DEVICES AND METHODS FOR MINIMALLY INVASIVE SPINAL STABILIZATION AND INSTRUMENTATION

• US 20170325970A1
• Filed: 06/12/2017
• Published: 11/16/2017
• Est. Priority Date: 12/07/2009
• Status: Active Grant

• Current Assignee: Samy Abdou Md
• Original Assignee: Samy Abdou Md
• Inventors: Abdou, Samy
• Granted Patent: US 10,543,107 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• 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 17/025 Joint distractors
• CPC Class Codes: A61B 17/1611 the two jaw elements being integral with respective elongate shaft elements
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/7032 Screws or hooks with U-shaped head or back through which longitudinal rods pass
• CPC Class Codes: A61B 17/7037 wherein pivoting is blocked when the rod is clamped
• CPC Class Codes: A61B 17/7077 for moving bone anchors attached to vertebrae, thereby displacing the vertebrae
• CPC Class Codes: A61B 17/7079 Tools requiring anchors to be already mounted on an implanted longitudinal or transverse element, e.g. where said element guides the anchor motion
• CPC Class Codes: A61B 17/708 with tubular extensions coaxially mounted on the bone anchors
• CPC Class Codes: A61B 17/7082 for driving, i.e. rotating, screws or screw parts specially adapted for spinal fixation, e.g. for driving polyaxial or tulip-headed screws driving other bone screws A61B17/8875
• 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 17/88 Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices A61B17/7074 takes precedence
• CPC Class Codes: A61B 2017/00473 Distal part, e.g. tip or head A61B2017/00464 takes precedence
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/564 Methods for bone or joint treatment
• CPC Class Codes: A61B 2017/681 Alignment, compression, or distraction mechanisms
• 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 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 2/4611 of spinal prostheses
• CPC Class Codes: A61F 2002/30131 : horseshoe- or crescent- or C-shaped or U-shaped
• CPC Class Codes: A61F 2002/30772 : Apertures or holes, e.g. of circular cross section
• 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 2002/4485 : comprising three or more adjacent spinal implants
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2310/00359 : Bone or bony tissue

Abstract

Described herein are devices and methods for fusion of adjacent vertebral bones using distractor platforms for exposure and resection of at least a portion of the facet joint, such as in performance of a TLiF procedure. In one embodiment, the distractor platform contains at least a first receptacle and/or extension adapted to couple to the implanted screw/bone marker and the method includes advancing a threaded segment of a bone fastener assembly into the identified first pedicle of the first vertebral bone, the first bone fastener assembly further comprises a second segment adapted to couple with a distraction platform adapted to concurrently attach onto at least one tissue retention blade and adapted to retain the tissue retention blade in the displaced position. Stabilization of a spinal segment is also provided by advancing a substantially concave orthopedic implant through an opening made in a posterior aspect of a disc space.

Claims

1-24. -24. (canceled)

25. A method for stabilization of a spinal segment, the spinal segment comprising a first vertebral bone, a second vertebral bone adjacent to the first vertebral bone, and an intervertebral disc space disposed between the first and second vertebral bones, the intervertebral disc space comprising an anterior surface and a posterior surface, the method comprising:

forming a corridor within tissues of a living subject utilizing a non-implantable tissue retractor, the corridor being positioned outside of the spinal segment;

exposing and removing a segment of a facet joint that couples the first and second vertebral bones;

advancing a first implant through the corridor so as to approach a posterior aspect of the intervertebral disc space at least partially through a transforaminal corridor, the transforaminal corridor being continuous with the corridor after the act of removing the segment of the facet joint;

creating an opening in an annulus fibrosus of the intervertebral disc space for insertion of the first implant into the intervertebral disc space, the opening in the annulus fibrosus being ipsilateral to the first facet joint;

advancing the first implant into the intervertebral disc space through the opening in the annulus fibrosis; and

advancing a second implant into the intervertebral disc space at least partially through the opening in the annulus fibrosus;

wherein the non-implantable tissue retractor comprises at least a distraction arm configured to selectively adjust at least one dimension of the corridor;

wherein a body of the first implant comprises a top surface and an opposing bottom surface that are connected by a first side surface and an opposing second side surface, the first side surface comprising a concave segment that extends inwardly towards the second side surface of the first implant;

wherein a body of the second implant comprises a top surface and an opposing bottom surface that are connected by a first side surface and an opposing second side surface, the first side surface of the second implant comprising a convex segment that extends outwardly and away from the second side surface of the second implant; and

wherein, after the acts of advancing the first and second implants into the intervertebral disc space, the first and second implant are positioned within the intervertebral disc space with the concave segment of the first implant facing the convex segment of the second implant.

26. The method of claim 25, wherein the non-implantable tissue retractor comprises an adjustment mechanism configured to enable enlargement of the corridor within the tissues outside of the spinal segment, and the method further comprises utilizing at least the adjustment mechanism to enlarge the corridor within the tissues outside of the spinal segment.

27. The method of claim 25, wherein, after the acts of advancing the first and second implants into the intervertebral disc space, the second side surface of the second implant is positioned to face the posterior surface of the intervertebral disc space.

28. The method of claim 25, after the acts of advancing the first and second implants into the intervertebral disc space, the second side surface of the first implant is positioned to face the anterior surface of the intervertebral disc space.

29. The method of claim 25, further comprising fastening a first fastener onto a first pedicle portion of the first vertebral bone, the first pedicle portion being ipsilateral to the facet joint.

30. The method of claim 29, further comprising fastening a second fastener onto a first pedicle portion of the second vertebral bone, the first pedicle portion being ipsilateral to the facet joint.

31. The method of claim 30, further comprising applying a distraction force to move the first fastener away from the second fastener during the act of advancing of the first implant into the intervertebral disc space.

32. The method of claim 30, further comprising interconnecting the first and second fasteners with and an interconnecting member after the act of advancing at least one of the first implant and the second implant into the intervertebral disc space.

33. The method of claim 30, further comprising fastening a third fastener onto a second pedicle portion of the first vertebral bone, the second pedicle portion of the first vertebral bone being contralateral to the facet joint.

34. The method of claim 33, further comprising fastening a fourth fastener onto a second pedicle portion of the second vertebral bone, the second pedicle portion of the second vertebral bone being contralateral to the facet joint.

35. The method of claim 34, further comprising interconnecting the third and fourth fasteners with an interconnecting member after at least one of the acts of advancing the first implant into the intervertebral disc space, and advancing the second implant into the intervertebral disc space.

36. The method of claim 25, further comprising using an orthopedic implant to fasten a spinous process of the first vertebral bone to a spinous process of the second vertebral bone after the act of advancing at least one of the first implant and the second implant into the intervertebral disc space.

37. The method of claim 25, further comprising placing a bone forming material within an internal cavity of the second implant, the bone forming material configured to provide a bony fusion between the first and second vertebral bones.

38. The method of claim 25, further comprising placing a bone forming material within the intervertebral disc space and outside of at least one of the first and second implants, the bone forming material enabling formation of a bony fusion between the first and second vertebral bones.

39. The method of claim 25, further comprising placing a bone forming material within the intervertebral disc space and between the first and second implants, the bone forming material promoting a bony fusion between the first and second vertebral bones.

40. The method of claim 25, wherein the act of advancing the first implant into the intervertebral disc space through the opening in the annulus fibrosus comprises:

advancing an anterior surface of the first implant through the opening in the annulus fibrosus and into the intervertebral disc space with at least a remainder of the first implant being positioned outside of the intervertebral disc space, the anterior surface (i) comprising one end of the first implant, and (ii) positioned between the first and second side surfaces of the first implant; and

advancing the remainder of the first implant into the intervertebral disc space via a curvilinear trajectory having a center of rotation positioned outside of the body of the first implant.

41. The method of claim 25, wherein the act of advancing the second implant at least partially into the intervertebral disc space through the opening in the annulus fibrosus comprises:

advancing an anterior surface of the second implant through the opening in the annulus fibrosus and into the intervertebral disc space with at least a remainder of the second implant being positioned outside of the intervertebral disc space, the anterior surface (i) comprising one end of the second implant, and (ii) positioned between the first and second side surfaces of the second implant; and

advancing the remainder of the second implant into the intervertebral disc space via a curvilinear trajectory having a center of rotation that is positioned outside of the body of the second implant.

42. A method for stabilization of a spinal segment, the spinal segment comprising a first vertebral bone, a second vertebral bone adjacent to the first vertebral bone, and an intervertebral disc space disposed between the first and second vertebral bones, the intervertebral disc space comprising an anterior surface and a posterior surface, the method comprising:

creating a corridor within tissues of a subject utilizing a non-implantable tissue retractor, the corridor being positioned outside of the spinal segment and extending between a skin surface of the subject and the spinal segment;

approaching a posterior surface of the intervertebral disc space;

creating an opening in a posterior aspect of an annulus fibrosus of the intervertebral disc space;

advancing a first implant into the intervertebral disc space through the opening in the annulus fibrosus; and

advancing a second implant into the intervertebral disc space through the opening in the annulus fibrosus;

wherein the non-implantable tissue retractor is positioned outside of the intervertebral disc space during the acts of advancing the first and second implants into the intervertebral disc space;

wherein a body of the second implant comprises a top surface and an opposing bottom surface that are connected by a first side surface and an opposing second side surface, the first side surface comprising a concave segment that extends inwardly and towards the second side surface of the second implant; and

wherein, after the act of advancing of the second implant into the intervertebral disc space, the second implant is positioned within the intervertebral disc space with the concave segment of the first side surface oriented toward the posterior surface of the intervertebral disc space.

43. The method of claim 42, wherein, after the acts of advancing the first and second implants into the intervertebral disc space, the first side surface of the second implant is positioned to face the anterior surface of the intervertebral disc space.

44. The method of claim 42, wherein a body of the first implant comprises a top surface and an opposing bottom surface that are connected by a first side surface and an opposing second surface, the first side surface of the first implant comprising a convex segment that extends outwardly and away from the second side surface of the first implant.

45. The method of claim 44, wherein, after the acts of advancing the first and second implants into the intervertebral disc space, the first and second implant are positioned within the intervertebral disc space with the concave segment of the second implant facing the convex segment of the first implant.

46. The method of claim 44, wherein, after the acts of advancing the first and second implants into the intervertebral disc space, the second side surface of the first implant is positioned to face the posterior surface of the intervertebral disc space.

47. The method of claim 42, further comprising using a transforminal approach to access the posterior aspect of the annulus fibrosus.

48. The method of claim 42, wherein the non-implantable tissue retractor comprises an adjustment mechanism configured to enable enlargement of the corridor within the tissues outside of the spinal segment, and the method further comprises utilizing at least the adjustment mechanism to enlarge the corridor within the tissues outside of the spinal segment.

49. The method of claim 42, further comprising removing at least a portion of a facet joint in order to access the posterior aspect of the annulus fibrosus, the facet joint being an articulation between the first and second vertebral bones.

50. The method of claim 49, further comprising fastening a first fastener onto a first pedicle portion of the first vertebral bone, the first pedicle portion being ipsilateral to the facet joint.

51. The method of claim 50, further comprising fastening a second fastener onto a first pedicle portion of the second vertebral bone, the first pedicle portion of the second vertebral bone being ipsilateral to the facet joint.

52. The method of claim 51, further comprising applying a distraction force to move the first fastener away from the second fastener before or during the act of advancing of the first implant into the intervertebral disc space.

53. The method of claim 51, further comprising interconnecting the first and second fasteners with and an interconnecting member after the act of advancing at least one of the first implant and the second implant into the intervertebral disc space.

54. The method of claim 51, further comprising fastening a third fastener onto a second pedicle portion of the first vertebral bone, the second pedicle portion of the first vertebral bone being contralateral to the facet joint.

55. The method of claim 54, further comprising fastening a fourth fastener onto a second pedicle portion of the second vertebral bone, the second pedicle portion of the second vertebral bone being contralateral to the facet joint.

56. The method of claim 55, further comprising interconnecting the third and fourth fasteners with an interconnecting member.

57. The method of claim 42, further comprising using an orthopedic implant to fasten a spinous process of the first vertebral bone to a spinous process of the second vertebral bone.

58. The method of claim 42, further comprising placing a bone forming material within an internal cavity of the second implant, the bone forming material configured to facilitate a bony fusion between the first and second vertebral bones.

59. The method of claim 42, further comprising placing a bone forming material within the intervertebral disc space and outside of at least one of the first and second implants, the bone forming material promoting formation of a bony fusion between the first and second vertebral bones.

60. The method of claim 42, further comprising placing a bone forming material within the intervertebral disc space and between the first and second implants, the bone forming material configured to promote formation of a bony fusion between the first and second vertebral bones.

61. The method of claim 42, wherein the act of advancing the first implant into the intervertebral disc space through the opening in the annulus fibrosus comprises:

advancing an anterior surface of the first implant through the opening in the annulus fibrosus and into the intervertebral disc space with at least a remainder of the first implant being positioned outside of the intervertebral disc space, the anterior surface (i) comprising one end of the first implant and (ii) positioned between the first and second side surfaces of the first implant; and

advancing the remainder of the first implant into the intervertebral disc space via a curvilinear trajectory having a center of rotation positioned outside of the body of the first implant.

62. The method of claim 42, wherein the act of advancing the second implant into the intervertebral disc space through the opening in the annulus fibrosus comprises:

advancing an anterior surface of the second implant through the opening in the annulus fibrosus and into the intervertebral disc space with at least a remainder of the second implant being positioned outside of the intervertebral disc space, the anterior surface (i) comprising one end of the second implant and (ii) positioned between the first and second side surfaces of the second implant; and

advancing the remainder of the second implant into the intervertebral disc space via a curvilinear trajectory having a center of rotation that is positioned outside of the body of the second implant.

63. A method for stabilization of a segment of a spinal column, the segment comprising a first vertebral bone, a second vertebral bone adjacent to the first vertebral bone, and an intervertebral disc space disposed between the first and second vertebral bones, the intervertebral disc space comprising an anterior surface and a posterior surface, the method comprising:

creating a corridor within tissues of a subject utilizing a non-implantable tissue retractor, the corridor being positioned outside of the segment of the spinal column and extending between a skin surface of the subject and the spinal segment;

removing a segment of a facet joint that couples the first and second vertebral bones;

creating an opening in a posterior aspect of an annulus fibrosus of the intervertebral disc space, the opening in the annulus fibrosus being ipsilateral to the first facet joint;

positioning a leading segment of a first implant at the opening in the posterior aspect of the annulus fibrosus; and

advancing a remaining segment of the first implant into the intervertebral disc space along a curvilinear trajectory formed within an axial plane of the intervertebral disc space, the curvilinear trajectory forming an arc centered about a central axis that extends along a direction of a longitudinal axis of the spinal column;

wherein a body of the first implant comprises a top surface and an opposing bottom surface that are connected by a first side surface and an opposing second side surface, the first side surface comprising a convex segment that extends outwardly and away from the second side surface of the second implant; and

wherein the central axis of the curvilinear trajectory is positioned outside of the first implant during the act of advancing the first implant into the intervertebral disc space.

64. The method of claim 63, further comprising fastening a first fastener onto a first pedicle portion of the first vertebral bone, the first pedicle portion being ipsilateral to the facet joint.

65. The method of claim 64, further comprising fastening a second fastener onto a first pedicle portion of the second vertebral bone, the first pedicle portion of the second vertebral bone being ipsilateral to the facet joint.

66. The method of claim 65, further comprising interconnecting the first and second fasteners with and an interconnecting member after the act of advancing the first implant into the intervertebral disc space.

67. The method of claim 65, further comprising fastening a third fastener onto a second pedicle portion of the first vertebral bone, the second pedicle portion of the first vertebral bone being contralateral to the facet joint.

68. The method of claim 67, further comprising fastening a fourth fastener onto a second pedicle portion of the second vertebral bone, the second pedicle portion of the second vertebral bone being contralateral to the facet joint.

69. The method of claim 68, further comprising interconnecting the third and fourth fasteners with an interconnecting member.

70. The method of claim 63, further comprising placing a bone forming material within an internal cavity of the first implant, the bone forming material promoting formation of a bony fusion between the first and second vertebral bones.

71. The method of claim 63, further comprising placing a bone forming material within the intervertebral disc space and at least partially outside of the first implant, the bone forming material promoting formation of a bony fusion between the first and second vertebral bones.