Minimally invasive spinal surgical methods and instruments

• US 5,741,261 A
• Filed: 06/25/1996
• Issued: 04/21/1998
• Est. Priority Date: 06/25/1996
• Status: Expired due to Fees

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: SDGI Holdings Incorporated (Medtronic Plc)
• Inventors: Boden, Scott, McKay, William F., Moctezuma, Joseph, Moskovitz, Peter A.
• Primary Examiner(s): Buiz, Michael
• Assistant Examiner(s): Shai, Daphna
• Application Number:
  US08/670,351
• Time in Patent Office: 665 Days
• Field of Search: 606/53, 606/60, 606/61, 606/79, 606/80, 606/81, 606/82, 606/83, 606/84, 606/85, 606/86
• US Class Current: 606/79
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1606 of forceps type, i.e. having two jaw elements moving relative to each other
• CPC Class Codes: A61B 17/1608 the two jaw elements being linked to two elongated shaft elements moving longitudinally relative to each other
• CPC Class Codes: A61B 17/1637 Hollow drills or saws producing a curved cut, e.g. cylindrical A61B10/025, A61B17/1695 take precedence
• CPC Class Codes: A61B 18/1442 Probes having pivoting end effectors, e.g. forceps
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/0042 with special provisions for gripping
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/320044 Blunt dissectors blunt suture needles A61B2017/06085
• 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 2/4601 for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• CPC Class Codes: A61F 2/4603 for insertion or extraction of endoprosthetic joints or of accessories thereof
• CPC Class Codes: A61F 2/4611 of spinal prostheses
• 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 2002/30062 (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/30153 rectangular
• CPC Class Codes: A61F 2002/30261 parallelepipedal
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2002/4649 : Bone graft or bone dowel harvest sites
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2230/0019 : rectangular
• CPC Class Codes: A61F 2230/0082 : parallelepipedal
• CPC Class Codes: A61F 2310/00293 : containing a phosphorus-containing compound, e.g. apatite
• CPC Class Codes: Y10S 606/907 : Composed of particular material or coated

Abstract

Minimally invasive spinal surgical techniques and tools are provided. The methods include separating the iliocostalis lumborum muscle from the anterior leaf of the thoracolumbar fascia to create a channel from the patient'"'"'s skin to the intertransverse interval. In one embodiment, the method also includes delivering graft material through the channel to the intertransverse interval. A device according to one aspect of the present invention includes a retraction portion having a flattened plate configured to atraumatically retract tissue to create a working space within an endosurgical site and a curved shaft attached to the retraction portion. The shaft includes a bend having a radius of preferably 160 degrees. A gripping portion is attached to the shaft and is configured for manually gripping and manipulating the device.

Claims

1. A minimally invasive method for arthrodesis of a spinal motion segment of a patient including a cephalad vertebra and a caudal vertebra, comprising the steps of:

making a transverse incision in the skin of the patient of about 2.5 cm at a generally posterolateral location about 10 cm from the midline at the level of a spinous process of the cephalad vertebra and centered over the border of the reflection of the thoracolumbar fascia;

exposing the posterior leaf of the thoracolumbar fascia beneath the skin;

making a second incision of about 2.5 cm through the thoracolumbar fascia in the direction of the fibers of the thoracolumbar fascia, the second incision centered beneath the transverse incision;

creating a channel through the transverse incision and the second incision to the intertransverse interval of the cephalad vertebra and the caudal vertebra, including

dissecting the lateral border of the iliocostalis lumborum from the anterior leaf of the thoracolumbar fascia;

dissecting the iliocostalis lumborum and longissimus thoracis muscles from the fascia medially about 0.5 cm dorsal to the junction of the transverse process and the lateral cortex of the cephalad articular facet; and

medially dissecting the intertransverse process membrane to the hiatus of the posterior rami of the segmental nerve and vessels;

inserting a probe through the channel to the intertransverse interval;

inserting a cannula into the channel and over the probe to the intertransverse interval;

removing the probe from the cannula;

inserting a burr into the cannula;

decorticating the transverse process of the caudal vertebra with the burr;

decorticating the transverse process of the cephalad vertebra with the burr; and

delivering graft material to the intertransverse interval after the decorticating steps.

2. The method of claim 1, further comprising inserting an endoscope into the channel for visualization.

3. The method of claim 1, further comprising:

establishing an accessory portal intersecting the channel.

4. The method of claim 3 wherein the portal is established through the longissimus thoracis muscle.

5. The method of claim 3 wherein the portal has a diameter of about 0.5 cm.

6. The method of claim 3, further comprising inserting an endoscope into the accessory portal for visualization of the intertransverse interval.

8. The method of claim 1 wherein the graft material is autograft, allograft, xenograft, a synthetic bone graft substitute, or a bone morphogenetic protein in a suitable carrier.

9. The method of claim 8 wherein the bone morphogenetic protein is a recombinant human bone morphogenetic protein.

10. The method of claim 9 wherein the carrier includes collagen.

11. The method of claim 9 wherein the carrier is a biphasic calcium phosphate ceramic.

12. The method of claim 11 wherein the carrier includes hydroxyapatite and tricalcium phosphate.

7. The method of 3, further comprising inserting a burr into the accessory portal for decorticating a transverse process.

13. A minimally invasive method for arthrodesis of a spinal motion segment of a patient including a cephalad vertebra and a caudal vertebra, comprising the steps of:

making a first incision through the patient'"'"'s skin at the level of the spinous process of one of the cephalad or the caudal vertebrae and centered over the border of the reflection of the thoracolumbar fascia;

making a second incision beneath the first incision and through the thoracolumbar fascia to expose the iliocostalis lumborum muscle;

inserting a tool through the incisions and dissecting the lateral border of the iliocostalis from the anterior leaf of the thoracolumbar fascia to create a first portion of a channel between the lateral border of the iliocostalis and the fascia;

dissecting the fascia through the incisions and from the anterior border of the iliocostalis and the anterior border of the longissimus thoracis muscles to create a second portion of the channel between the fascia and the anterior borders;

inserting a cannula through the first and second portions of the channel to the intertransverse interval between the cephalad and caudal vertebrae; and

delivering graft material to the intertransverse interval through the cannula.

14. The method of claim 13, further comprising:

inserting a burr through the channel to the intertransverse interval;

decorticating bone at the intertransverse interval; and

removing the burr.

15. The method of claim 13, further comprising inserting an endoscope into the channel for visualization.

16. The method of claim 13, further comprising:

establishing an accessory portal intersecting the channel.

17. The method of claim 16, further comprising inserting an endoscope into the accessory portal for visualization of the intertransverse interval.

18. The method of 16, further comprising inserting a burr into the accessory portal for decorticating a transverse process.

19. The method of claim 18 wherein the second incision is made in the direction of the fibers of the fascia.