MODULAR SURGICAL INSTRUMENTS AND RELATED METHODS

• US 20190069934A1
• Filed: 09/05/2017
• Published: 03/07/2019
• Est. Priority Date: 09/05/2017
• Status: Active Grant

• Current Assignee: Medos International Sarl (Johnson & Johnson)
• Original Assignee: Medos International Sarl (Johnson & Johnson)
• Inventors: Mickiewicz, Christopher, Gracia, Mark, Runco, Thomas, Batchelor, Sarah, Fournier, Richard
• Granted Patent: US 10,610,269 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/7001 Screws or hooks combined with longitudinal elements which do not contact vertebrae A61B17/7058 takes precedence
• CPC Class Codes: A61B 17/7032 Screws or hooks with U-shaped head or back through which longitudinal rods pass
• CPC Class Codes: A61B 17/7076 for driving, positioning or assembling spinal clamps or bone anchors specially adapted for spinal fixation
• 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 17/7085 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 17/861 specially shaped for gripping driver
• CPC Class Codes: A61B 2017/0046 with a releasable handle; with handle and operating part separable
• CPC Class Codes: A61B 2090/037 with a frangible part, e.g. by reduced diameter

Abstract

Modular surgical instruments and related methods are disclosed herein, e.g., for performing rod reduction, derotation, and/or set screw insertion during spinal surgery. An exemplary system can include an instrument body configured to couple to a bone anchor assembly to provide a modular platform for carrying out various steps of a surgical procedure. For example, the instrument body can receive a reduction instrument therethrough for reducing a spinal rod into the bone anchor assembly. A derotation instrument can be attached to the reduction instrument for performing derotation maneuvers or applying other manipulation forces. A modular driver or handle adapter can be attached to the reduction instrument and/or to the derotation instrument to facilitate rod reduction. Any of the instrument body, the reduction instrument, and the derotation instrument can include a working channel therethrough. A set screw or closure mechanism, and a driver instrument for applying the set screw or closure mechanism to the bone anchor assembly, can be inserted through the working channel.

Claims

1. A surgical instrument, comprising:

a housing having a central opening, a proximal end, a distal end, and a central longitudinal axis A1 extending between the proximal and distal ends;

first and second fixed arms extending distally from the housing;

first and second pivoting arms movably coupled to the housing, each pivoting arm having a proximal end and a distal end, the pivoting arms being configured to selectively retain a bone anchor therebetween; and

a locking member that is movable relative to the housing between a locked position and an unlocked position, wherein;

in the locked position, a blocking portion of the locking member is aligned with the pivoting arms and interferes with movement of the pivoting arms relative to the housing; and

in the unlocked position, a relief portion of the locking member is aligned with the pivoting arms such that the arms are free to move relative to the housing.

2. The instrument of claim 1, wherein the pivoting arms are mounted in recesses formed in the fixed arms.

3. The instrument of claim 1, wherein the pivoting arms are pivotally coupled to the housing at a location intermediate the proximal and distal ends of the pivoting arms.

4. The instrument of claim 1, wherein the blocking and relief portions of the locking member are positionable adjacent to and radially-inward from the proximal ends of the pivoting arms.

5. The instrument of claim 1, wherein the locking member comprises a ring that is rotatable relative to the housing about the axis A1 to move between the locked and unlocked positions.

6. The instrument of claim 1, wherein the locking member comprises a ring that is translatable relative to the housing along the axis A1 to move between the locked and unlocked positions.

7. The instrument of claim 1, wherein the housing comprises a tubular central portion with opposed wings extending laterally therefrom, the pivoting arms being mounted in the opposed wings.

8. The instrument of claim 1, wherein the locking member includes a biased mating tab that selectively engages recesses formed in a sidewall of the housing to maintain a position of the locking member relative to the housing.

9. The instrument of claim 1, further comprising a reducer shaft threadably mounted in the central opening of the housing.

10. The instrument of claim 9, wherein the reducer shaft comprises a first portion having an exterior thread and being configured to rotate relative to the housing to advance the reducer shaft distally relative to the housing.

11. The instrument of claim 10, wherein the reducer shaft comprises a second portion that is rotationally-fixed relative to the housing, the second portion comprising a distal-facing rod-engaging surface.

12. The instrument of claim 11, wherein the first portion includes one or more resilient arms engaged with a circumferential groove formed in an interior surface of the second portion.

13. The instrument of claim 9, wherein the reducer shaft defines a working channel extending therethrough.

14. The instrument of claim 9, wherein the reducer shaft comprises a drive interface at a proximal end of the reducer shaft.

15. The instrument of claim 9, further comprising a derotation shaft selectively attachable to the reducer shaft.

16. The instrument of claim 15, wherein the derotation shaft comprises an elongate body defining a working channel extending therethrough, the working channel of the derotation shaft being in communication with a working channel of the reducer shaft and the central opening of the housing.

17. The instrument of claim 15, wherein the derotation shaft includes opposed hinged arms and a locking ring, wherein the locking ring is movable between a locked position in which the locking ring urges the hinged arms radially inward to engage a groove formed in the reducer shaft and an unlocked position in which the hinged arms can move radially outward to disengage from the groove of the reducer shaft.

18. The instrument of claim 15, wherein the derotation shaft comprises a drive interface at a proximal end of the derotation shaft.

19. A surgical method, comprising:

implanting a bone anchor in a bone of a patient, the bone anchor comprising a receiver member having a rod seat;

positioning an instrument body in an unlocked configuration, the instrument body having a housing, opposed fixed arms extending distally from the housing and defining a rod slot therebetween, opposed pivoting arms movably coupled to the housing, a locking member, and a working channel extending through the instrument body, wherein the pivoting arms are free to pivot relative to the housing when the instrument body is in the unlocked configuration;

moving distal ends of the pivoting arms apart from one another;

positioning the bone anchor between the fixed arms of the instrument body such that the rod slot of the instrument body is aligned with the rod seat of the bone anchor;

moving the distal ends of the pivoting arms towards one another to engage a mating feature of the bone anchor;

positioning the instrument body in a locked configuration, wherein the locking member interferes with movement of the pivoting arms relative to the housing when the instrument body is in the locked configuration, thereby preventing the pivoting arms from disengaging from the mating feature of the bone anchor.

20. The method of claim 19, further comprising placing a rod within the rod slot and advancing a reducer shaft through the working channel of the instrument body to urge the rod distally into the rod seat of the bone anchor.

21. The method of claim 20, further comprising attaching a handle or driver adapter to the reducer shaft and applying torque to the handle or driver adapter to rotate the reducer shaft.

22. The method of claim 20, further comprising inserting a set screw through a working channel of the reducer shaft and through the working channel of the instrument body and securing the set screw to the bone anchor.

23. The method of claim 22, wherein a step of reducing the rod into the rod seat and a step of securing the set screw to the bone anchor are performed without disconnecting the instrument body from the bone anchor between said steps.

24. The method of claim 20, further comprising attaching a derotation shaft to the reducer shaft and applying a manipulation force to the derotation shaft to reposition the bone of the patient.

25. The method of claim 24, further comprising inserting a set screw through a working channel of the derotation shaft, through a working channel of the reducer shaft, and through the working channel of the instrument body, and securing the set screw to the bone anchor.

26. The method of claim 25, wherein a step of applying the manipulation force, a step of reducing the rod into the rod seat, and a step of securing the set screw to the bone anchor are performed without disconnecting the instrument body from the bone anchor between said steps.

27. The method of claim 24, wherein attaching the derotation shaft comprises inserting a male drive interface of the reducer shaft into a female drive interface of the derotation shaft.

28. The method of claim 24, wherein attaching the derotation shaft comprises moving hinged arms of the derotation shaft into engagement with a groove formed in the reducer shaft.

29. The method of claim 28, wherein the hinged arms are moved into engagement with the groove by rotating or axially translating a locking ring along an exterior surface of the derotation shaft.

30. The method of claim 24, further comprising attaching a handle or driver adapter to the derotation shaft and applying torque to the handle or driver adapter to rotate the derotation shaft and the reducer shaft.

31. The method of claim 19, wherein the bone anchor is implanted after attaching the instrument body to the bone anchor.

32. The method of claim 19, wherein the bone anchor is implanted using a driver shaft inserted through the working channel of the instrument body while the instrument body is attached to the bone anchor.