TRANSILIAC-TRANSSACRAL METHOD OF PERFORMING LUMBAR SPINAL INTERVENTIONS

• US 20110009869A1
• Filed: 05/11/2010
• Published: 01/13/2011
• Est. Priority Date: 05/11/2009
• Status: Active Grant

• Current Assignee: Trinity Orthopedics, LLC
• Original Assignee: Trinity Orthopedics, LLC
• Inventors: Marino, James F., Elbanna, Jamil
• Granted Patent: US 8,439,925 B2
• Time in Patent Office: Days
• US Class Current: 606/87
• CPC Class Codes: A61B 17/1757 for the spine

Abstract

This disclosure is directed to minimally-invasive devices, methods and systems for treating vertebral diseases and injuries using multiple therapeutic procedures through small access portals of sufficient dimension that minimize trauma to the patient. More particularly, disclosed herein are devices, methods and systems for an intraosseous transiliac-transsacral surgical approach through the iliac ala and sacral ala that can be used for a variety of surgical procedures within the lumbar spine.

Claims

1. A method of accessing the lumbosacral region of a patient comprising percutaneously forming a bony pathway by inserting bone penetration instrumentation through a portion of an iliac ala, sacroiliac joint, and sacral ala to a region of a L5-S1 disc space.

2. The method of claim 1, wherein the bony pathway aligns generally parallel to a coronal plane of the L5-S1 disc space.

3. The method of claim 1, wherein the bony pathway approaches the L5-S1 disc space along a coronal plane of the L5-S1 disc space at an angle that is between about 5 and 40 degrees relative to an axial plane of the L5-S1 disc.

4. The method of claim 1, wherein the bony pathway approaches the L5-S1 disc space along a coronal plane of the L5-S1 disc space at an angle that is between about 5 and 20 degrees relative to an axial plane of the L5-S1 disc.

5. The method of claim 1, wherein the bony pathway approaches the L5-S1 disc space along a coronal plane of the L5-S1 disc space at an angle that is generally parallel to an axial plane of the L5-S1 disc.

6. The method of claim 1, further comprising percutaneously placing a guide instrument in a sacral pedicle.

7. The method of claim 6, wherein the guide instrument has a longitudinal axis that aligns with an axial plane of the L5-S1 disc space from a generally posterior to posterior-lateral aspect of the sacral pedicle to a generally anterior or anterior-medial aspect of the sacral pedicle.

8. The method of claim 7, further comprising attaching to the guide instrument a curvilinear frame comprising a port adjustably offset at an angle from the longitudinal axis of the guide instrument.

9. The method of claim 8, wherein the curvilinear frame provides an arcuate track along which the port provides a directed surgical path intersecting the longitudinal axis of the guide instrument at a location anterior to the sacral pedicle.

10. The method of claim 9, further comprising adjusting the port along the curvilinear frame such that the angle of the port relative to the longitudinal axis of the guide instrument is between about 50 and 100 degrees.

11. The method of claim 9, wherein inserting the bone penetration instrumentation through the port directs a distal end of the bone penetration instrumentation to contact the iliac ala.

12. The method of claim 1, further comprising performing disc excision in the L5-S1 disc space.

13. The method of claim 1, wherein the bone penetration instrumentation extends through the L5-S1 disc space to contact the vertebral body of L5 vertebra.

14. The method of claim 13, further comprising performing endplate decortication of the L5 vertebra.

15. The method of claim 1, further comprising inserting a lumbosacral transfixation construct through the bony pathway.

16. The method of claim 1, further comprising performing an intervention selected from the group consisting of intervertebral fixation, intervertebral distraction, intervertebral fusion, disc excision, arthroplasty and nucleoplasty.

17. The method of claim 1, further comprising percutaneously forming a bony pathway by inserting bone penetration instrumentation through a contra-lateral iliac ala, sacroiliac joint, and sacral ala to the region of the L5-S1 disc space.

18. The method of claim 17, wherein the contra-lateral bony pathway provides bilateral access to the region of the L5-S1 disc space.