology, Inc.
• Inventors: Carver, Jonathan, Eyster, Edward Fletcher, Tu, Kurin, Lombrozo, Peter, Tanaka, Shigeru, McCormack, Bruce M., Leugers, Martin, Smith, Jeffrey D., Druker, Joshua, Liou, Edward
• Granted Patent: US 8,425,558 B2
• Time in Patent Office: Days
• US Class Current: 606/83
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/0642 for bones, e.g. for osteosynthesis or connecting tendon to bone
• 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 17/1735 for rasps or chisels
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/7064 Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
• CPC Class Codes: A61B 17/7074 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 17/863 with thread interrupted or changing its form along shank, other than constant taper
• CPC Class Codes: A61B 17/8811 characterised by the introducer tip, i.e. the part inserted into or onto the bone
• CPC Class Codes: A61B 17/8819 characterised by the introducer proximal part, e.g. cannula handle, or by parts which are inserted inside each other, e.g. stylet and cannula A61B17/8825 takes precedence
• CPC Class Codes: A61B 17/8822 characterised by means facilitating expulsion of fluid from the introducer, e.g. a screw pump plunger, hydraulic force transmissions, application of vibrations or a vacuum
• CPC Class Codes: A61B 2017/00424 ergonomic, e.g. fitting in fist
• CPC Class Codes: A61B 2017/00429 with a roughened portion
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/320028 with reciprocating movements
• CPC Class Codes: A61B 2090/031 torque limiting
• CPC Class Codes: A61B 2090/034 abutting on parts of the device itself
• CPC Class Codes: A61B 2090/037 with a frangible part, e.g. by reduced diameter
• 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 2/4455 : 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 2/447 : substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
• CPC Class Codes: A61F 2/4611 : of spinal prostheses
• CPC Class Codes: A61F 2002/30131 : horseshoe- or crescent- or C-shaped or U-shaped
• CPC Class Codes: A61F 2002/30168 : L-shaped
• CPC Class Codes: A61F 2002/30176 : V-shaped
• CPC Class Codes: A61F 2002/30266 : wedge-shaped parallelepipeds
• CPC Class Codes: A61F 2002/30289 : helically-coiled
• CPC Class Codes: A61F 2002/30378 : Spherically-shaped protrusion and recess
• CPC Class Codes: A61F 2002/30405 : made by screwing complementary threads machined on the parts themselves
• CPC Class Codes: A61F 2002/30451 : soldered or brazed or welded
• CPC Class Codes: A61F 2002/30471 : connected by a hinged linkage mechanism, e.g. of the single-bar or multi-bar linkage type
• CPC Class Codes: A61F 2002/30484 : Mechanically expandable devices located on the first prosthetic part for locking into or onto the second prosthetic part
• CPC Class Codes: A61F 2002/30507 : using a threaded locking member, e.g. a locking screw or a set screw
• CPC Class Codes: A61F 2002/3052 : unrestrained in only one direction, e.g. moving unidirectionally
• CPC Class Codes: A61F 2002/30523 : by means of meshing gear teeth
• CPC Class Codes: A61F 2002/30538 : for adjusting angular orientation
• CPC Class Codes: A61F 2002/30556 : for adjusting thickness
• CPC Class Codes: A61F 2002/30599 : stackable
• CPC Class Codes: A61F 2002/30733 : Inserts placed into an endoprosthetic cavity, e.g. for modifying a material property
• CPC Class Codes: A61F 2002/30841 : Sharp anchoring protrusions for impaction into the bone, e.g. sharp pins, spikes
• CPC Class Codes: A61F 2002/3085 : with a threaded, e.g. self-tapping, bone-engaging surface, e.g. external surface
• CPC Class Codes: A61F 2002/30904 : serrated profile, i.e. saw-toothed
• CPC Class Codes: A61F 2002/448 : comprising multiple adjacent spinal implants within the same intervertebral space or within the same vertebra, e.g. comprising two adjacent spinal implants
• CPC Class Codes: A61F 2002/4627 : with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
• CPC Class Codes: H04L 45/00 : Routing or path finding of packets in data switching networks routing or path finding in wireless networks H04W40/00
• CPC Class Codes: H04L 45/02 : Topology update or discovery
• CPC Class Codes: H04L 45/22 : Alternate routing
• CPC Class Codes: H04L 45/28 : using route fault recovery
• CPC Class Codes: H04W 28/04 : Error control

Abstract

A spinal joint distraction system for treating a facet joint including articular surfaces having a contour is disclosed and may include a delivery device including a generally tubular structure adapted to engage a facet joint, an implant adapted to be delivered through the delivery device and into the facet joint, the implant comprising two members arranged in opposed position, and an implant distractor comprising a generally elongate member adapted to advance between the two members of the implant causing separation of the members and distraction of the facet joint, wherein the implant is adapted to conform to the shape of the implant distractor and/or the articular surfaces of the facet upon being delivered to the facet joint. Several embodiments of a system, several embodiments of an implant, and several methods are disclosed including a method for interbody fusion.

Claims

1. A spinal joint distraction system for treating a facet joint including articular surfaces having a contour, the system comprising:

a delivery device including a generally tubular structure adapted to engage a facet joint;

an implant adapted to be delivered through the delivery device and into the facet joint, the implant comprising two members arranged in opposed position; and

an implant distractor comprising a generally elongate member adapted to advance between the two members of the implant causing separation of the members and distraction of the facet joint,

wherein the implant is adapted to conform to the shape of the implant distractor upon being delivered to the facet joint.

2. The system of claim 1, further comprising a driver assembly adapted to hold the implant and advance the implant distractor, the driver assembly further adapted for insertion through the delivery device.

3. The system of claim 2, further comprising a chisel adapted for insertion through the delivery device to facilitate initial engagement with the facet joint.

4. The system of claim 3, further comprising a decorticator adapted for lateral engagement with the delivery device.

5. The system of claim 4, further comprising a malleting tool with a first end adapted to engage the decorticator for a malleting process and a second end adapted to facilitate separation of parts of the system.

6. The system of claim 5, further comprising an injector adapted for insertion through the delivery device and further adapted to deliver a bone paste.

7. A spinal joint distraction system comprising:

a delivery device and chisel assembly adapted to engage a facet joint; and

a driver assembly adapted to hold and distract an implant, the driver assembly further adapted for insertion through the delivery device to deliver and distract the implant.

8. The system of claim 7, further comprising a place holding chisel adapted to replace the chisel and maintain the established position of the delivery device and chisel assembly.

9. The system of claim 8, wherein:

the delivery device of the assembly comprises;

a tubular shaft; and

a receiving assembly positioned on a proximal end of the tubular shaft; and

the chisel of the assembly comprises a handle having a connection feature adapted to engage the receiving assembly.

10. The system of claim 9, wherein the connection feature includes a protrusion or recess adapted to form a detent relationship with an opposing protrusion or recess respectively.

11. The system of claim 9, wherein the connection feature includes a latch type feature positioned on a deflectable portion of the handle, wherein advancing the chisel handle toward the receiving assembly causes the latch type feature to snap into place and depressing the deflectable portion of the handle releases the latch type feature.

12. The system of claim 8, wherein the receiving assembly further comprises a malleting anvil positioned on a proximal face of the receiving assembly.

13. The system of claim 8, wherein the chisel includes a slot cavity adapted to receive the malleting anvil and a malleting head adapted to engage the malleting anvil to resist relative motion between the delivery device and the chisel during malleting.

14. The system of claim 7, wherein the delivery device of the assembly includes forks adapted to penetrate the facet joint.

15. The system of claim 14, wherein the delivery device further comprises a bull nose positioned on the surface of the forks near the intersection of the forks with the tubular structure, the bull nose adapted to mark the position of the delivery device.

16. The system of claim 14, further comprising an indication hole positioned along the lateral side of the delivery device near the intersection of the forks and the tubular structure.

17. The system of claim 7, wherein the driver assembly includes an implant shaft having a diameter substantially equal to or less than a width of the implant.

18. The system of claim 7, wherein the driver assembly further comprises a handle with a malleting bar adapted to transfer malleting blows to the driver assembly.

19. The system of claim 18, wherein the driver assembly further comprises a slot cavity having a bearing surface, the slot cavity adapted to receive the malleting anvil of the receiving assembly and the bearing surface is adapted to engage the malleting anvil to resist relative motion between the delivery device and the driver assembly during malleting.

20. The system of claim 7, further comprising a decorticator adapted for positioning upon the delivery device from a lateral side of the delivery device.

21. The system of claim 20, wherein the decorticator comprises a U-shaped longitudinally extending member with teeth on a distal end.

22. The system of claim 21, wherein the decorticator further comprises a malleting element at a proximal end adapted to distribute malleting blows to the longitudinally extending member.

23. The system of claim 7, wherein the driver assembly includes arms adapted to hold an implant, wherein the arms are positioned within a boundary defined by a width of the implant.

24. A spinal distraction implant for the distraction of a facet joint having articular surfaces, the implant comprising a first and a second member arranged in opposing position, each of the first and second member comprising:

a threaded slot passing through the member adapted to receive a thread feature; and

a plurality of teeth spaced along two parallel lateral edges, the teeth adapted to engage the articular surfaces of the facet joint,

wherein, the implant is constructed from a malleable material and is further adapted to conform to the shape of the articular sufaces upon being distracted within a facet joint.

25. The implant of claim 24, wherein the plurality of teeth have a linearly sloped distal face and a proximal face positioned orthogonally to the respective first or second member.

26. The implant of claim 25, wherein the teeth are equally spaced.

27. The implant of claim 24, wherein the first and second members each have an interlocking enagement feature on respective distal edges, wherein the first and second members engage one another via their respective interlocking engagement features.

28. The implant of claim 27, wherein the first and second members are further coupled together via a weld.

29. A method of distracting a facet joint and a contralateral facet joint of a spine comprising:

inserting a delivery device and chisel assembly into the facet joint;

removing the chisel from the assembly and replacing the chisel with a place holding chisel;

removing the delivery device from the facet joint;

inserting the delivery device and chisel assembly into the contralateral facet joint;

removing the chisel from the assembly;

placing and distracting a first implant in the contralateral facet joint;

removing the delivery device from the contralateral facet joint;

placing the delivery device back in the facet joint via the place holding chisel; and

placing and distracting a second implant in the facet joint.

30. The method of claim 29, wherein the place holding chisel is a radiolucent chisel.

31. The method of claim 29, further comprising performing lateral fluoroscopy to determine proper placement of the first implant.

32. A method of distracting a facet joint of the spine comprising:

inserting a delivery device and chisel assembly into the facet joint to provide initial distraction and decorticate the surface of the joint;

removing the chisel assembly from the delivery device;

inserting a driver assembly through the delivery device, the driver assembly holding an implant and further comprising an implant distractor adapted to distract the implant;

distracting the implant; and

removing the driver assembly and the delivery device.

33. The method of claim 32, further comprising positioning the delivery device and chisel assembly by selectively malleting a proximal end thereof.

34. The method of claim 32, further comprising selectively malleting a proximal end of the driver assembly.

35. The method of claim 32, further comprising positioning a decorticator on the delivery device from the lateral side of the device.

36. The method of claim 35, further comprising:

advancing the decorticator along the length of the driver assembly;

positioning a malleting tool against the proximal end of the decorticator; and

malleting the malleting tool to forcibly advance the decorticator and decorticate the lateral mass of the facet joint.

37. The method of claim 36, further comprising retracting, rotating, and re-advancing the decorticator in a new position and malleting the malleting tool to decorticate a different location.

38. The method of claim 32, further comprising obtaining intra-operative patient symptom feedback.

39. A spinal distraction implant delivery tool, comprising:

an implant; and

an assembly, the assembly comprising;

a means for holding the implant;

a means for positioning the implant within a facet joint; and

a means for distracting the implant.

40. The tool of claim 39, wherein the implant comprises:

a first substantially planar member and a second substantially planar member arranged in parallel and opposing position to the first substantially planar member; and

a biasing connection connecting the first and second planar members to one another, the biasing connection adapted to create a biasing force directed toward biasing the members toward the parallel and opposing position.

41. The tool of claim 40, wherein the means for holding includes a pair of implant holding arms, the arms adapted to pass between the planar members and force them apart against the biasing force.

42. The tool of claim 41, wherein the holding arms each include a means for engaging the implant.

43. The tool of claim 40, wherein the means for distracting the implant includes an implant distractor and a means for rotatably advancing the implant distractor.

44. The tool of claim 43, wherein the implant distractor comprises a generally elongate member adapted to pass between the substantially planar members and force the members apart against the biasing force.

45. The tool of claim 44, further comprising a chisel configured to locate the facet joint and allow for adjustment of the trajectory of the tool.

46. A method of performing an interbody fusion, the method comprising:

inserting a delivery device and chisel assembly into a joint between vertebral bodies of the spine;

removing the chisel assembly from the delivery device;

inserting a driver assembly through the delivery device, the driver assembly holding an implant and further comprising an implant distractor adapted to distract the implant;

distracting the implant; and

removing the driver assembly and the delivery device.

47. The method of claim 46, further comprising repeating the steps to place a second implant in the joint.