Minimally invasive spinal surgical methods & instruments

• US 5,891,147 A
• Filed: 09/29/1997
• Issued: 04/06/1999
• Est. Priority Date: 06/25/1996
• Status: Expired due to Term

• Current Assignee: SDGI Holdings 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:
  US08/939,848
• Time in Patent Office: 554 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, 606/92, 128/898
• 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 device for inserting graft material into a fusion site, comprising:

a carrier element including an elongated handle and a sheath attached to one end of said handle, said sheath sized to receive the graft material, said sheath including two side walls connected by a seat, said seat defining an opening sized to expose a portion of the graft material without permitting the graft material to exit said sheath through said opening; and

an obturator portion including an elongated gripping portion and an impactor attached to an end of said gripping portion, said impactor sized to fit through said opening to eject graft material received within said sheath.

2. The device of claim 1 wherein said sheath is rectangular shaped to receive graft material shaped in a rectangular block.

3. A method for arthrodesis of motion segments of the spine, comprising:

creating a channel between posterior aspects of the spine to a fusion site, the channel defined between fascia and muscle and terminating at a tissue barrier between the channel and the spinal canal; and

delivering an osteogenic device through the channel to the fusion site.

4. The method of claim 3 wherein the tissue barrier includes the posterolateral attachments of the longissimus thoracis muscle at the facet joint.

5. The method of claim 4 wherein the osteogenic device includes a bone morphogenetic protein.

6. The method of claim 5 wherein the osteogenic device includes a bioceramic.

7. The method of claim 6 wherein the osteogenic device includes a biphasic hydroxyapatite/tricalcium phophate ceramic.

8. The method of claim 4, further comprising:

dissecting the longissimus thoracis muscle from its attachments to the thoracolumbar fascia, the transverse processes and the intertransverse membrane to expose the transverse processes while preserving the attachment of muscle to the facet joints of the motion segment thereby leaving a tissue barrier between the channel and the epidural space.

9. A method for arthrodesis of a motion segment after laminectomy, comprising:

developing the areolar plane between 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;

dissecting the longissimus thoracis muscle from its attachments to the thoracolumbar fascia, the transverse processes and the intertransverse membrane to expose the transverse processes while preserving the attachment of the longissimus thoracis to the facet joint thereby leaving a tissue barrier between the arthrodesis site and the epidural space; and

delivering graft material through the channel to the intertransverse interval.