Spinal stabilization surgical method

• US 5,489,307 A
• Filed: 09/01/1994
• Issued: 02/06/1996
• Est. Priority Date: 02/10/1993
• Status: Expired

• Current Assignee: Zimmer Spine, Inc. (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Spine-Tech, Inc. (Sulzer Medica)
• Inventors: Kohrs, Douglas W., Kuslich, Stephen D.
• Primary Examiner(s): Willse, David H.
• Application Number:
  US08/299,807
• Time in Patent Office: 523 Days
• Field of Search: 623/17, 606/61, 606/87, 606/96, 606/90, 606/99
• US Class Current: 128/898
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/86 Pins or screws or threaded wires; nuts therefor A61B17/72 take precedence
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61F 2/30723 Plugs or restrictors for sealing a cement-receiving space tools for inserting plugs A61F2/4614; sealing collars for use during cementing A61B17/8808
• CPC Class Codes: A61F 2/30744 End caps, e.g. for closing an endoprosthetic cavity
• 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 2/446 having a circular or elliptical cross-section substantially parallel to the axis of the spine, e.g. cylinders or frustocones
• CPC Class Codes: A61F 2/4611 of spinal prostheses
• CPC Class Codes: A61F 2/4637 for connecting or disconnecting two parts of a prosthesis
• CPC Class Codes: A61F 2002/2835 Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30235 tubular, e.g. sleeves
• CPC Class Codes: A61F 2002/305 Snap connection
• CPC Class Codes: A61F 2002/30593 hollow
• CPC Class Codes: A61F 2002/30672 temporary
• CPC Class Codes: A61F 2002/30785 parallel
• CPC Class Codes: A61F 2002/30787 inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/3085 with a threaded, e.g. self-tapping, bone-engaging surface, e.g. external surface
• CPC Class Codes: A61F 2002/30861 having threads of increasing or decreasing height
• CPC Class Codes: A61F 2002/30868 Square, rectangular or rhomboidal threads
• CPC Class Codes: A61F 2002/448 : comprising multiple adjacent spinal implants within the same intervertebral space or within the same vertebra, e.g. comprising two adjacent spinal implants
• CPC Class Codes: A61F 2002/4681 : by applying mechanical shocks, e.g. by hammering
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2230/0069 : cylindrical

Abstract

Spinal fusion implants are inserted into a disc space of disc material separating first and second vertebrae by forming bores between the vertebrae. A distraction spacer is temporarily put in place on one side of the vertebrae while a bore is being formed on an opposite side of the vertebrae.

Claims

1. A surgical method for implanting at least two spinal fusion implants into a disc space of disc material separating a first and second vertebrae, said disc space and first and second vertebrae divisible into first and second sides separated by a sagittal plane, said method comprising the steps of:

(a) inserting a rigid distraction spacer into said disc space at a desired first implant location on said first side with said first distraction spacer sized for external surfaces of said first distraction spacer to act against first and second end plates of said first and second vertebrae, respectively, to urge said first and second vertebrae apart upon said insertion, said spacer inserted for said spacer to be recessed within said space so as not to substantially protrude beyond said space;

(b) placing a guide at said second side while maintaining distraction at said first implant location with said distraction spacer and with said guide adapted to direct tools axially through an axis parallel to and equidistant between opposing end plates of said first and second vertebrae;

(c) forming a second implant bore at a desired second implant location by removing bone material from said first and second vertebrae and by removing disc material at said second implant location with said second implant bore sized to receive said second implant, said forming of said second bore utilizing at least a first boring tool guided by said guide;

(d) implanting said second implant into said second implant bore;

(e) removing first distraction spacer and applying a guide to said first side;

(f) forming a first implant bore at said desired first location by removing bone material from said first and second vertebrae and by removing disc material at said first implant location with said first bore sized to receive said first implant, said forming of said first bore utilizing at least a first boring tool guided by said guide at said first side; and

(g) implanting said first implant into said first implant bore.

2. A method according to claim 1 wherein said step of placing a guide at said second side includes:

(a) providing a guide tube having an open first end and an open second end with attachment means on said first end for securing said first end to said first and second vertebrae;

(b) placing said first end against said first and second vertebrae with said guide tube aligned with said second implant location.

3. A method according to claim 2 wherein said step of forming said second bore includes inserting a boring tool into said guide tube with said boring tool sized to form said second implant bore and operating said boring tool to bore into and remove said bone material while guiding said boring tool with said guide tube.

4. A method according to claim 2 wherein said implant is inserted through said guide tube.

5. A method wherein according to claim 1 wherein said step of applying said guide to said first side includes:

(a) providing a guide tube having an open first end and open second end with attachment means on said first end for securing said first end to said first and second vertebrae;

(b) urging said end against said first and second vertebrae with said guide tube aligned with said first implant location.

6. A method according to claim 1 wherein said step of placing said guide at said second side includes inserting a guide pin into said disc space at said second implant location with the guide pin selected to be of a size approximate to a size of said distraction spacer;

providing a guide tube having an open first end and an open second end with attachment means on said first end for securing said first end to said first and second vertebrae;

urging said first end against said first and second vertebrae with said tube aligned by said guide pin to be in alignment with said second implant location.

7. A method according to claim 6 wherein said step of forming said second implant bore includes removing said guide pin through said guide tube after said urging of said first end against said first and second vertebrae and inserting a boring tool into said guide tube with said boring tool sized to form said second implant bore and operating said boring tool to bore into and remove said bone material while guiding said boring tool with said guide tube.

8. A method according to claim 6 wherein a guide pin of a size substantially equal to said guide pin used to align said guide tube is secured to a boring tool to prebore said second implant bore with said tool and attached guide pin inserted into said guide tube and operated to partially bore into said vertebrae to a desired depth.

9. A method according to claim 6 comprising providing a tube guide attached to said guide pin and passing said guide tube over said tube guide to place said tube against said vertebrae in a desired position with said tube guide aligning said guide tube.

10. A method according to claim 8 wherein said desired depth is less than a finished depth, removing said boring tool and attached guide pin through said guide tube and inserting a finish boring tool into said guide tube and operating said finish boring tool to finally bore form a finished bore between said vertebrae.

11. A method according to claim 1 wherein said distraction spacer is inserted into said desired first implant location to a depth sufficient to move a patient'"'"'s anatomical features toward said first implant location without interference from said distraction spacer.

12. A surgical method for implanting at least two spinal fusion implants into a disc space of disc material separating a first and second vertebrae, said disc space and first and second vertebrae divisible into first and second sides divided by a sagittal plane;

said method comprising the steps of;

(a) placing a distraction spacer between said vertebrae at one of said sides with said distraction spacer having a fixed size for external surfaces of said distraction spacer acting against first and second end plates of said first and second vertebrae, respectively, to distract said vertebrae as said distraction spacer is inserted into said disc space;

(b) forming a first implant receiving bore in the other of said sides while retaining said distraction plug in place at said one of said sides, said forming including using a guide pin having external surfaces spaced apart substantially equal to a spacing of said external surfaces of said distraction spacer to place a guide at said other of said sides to guide a boring tool along an axis parallel to and equally spaced from end plates of said vertebrae, said forming further including inserting said guide pin into said disc space with said external surfaces of said guide pin guided by said end plates for said guide pin to be centrally positioned between said vertebrae and with an axis of said guide pin substantially parallel to said end plates.

13. A method according to claim 12 comprising inserting a first implant into said first bore and removing said distraction spacer and forming a second finished bore in said one of said sides sized to receive a second implant and placing said second implant in said second bore.

14. A method according to claim 13 wherein said bores are formed on a posterior side of said vertebrae.

15. A method according to claim 13 wherein said bores are formed on an anterior side of said vertebrae.

16. A method according to claim 13 wherein said bores are formed laparoscopically.

17. A method according to claim 12 wherein said distraction spacer is placed between said vertebrae to a depth sufficient to move a patient'"'"'s anatomical features toward a location of insertion of said distraction spacer without interference from distraction spacer.

18. A method for implanting a spinal fusion implant into a disc space of disc material separating opposing end plates of a first and second vertebrae, said method comprising the steps of:

(a) securing a guide pin to a drill tube guide of predetermined dimensions with said guide pin sized approximate to a desired distraction of said vertebrae and inserting said guide pin into said disc space with external surfaces of said guide pin guided by said end plates for said guide pin to be centrally positioned between said vertebrae and with an axis of said guide pin substantially parallel to said end plates;

(b) placing a guide tube over said drill tube guide and securing said guide tube to said first and second vertebrae;

(c) removing said guide pin and said drill tube guide through said guide tube while retaining said guide tube secured to said first and second vertebrae;

(d) boring an implant bore between said first and second vertebrae by inserting a boring tool into said guide tube, said boring including providing a boring tool with a guide pin, sized substantially equally to said guide pin secured to said drill tube guide, secured to said boring tool for movement therewith and at least partially boring said bore with said guide pin guiding said boring tool between said vertebrae.

19. A surgical method for implanting a spinal fusion implant into a disc space of disc material separating opposing end plates of a first and a second vertebrae, said method comprising the steps of:

at least partially forming a bore for receiving said implant by inserting a boring tool into said disc space and rotating said tool to at least partially bore into each of said first and second vertebrae, said forming including providing a guide on a distal end of said boring tool with said guide having diametrically opposite external surfaces spaced apart a distance equal to a desired distraction of said vertebrae, said guide secured to said boring tool for movement therewith, said forming further including inserting said guide between said end plates with said end plates guiding said external surfaces to retain said guide centrally positioned between said end plates and with an axis of said guide generally parallel to said end plates, said forming still further including advancing said boring tool into said disc spacing with said guide maintaining an axis of said boring tool generally coaxial with-said axis of said guide.

20. A surgical method for implanting a spinal fusion implant into a disc space for disc material separating opposing end plates of a first and second vertebrae, said method comprising the steps of:

providing a guide tool having external dimensions sized to be received within a guide tube and having a guide pin on a distal end of said guide tool with said guide pin having external surfaces spaced apart approximate to said desired distraction;

inserting said guide pin into said disc space with said end plates guiding said external surfaces for said end plates to retain an axis of said guide pin and said guide tool generally parallel to and centrally received between said vertebrae and with said vertebrae distracted at least after insertion of said tool;

providing said guide tube with teeth on a distal end thereof and placing said guide tube over said guide tool with said teeth opposing said vertebrae and with said guide tool maintaining an axis of said guide tube generally parallel to and centrally received between said vertebrae;

urging said guide tube distal end against said vertebrae for said teeth to penetrate into said vertebrae;

placing a protective sleeve over an exterior of said guide tube before urging said guide tube distal end against said vertebrae with said sleeve sized to move slidably on said guide tube in a direction generally parallel to said axis of said guide tube and with said sleeve having a blunt distal end extending beyond and cover said teeth;

said urging including said blunt distal end against said vertebrae and urging said teeth into said vertebrae whereby said blunt distal end covers said teeth and abuts said vertebrae until said teeth penetrate into said vertebrae; and

removing said guide pin and said guide tool through said guide tube.