Minimally Invasive Surgical System

• US 20100312279A1
• Filed: 08/23/2007
• Published: 12/09/2010
• Est. Priority Date: 08/23/2006
• Status: Active Grant

• Current Assignee: Pioneer Surgical Technology Incorporated (Surgalign Holdings, Inc.)
• Original Assignee: Pioneer Surgical Technology Incorporated (Surgalign Holdings, Inc.)
• Inventors: Kovarik, John, Songer, Matthew N., Gephart, Matthew P., White, John, Berman, Phillip J.
• Granted Patent: US 8,551,141 B2
• Time in Patent Office: Days
• US Class Current: 606/264
• 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 17/3209 Incision instruments
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3472 for bones, e.g. intraosseus injections
• CPC Class Codes: A61B 17/70 Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
• CPC Class Codes: A61B 17/7002 Longitudinal elements, e.g. rods
• CPC Class Codes: A61B 17/7004 with a cross-section which varies along its length A61B17/7019 takes precedence
• CPC Class Codes: A61B 17/701 Longitudinal elements with a non-circular, e.g. rectangular, cross-section A61B17/7005, A61B17/7007 take precedence
• CPC Class Codes: A61B 17/7011 Longitudinal element being non-straight, e.g. curved, angled or branched adjustable length longitudinal elements A61B17/7014; A61B17/7019 takes precedence, e.g. coil springs
• CPC Class Codes: A61B 17/7013 the shape of the element being adjustable before use adjustable length plates A61B17/7014
• 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 17/7037 wherein pivoting is blocked when the rod is clamped
• CPC Class Codes: A61B 17/7043 with a longitudinal element fixed to one or more transverse elements which connect multiple screws or hooks
• CPC Class Codes: A61B 17/708 with tubular extensions coaxially mounted on the bone anchors
• CPC Class Codes: A61B 17/7083 Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements
• 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 17/7086 Rod reducers, i.e. devices providing a mechanical advantage to allow a user to force a rod into or onto an anchor head other than by means of a rod-to-bone anchor locking element; rod removers
• CPC Class Codes: A61B 17/7091 for applying, tightening or removing longitudinal element-to-bone anchor locking elements, e.g. caps, set screws, nuts or wedges
• CPC Class Codes: A61B 2017/00991 : Telescopic means
• CPC Class Codes: A61B 2017/0256 : for the spine
• CPC Class Codes: A61B 2017/22038 : with a guide wire
• CPC Class Codes: A61B 2017/3443 : with means for adjusting the length of a cannula
• CPC Class Codes: A61B 2017/3445 : used as instrument channel for multiple instruments
• CPC Class Codes: A61B 2017/3447 : Linked multiple cannulas
• CPC Class Codes: A61B 2090/034 : abutting on parts of the device itself

Abstract

A multi-stage minimally invasive surgical procedure and associated instruments are disclosed. First, the surgical site is prepared. After preparation, the bone screws or anchors are attached to the bone. Subsequent to insertion of the screws, a rod or connecting member is positioned within the yoke portion of the bone screw. Caps are then placed in a pre-lock position within the yokes. The bone screws may be compressed together or distracted along the rod or connecting member, thereby setting the final spacing of the bones or bone segments. Finally the caps are moved to a final lock position to fix the screws to the rod or connecting member to maintain the bones in position relative to each other.

Claims

1-33. -33. (canceled)

34. A minimally invasive surgical system for seating a spinal rod into a pedicle screw assembly fastened to a vertebral bone, the system comprising:

a tubular member adapted to releasably engage the pedicle screw assembly and having a sidewall and an aperture extending through the sidewall;

a sleeve configured to slide over the tubular member and contact the spinal rod, the sleeve having a fulcrum positioned on the exterior of the sleeve and an aperture alignable with the tubular member aperture when the sleeve is positioned over the tubular member; and

a lever tool having an end portion adapted to fit through the sleeve aperture and at least partially into the tubular member aperture and an intermediate portion adapted to abut the fulcrum for urging the sleeve and spinal rod toward the pedicle screw assembly.

35. The minimally invasive surgical system of claim 34, wherein the lever tool creates a moment arm between the end portion and intermediate portion abutting the fulcrum to translate pivotal movement of the lever tool about the fulcrum into translational movement of the sleeve relative to the tubular member for urging the sleeve and spinal rod toward the pedicle screw assembly.

36. The minimally invasive surgical system of claim 34, wherein the fulcrum includes a ledge above a lower end of the sleeve aperture that permits the lever tool to pivot about a point elevated from the lower end of the sleeve aperture.

37. The minimally invasive surgical system of claim 34, wherein the end portion of the lever tool includes at least one surface configured to engage a portion of sidewall of the tubular member adjacent the aperture in the tubular member.

38. The minimally invasive surgical system of claim 34, wherein the fulcrum includes a depression for guiding the lever tool through the sleeve aperture and at least partially into the tubular member aperture.

39. The minimally invasive surgical system of claim 34, wherein the sleeve includes an opening sized to accommodate the fulcrum of an adjacent sleeve when the two sleeves are drawn into close proximity with each other.

40. The minimally invasive surgical system of claim 34, including:

a first receiving member positioned on the exterior of the sleeve;

a second tubular member adapted to releasably engage a second pedicle screw assembly fastened to a second vertebral bone;

a second receiving member connected to the exterior of the second tubular member; and

a tool having two moveable pins each on a pair of pivotably connected arms and sized to fit within the receiving members for moving the tubular members relative to each other a distance proportional to a user input when the pins are inserted into the receiving members permitting manipulation of the vertebral bones without projecting into the tubular members.

41. A minimally invasive surgical system for manipulating a fixation device relative to an anchor secured in a bone, the system comprising:

a tubular member having a longitudinally extending passage and an outer wall with an aperture extending through the outer wall, the tubular member configured to be releasably engageable to the anchor; and

a sleeve sized to be positioned around the tubular member and contact the fixation device, the sleeve having an aperture alignable with the aperture in the tubular member when the sleeve is positioned around the tubular member, the sleeve having a ledge extending outward from the exterior of the sleeve and positioned adjacent the sleeve aperture to provide a fulcrum for a tool insertable through both apertures when the apertures are at least partially aligned for urging the sleeve and the fixation device toward the anchor relative to the tubular member.

42. The minimally invasive surgical system of claim 41 wherein the distance between the fulcrum and the sidewall of the tubular member is greater than the distance between the sidewall of the tubular member and the sleeve when the sleeve is positioned around the tubular member and contacts the fixation device.

43. The minimally invasive surgical system of claim 41, wherein the ledge includes a depression that guides the tool into the sleeve aperture.

44. The minimally invasive surgical system of claim 41, wherein the sleeve includes an opening sized to accommodate the ledge of an adjacent sleeve when the two sleeves are brought into close proximity with each other.

45. The minimally invasive surgical system of claim 41, including:

a second tubular member releasably engageable to a second anchor;

a receiving member connected to the exterior of each of the tubular members; and

a second tool having portions configured to be removably inserted into the receiving members and shifted relative to one another to produce movement of the anchors without extending into the passages of the tubular members.

46. A method of seating a spinal rod into a pedicle screw assembly, the method comprising:

engaging a tubular member relative to the pedicle screw assembly;

positioning a sleeve around the tubular member until a distal end of the sleeve abuts the spinal rod;

urging the spinal rod toward the pedicle screw assembly by exerting an upward force on the tubular member and a downward force on the sleeve using a lever and a fulcrum outwardly spaced from a sidewall of the sleeve to move the sleeve toward the pedicle screw assembly.

47. The method of claim 46 wherein the step of urging the spinal rod toward the pedicle screw assembly further includes:

inserting a portion of the lever through partially aligned apertures on the tubular member and sleeve; and

pivoting the lever about the fulcrum to move the sleeve toward the pedicle screw assembly.

48. The method of claim 47, wherein the step of inserting the portion of the lever through both apertures includes engaging a hook-shaped segment of the lever with a portion of the sidewall of the tubular member adjacent the aperture of the tubular member.

49. The method of claim 46 wherein the step of urging the spinal rod toward the pedicle screw assembly further includes pivoting the lever about a surface of the fulcrum positioned above a lower end of the sleeve aperture.

50. The method of claim 46, including:

engaging a second tubular member to a second pedicle screw assembly and positioning a second sleeve about the second tubular member;

inserting pins of a second tool into receiving members connected to the exterior of the sleeves; and

adjusting a pair of handles on the second tool to manipulate the positioning of the pins and alter the distance between the tubular members.