Surgical instruments useful for endoscopic spinal procedures

• US 5,697,889 A
• Filed: 05/05/1995
• Issued: 12/16/1997
• Est. Priority Date: 03/16/1994
• Status: Expired due to Term

• Current Assignee: Gus J. Slotman, United States Surgical Corporation (Medtronic Plc), Sherman Stein
• Original Assignee: Gus J. Slotman, United States Surgical Corporation (Medtronic Plc), Sherman Stein
• Inventors: Stein, Sherman, Castro, Salvatore, Ratcliff, Keith, Slotman, Gus J., Green, David T., Mililli, Carlo A.
• Primary Examiner(s): FLANAGAN, BEVERLY MEINDL
• Application Number:
  US08/435,511
• Time in Patent Office: 956 Days
• Field of Search: 600/184, 600/190, 600/196, 600/201, 600/204, 600/210, 600/215, 600/218, 600/219, 600/222, 600/225, 600/235, 606/191, 606/205, 606/206, 606/207, 606/60, 606/61, 606/86, 606/105
• US Class Current: 600/204
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/2936 Pins in guiding slots
• CPC Class Codes: A61B 2017/2943 Toothed members, e.g. rack and pinion
• CPC Class Codes: A61B 2017/2944 Translation of jaw members
• 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 2002/4635 using minimally invasive surgery

Abstract

The present invention provides endoscopic instrumentation and surgical techniques especially useful for accessing at least a portion of an intervertebral disc. Vertebrae spreading instruments are provided for spreading adjacent vertebrae to facilitate access to the intervertebral disc are. The disclosed surgical method uses an anterior approach to access the intervertebral disc and spreads adjacent vertebrae utilizing an endoscopic vertebrae spreading instrument.

Claims

1. An endoscopic surgical instrument for spreading vertebrae comprising:

a handle portion including an actuation member for manipulating an actuation mechanism;

an elongated endoscopic section defining a longitudinal axis and extending distally from said handle portion;

said actuation mechanism at least partially extending within said elongated endoscopic section and movable in response to movement of said actuation member; and

a vertebrae spreading mechanism operatively associated with a distal end of said endoscopic section and movable between open and closed positions by said actuation mechanism in response to movement of said actuation member, said vertebrae spreading mechanism including at least two vertebrae spreading arm members having exterior tissue contacting surfaces, each tissue contacting surface longitudinally extending along a major portion of the length of a respective arm member, said tissue contacting surfaces obliquely oriented relative to said longitudinal axis when in said closed position of said vertebrae spreading mechanism to define a reduced profile of said vertebrae spreading mechanism to facilitate insertion within adjacent vertebrae.

2. An endoscopic surgical instrument according to claim 1 wherein said at least two vertebrae spreading arm members are pivotal between said open and closed positions.

3. An endoscopic surgical instrument according to claim 2 wherein said at least two vertebrae spreading arm members include camming slots operatively associated with said actuation mechanism for movement of said arm members between said open and closed positions.

4. An endoscopic surgical instrument according to claim 3 wherein said actuation mechanism includes an actuation rod coaxially reciprocable within said endoscopic section, said actuation rod including means interfitting with said arm members camming slots, said interfitting means moving said arm members between said open and closed positions.

5. An endoscopic surgical instrument according to claim 1 wherein said tissue contacting surfaces are obliquely oriented relative to said longitudinal axis when in said open position of said vertebrae spreading mechanism.

6. An endoscopic surgical instrument according to claim 1 wherein said tissue contacting surfaces of a first arm member and a second arm member are respectively oriented at positive and negative oblique angles with respect to said longitudinal axis when in said closed position.

7. An endoscopic surgical instrument for spreading tissue such as the vertebrae which comprises:

a handle portion;

an elongated portion extending distally from said handle portion and defining a longitudinal axis;

a tissue spreading mechanism supported at a distal end of said elongated portion, said tissue spreading mechanism including at least two spreading members, said tissue spreading mechanism moveable between a first closed position wherein said first and second tissue spreading members are generally adjacent each other and a second at least partially open position wherein said tissue spreading members are displaced from each other;

each of said spreading members having an inner surface adjacent the opposing spreading member and an outer surface, said outer surface including a longitudinally extending tissue gripping surface, each said spreading member defining a cross-sectional dimension which gradually increases from distal to proximal over a major portion of its length such that said tissue gripping surfaces are obliquely oriented relative to said longitudinal axis when in said first position; and

an actuating mechanism for moving said at least two spreading members between said first position and said second position.

8. An endoscopic surgical instrument according to claim 7 wherein said actuating mechanism comprises:

a rod member adapted to reciprocally slide within said elongated portion; and

a linkage mechanism supported at a distal end of said rod member and operatively connecting said rod member with said tissue spreading mechanism such that distal axial movement of said rod member causes said at least two spreading members to move to said second open position and proximal movement of said rod member causes said at least two spreading members to move to said first closed position.

9. An endoscopic surgical instrument according to claim 7, wherein each of said spreading members is composed of a material of sufficient rigidity to spread the vertebrae when moved to said open position.

10. An endoscopic surgical instrument according to claim 9, wherein each said spreading member defines a cross-sectional dimension at a distal end thereof which is less than a cross-sectional dimension defined at a proximal end thereof.

11. An endoscopic surgical instrument according to claim 9, wherein said actuation member pivots said spreading members with respect to said longitudinal axis.

12. An endoscopic surgical instrument according to claim 11, wherein said actuation member comprises a rotatable knob.

13. An endoscopic surgical instrument according to claim 7 wherein said tissue gripping surfaces of each said spreading members include irregularities to facilitate engagement with tissue.

14. An endoscopic surgical instrument for spreading vertebrae, which comprises:

a handle portion including a frame dimensioned to be grasped by the hand of a user and an actuating member movably mounted to the frame;

an elongated portion connected to the frame and having proximal and distal ends;

a tissue spreading assembly mounted to the distal end of the elongated portion and defining a longitudinal axis, the tissue spreading assembly including first and second tissue spreading members mounted for movement between a closed position and an at least partially open position, the first and second tissue spreading members each having an outer engaging surface extending along a major portion of the length thereof, the outer engaging surfaces of the first and second tissue spreading members being angularly oriented at respective positive and negative acute angles relative to said longitudinal axis when in said closed position thereof to thereby define a reduced profile of the tissue spreading assembly to facilitate insertion between adjacent vertebrae; and

an actuator mounted to the handle portion and operatively connected to the tissue spreading assembly, the actuator movable to cause movement of the first and second tissue spreading members between the closed and open positions.

15. The endoscopic surgical instrument according to claim 14 wherein the outer engaging surfaces include irregularities to facilitate engagement with the adjacent vertebrae.

16. The endoscopic surgical instrument according to claim 14 wherein the outer engaging surfaces of the first and second tissue spreading members are in general parallel relation when in the at least partially open position.

17. An endoscopic surgical instrument for spreading vertebrae, which comprises:

a handle portion including a frame dimensioned to be grasped by the hand of a user and an actuating member movably mounted to the frame;

an elongated portion connected to the frame and having proximal and distal ends;

a tissue spreading assembly mounted to the distal end of the elongated portion and defining a longitudinal axis, the tissue spreading assembly including first and second tissue spreading members mounted for movement between a closed position and an at least partially open position, the first and second tissue spreading members each having an inner surface adjacent the other spreading member and an outer engaging surface, the outer engaging surfaces of the first and second tissue spreading member each lying in a plane angularly oriented relative to said longitudinal axis when in said closed position thereof, the outer engaging surfaces including irregularities to facilitate engagement with vertebrae.

18. An endoscopic instrument according to claim 17, wherein the outer engaging surfaces of each of the first and second tissue spreading members extend along a major portion of the length of the respective tissue spreading members.