SYSTEM AND METHOD FOR WIRE-GUIDED PEDICLE SCREW STABILIZATION OF SPINAL VERTEBRAE

• US 20110196429A1
• Filed: 09/30/2009
• Published: 08/11/2011
• Est. Priority Date: 10/01/2008
• Status: Active Grant

• Current Assignee: Sherwin Hua
• Original Assignee: Sherwin Hua
• Inventors: Hua, Sherwin
• Granted Patent: US 8,556,940 B2
• Time in Patent Office: Days
• US Class Current: 606/279
• CPC Class Codes: A61B 17/7001 Screws or hooks combined with longitudinal elements which do not contact vertebrae A61B17/7058 takes precedence
• CPC Class Codes: A61B 17/7002 Longitudinal elements, e.g. rods
• 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 17/7053 with parts attached to bones or to each other by flexible wires, straps, sutures or cables
• 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 17/8863 Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• CPC Class Codes: A61B 2090/392 Radioactive markers
• CPC Class Codes: A61B 2090/3937 Visible markers
• CPC Class Codes: A61B 2090/3941 Photoluminescent markers
• CPC Class Codes: A61B 2090/3954 magnetic, e.g. NMR or MRI
• CPC Class Codes: A61B 2090/3966 Radiopaque markers visible in an X-ray image
• CPC Class Codes: A61B 90/92 coded with colour

Abstract

An improved system and method for positioning screws and rods to immobilize bones is provided. Specifically, the system and method is optimal for performing transforaminal lumbar interbody fusion (TLIF) and other interbody fusions in the spine. The system involves pedicle screws detachably connected to wires that guide rods down to the screws. The wires are strong, narrow, flexible, adjustable in tension, and easily disconnected from the screws after rod placement via a process such as cutting, radiating, burning, dissolving, etc. The use of wires to place the rods avoids the conventional bulky tower apparatuses of the prior art while at the same time enhancing the accuracy of placement. One of the preferred methods involves relying upon the natural lordotic curvature of the spine and the narrow diameter of the wires to insert many elements through a single minimally invasive incision.

Claims

1-53. -53. (canceled)

54. A method of treating the spine, comprising:

making an incision in the skin of a patient to provide access to a spinal location;

delivering a first screw through the incision and into a first vertebra;

delivering a second screw through the same incision and into a second vertebra;

delivering a spinal fixation element through the incision into contact with the first and second screws, wherein the spinal fixation element is guided to the first and second screw by at least a first elongate guiding element extending away from the first screw and at least a second elongate guiding element extending away from the second screw, the first and second elongate guiding elements extending through the incision and overlapping with one another, wherein the first and second elongate guiding elements are capable of guiding the spinal fixation element towards the first and second screws at any orientation permitted geometrically by the guiding elements including an angle not parallel to a long axis of either of the guiding elements; and

locking the spinal fixation element to each of the screws.

55. The method of claim 54, wherein the first and second guiding elements intersect at the incision.

56. The method of claim 54, wherein the elongate guiding elements comprise at least one wire extending from the first screw and at least one wire extending from the second screw.

57. The method of claim 56, wherein the elongate guiding elements comprise at least one wire portion extending from each side of the first screw and at least one wire portion extending from each side of the second screw.

58. The method of claim 54, further comprising disconnecting the elongate guiding elements from the screws after locking the spinal fixation element to each of the screws.

59. The method of claim 54, wherein the first and second elongate guiding elements are attached to the first and second screws, respectively, through a mechanical clamp or device that securely holds respective screw heads, and the clamp or device is removed along with the guiding elements after the spinal fixation element is guided into contact and locked to each of the screws.

60. The method of claim 54, wherein at least one of the first and second elongate guiding elements comprises a rigid tower.

61. The method of claim 54, wherein both of the first and second elongate guiding elements comprise rigid towers.

62. The method of claim 54, wherein the first screw has a short tower attached thereto and a wire attached to the short tower, wherein when the first screw is delivered into the first vertebra, the short tower is positioned below the incision and the wire extends through the incision.

63. The method of claim 54, wherein locking the spinal fixation element to each of the screws comprises delivering a locking assembly to each of the screws using the elongate guiding elements.

64. The method of claim 54, further comprising guiding a tool to the first and second screws using one or more of the guiding elements.

65. The method of claim 64, wherein the tool is used to compress, distract, or reduce the relative positions of adjacent vertebrae.

66. The method of claim 54, wherein the spinal fixation element comprises a flexible connector that provides for dynamic stabilization.

67. The method of claim 54, wherein the spinal fixation element is a rod that provides for spinal fusion.

68. The method of claim 54, further comprising delivering one or more additional screws into additional vertebrae through the same incision or through additional incisions and delivering the spinal fixation element into contact with the one or more additional screws.

69. The method of claim 54, wherein the incision used to deliver the first and second screws is between 1 and 4 cm.

70. The method of claim 54, wherein the guiding elements intersect at an intersection point, and wherein the depths of each guiding element below the intersection point is measured and reflected above the intersection point to produce a virtual reflected image of the relative positions of the screws so that the length and contour of the spinal fixation element can be pre-bent or chosen by a surgeon to the correct curvature and size.

71. The method of claim 54, wherein locking the spinal fixation element to each of the screws is performed by a locking assembly present on each of the screws before the spinal fixation element is received by the screws.

72. A method of treating the spine, comprising:

providing an opening in the skin of a patient to provide access to a spinal location;

delivering a first screw through the opening and into a first vertebra, the first screw having a wire directly or indirectly attached to the first screw extending upwardly therefrom through the opening;

delivering a second screw through the opening and into a second vertebra, the second screw having a rigid tower detachably connected to the second screw extending upwardly from the second screw; and

delivering a spinal fixation element through the opening into contact with the first and second screws, wherein the spinal fixation element is guided to the first and second screw by at least one or both of the wire and the rigid tower.

73. The method of claim 72, wherein providing an opening comprises making a percutaneous or minimally invasive incision in skin, and wherein the first screw, second screw and spinal fixation element are delivered through the same percutaneous or minimally invasive skin incision.

74. The method of claim 72, wherein the rigid tower detachably connected to the second screw is a second tower, and wherein the first screw has detachably connected thereto an upwardly extending first tower with an upper end positioned below the opening when the first screw is delivered into the first vertebra, and the wire extends upwardly from the first tower through the opening.

75. The method of claim 74, wherein the second tower has an upper end positioned below the opening when the second screw is delivered into the second vertebra with a wire extending upwardly from the second tower through the opening.

76. The method of claim 74, wherein the second tower has an upper end positioned above the opening when the second screw is delivered into the second vertebra.

77. The method of claim 72, wherein the wire extending upwardly from the first screw is attached to an area within a head of the screw.

78. The method of claim 72, wherein at least one of the steps is performed by stereotactic guidance.

79. The method of claim 72, further comprising locking the spinal fixation element to each of the first and second screws.

80. The method of claim 72, wherein the wire extending upwardly from the first screw overlaps with a guiding element extending upwardly from the second screw when delivering a spinal fixation element through the opening.