Method and instrumentation for implant insertion

• US 6,063,088 A
• Filed: 03/24/1997
• Issued: 05/16/2000
• Est. Priority Date: 03/24/1997
• Status: Expired due to Term

• Current Assignee: Howmedica Osteonics Corp. (Stryker Corporation)
• Original Assignee: United States Surgical Corporation (Medtronic Plc)
• Inventors: Winslow, Charles J.
• Primary Examiner(s): Tucker, Guy V.
• Application Number:
  US08/822,530
• Time in Patent Office: 1,149 Days
• Field of Search: 606/61, 606/60, 606/72, 606/73, 606/90, 606/80, 606/99, 606/96, 606/79, 623/17
• US Class Current: 606/86.00A
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1631 Special drive shafts, e.g. flexible shafts A61B17/1642, A61B17/164 take precedence
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 2017/0256 for the spine
• 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 2/446 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 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 2002/30113 circular
• CPC Class Codes: A61F 2002/30125 elliptical or oval
• CPC Class Codes: A61F 2002/30154 square
• CPC Class Codes: A61F 2002/30228 Cylinders of elliptical or oval basis
• CPC Class Codes: A61F 2002/30235 tubular, e.g. sleeves
• CPC Class Codes: A61F 2002/30405 made by screwing complementary threads machined on the parts themselves
• CPC Class Codes: A61F 2002/30593 hollow
• CPC Class Codes: A61F 2002/30616 Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2002/30622 Implant for fusing a joint or bone material
• CPC Class Codes: A61F 2002/30774 internally-threaded
• 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 2002/30863 : the entry end surface having flutes, relief grooves, starter notches or bevelled indentations
• 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 2002/4627 : with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
• CPC Class Codes: A61F 2002/4687 : Mechanical guides for implantation instruments
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2230/0006 : circular
• CPC Class Codes: A61F 2230/0008 : elliptical or oval
• CPC Class Codes: A61F 2230/0021 : square
• CPC Class Codes: A61F 2230/0069 : cylindrical
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00179 : Ceramics or ceramic-like structures

Abstract

A system for drilling a bore in adjacent vertebrae to facilitate the insertion of a fusion implant includes a surgical retractor having a sleeve member with proximal and distal end portions and defining a longitudinal opening and a drill instrument positionable within the longitudinal opening of the surgical retractor. The retractor is configured for insertion at least partially into an intervertebral space between adjacent opposed vertebrae to distract the adjacent vertebrae to a desired predetermined distracted position. At least one anchoring member may be associated with the surgical retractor to facilitate mounting thereof to the vertebrae. The drill instrument includes an elongate member having a longitudinal passageway and defining at least one distal cutting surface and a drill member disposed within the elongate member and having a distal drill head. The drill member is rotatably movable within the elongate member and is also longitudinally fixed to the elongate member such that advancement of the drill member within the retractor causes corresponding advancement of the elongate member such that the distal cutting surface of the elongate member and the distal drill head of the drill member cooperate to cut a non-circular, e.g., an elliptical-shaped, bore in the adjacent vertebrae. Preferably, the elongate member of the drill instrument includes first and second diametrically opposed distal cutting surfaces. The cutting surfaces may be arcuately-shaped.

Claims

1. A system for drilling a bore in adjacent vertebrae to facilitate the insertion of a fusion implant, which comprises:

a surgical retractor including a sleeve member having proximal and distal end portions and defining a longitudinal opening, the distal end portion configured for insertion at least partially into an intervertebral space between adjacent opposed vertebrae to distract the adjacent vertebrae; and

a drill instrument positionable within the longitudinal opening of the surgical retractor, the drill instrument including;

an elongate member defining at least one distal cutting surface; and

a drill member disposed within the elongate member and having a distal cutting head, the drill member being rotatably movable within the elongate member and being longitudinally fixed to the elongate member such that advancement of the drill member within the adjacent vertebrae causes corresponding advancement of the elongate member such that the distal cutting surface and the distal cutting head cooperate to cut a bore in the adjacent vertebrae.

2. The system according to claim 1 wherein the distal end portion of the sleeve member of the surgical retractor includes two spaced apart retractor arms having first and second supporting surfaces.

3. The system according to claim 2 wherein the elongate member of the drill instrument includes first and second diametrically opposed distal cutting surfaces.

4. The system according to claim 1 including alignment means for aligning and maintaining the elongate member of the drill instrument at a predetermined angular orientation within the sleeve member of the surgical retractor.

5. The system according to claim 4 wherein the alignment means includes at least one groove defined in the sleeve member of the surgical retractor, the at least one groove dimensioned to accommodate a corresponding spline of the elongate member.

6. The system according to claim 1 wherein the sleeve member of the surgical retractor includes an internal threaded portion, the internal threaded portion threadably engageable with an external threaded portion of the drill instrument whereby rotation of the drill instrument causes distal translation of the drill instrument relative to the surgical retractor.

7. The system according to claim 1 including at least one anchoring member associated with the elongate member and moveable relative to the elongated member to facilitate mounting to vertebrae.

8. The system according to claim 1 wherein the longitudinal opening of the sleeve member of the surgical retractor extends substantially the length of the sleeve member.

9. A system for drilling a bore in adjacent vertebrae to facilitate the insertion of a fusion implant, which comprises:

a surgical retractor including a sleeve member having proximal and distal end portions and defining a longitudinal opening, the distal end portion configured for insertion at least partially into an intervertebral space between adjacent opposed vertebrae to distract the adjacent vertebrae, the sleeve member including an internal threaded portion;

a drill instrument positionable within the longitudinal opening of the surgical retractor, the drill instrument including a drill member having a distal cutting head and an external threaded portion engageable with the internal threaded portion of the retractor whereby rotation of the drill instrument causes distal translation of the drill instrument relative to the surgical retractor.

10. The system according to claim 9 wherein the distal end portion of the sleeve member of the surgical retractor includes two spaced apart retractor arms having first and second supporting surfaces.

11. A method for performing a surgical procedure, comprising the steps of:

providing a surgical retractor including an elongate member having an outer wall and defining proximal and distal end portions, the elongate member having a longitudinal opening, the distal end portion including two spaced apart retractor arms having first and second supporting surfaces, the retractor arms being fixed with respect to the outer wall, and at least one anchor member mounted to the elongate member;

inserting the retractor arms within the intervertebral space whereby the fist and second supporting surfaces of each retractor arm respectively engage and distract the adjacent opposed vertebrae;

mounting the surgical retractor to the adjacent vertebrae by securing the at least one anchor member to the adjacent vertebrae; and

performing the surgical procedure adjacent the distracted vertebrae.

12. A method for performing a surgical procedure, comprising the steps of:

providing a surgical retractor including an elongate member having proximal and distal end portions and defining a longitudinal opening, the distal end portion including two spaced apart retractor arms having first and second supporting surfaces, and at least one anchor member mounted to the elongate member;

inserting the retractor arms within the intervertebral space whereby the first and second supporting surfaces of each retractor arm respectively engage and distract the adjacent opposed vertebrae;

mounting the surgical retractor to the adjacent vertebrae by securing anchor members associated with the surgical retractor to the adjacent vertebrae; and

introducing surgical instrumentation within the opening of the surgical retractor to perform the surgical procedure adjacent the distracted vertebrae.

13. A method for fusing adjacent vertebral bodies, comprising the steps of:

a) accessing the intervertebral disc space;

b) providing a retractor including a retractor sleeve having proximal and distal end portions, the distal end portion having opposed retractor arms extending in a general longitudinal direction;

c) positioning the retractor arms within the intervertebral disc space whereby first and second supporting surfaces of each arm contact opposed vertebra bodies;

d) introducing a drill instrument into the retractor sleeve and advancing the drill instrument within the sleeve to the disc space, the drill instrument including an elongate member defining at least one distal cutting surface and a drill member rotatably mounted within the elongate member and having a distal cutting head;

e) actuating the drill instrument such that the distal cutting head of the drill member and the distal cutting surface of the elongate member are advanced into the adjacent vertebrae to cooperate and cut a bore in the vertebra bodies;

f) removing the drill instrument from the sleeve; and

g) introducing a fusion implant into the bore.

14. The method according to claim 13 wherein the bore formed in the vertebral bodies defines a general elliptical cross-sectional dimension and wherein the step of introducing includes inserting a fusion implant having a general elliptical cross-sectional dimension into the bore.

15. The method according to claim 14 wherein in a final inserted position of the fusion implant, a major axis of the implant is in the transverse direction generally parallel to the vertebral end plates.

16. A surgical retractor instrument comprising an elongated member defining an outer wall portion and having proximal and distal end portions, the elongated member defining a longitudinal passage for reception of a surgical instrument, the distal end portion having first and second retractor arms extending in a general longitudinal direction, the retractor arms being stationary with respect to the outer wall portion of the elongated member, each retractor arm having first and second supporting surfaces for engaging opposed tissue portions, each retractor arm defining a dimension between the first and second supporting surfaces sufficient to distract the opposed tissue portions upon insertion thereof, and at least one anchoring member mounted to the elongated member and moveable relative to the elongated member to facilitate mounting to the tissue portion.

17. The surgical retractor according to claim 16 wherein the first and second supporting surfaces of each retractor arm are in general parallel relation.

18. The surgical retractor according to claim 17 wherein each retractor arm has a tapered end portion for facilitating insertion within an intervertebral space.

19. The surgical retractor according to claim 17 wherein the first and second supporting surfaces of each retractor arm are in general parallel relation to a longitudinal axis of the elongated body.

20. The surgical retractor according to claim 16 wherein the longitudinal passage of the elongated member extends substantially the length of the elongated member.

21. A surgical retractor comprising an elongated member having proximal and distal end portions and defining a longitudinal passage for reception of a surgical instrument, the distal end portion having first and second retractor arms extending in a general longitudinal direction, each retractor arm having first and second supporting surfaces for engaging opposed tissue portions, each retractor arm defining a dimension between the first and second supporting surfaces sufficient to distract the opposed tissue portions upon insertion thereof, and at least one anchoring member mounted, to the elongated member and moveable relative to the elongated member to facilitate mounting to the tissue portion, the at least one anchoring member having a distal screw thread wherein rotation of the one anchoring member advances the screw thread into the tissue portion.

22. A surgical retractor comprising an elongated member having proximal and distal end portions and defining a longitudinal passage for reception of a surgical instrument, the distal end portion having first and second retractor arms extending in a general longitudinal direction, each retractor arm having first and second supporting surfaces for engaging opposed tissue portions, each retractor arm defining a dimension between the first and second supporting surfaces sufficient to distract the opposed tissue portions upon insertion thereof;

at least one anchoring member mounted to the elongated member and moveable relative to the elongated member to facilitate mounting to the tissue portion; and

an outer rail extending longitudinally along an outer surface of the elongated member, the rail defining a longitudinal opening for at least partial reception of the at least one anchoring member.

23. The surgical retractor according to claim 22 including first and second anchoring members mounted to the elongated member.

24. The surgical retractor according to claim 23 including first and second diametrically opposed outer rails extending longitudinally along an outer surface of the elongated member, the first and second rails each defining a longitudinal opening for reception of respective first and second anchoring members.

25. A surgical drill instrument for drilling a bore in bony tissue comprising an elongate member defining a longitudinal axis and having a longitudinal passageway and a drill member positioned within the longitudinal passageway of the elongate member and mounted for rotational movement therein, the elongate member defining at least one distal cutting surface dimensioned to cut bony tissue, the drill member including a distal cutting head, the drill member operatively connected to the elongate member such that rotation and advancement of the drill member causes corresponding advancement of the elongate member such that the one distal cutting head surface of the elongate member and the distal cutting head of the drill head cooperate to form a substantially elliptical bore in the bony tissue upon advancement therein.

26. The surgical retractor according to claim 25 wherein the elongate member includes first and second diametrically opposed distal cutting surfaces.

27. The surgical retractor according to claim 26 wherein the distal cutting surfaces are arcuately shaped.

28. A method for performing a surgical procedure, comprising the steps of:

providing a surgical retractor including an elongate member having proximal and distal end portions and defining a longitudinal opening extending along at least a portion of the length of the elongate member, the distal end portion including two spaced apart retractor arms having first and second supporting surfaces, the retractor arms being longitudinally fixed with respect to the proximal end portion of the elongate member;

inserting the retractor arms within the intervertebral space whereby the first and second supporting surfaces of each retractor arm respectively engage and distract the adjacent opposed vertebrae;

mounting the surgical retractor to the adjacent vertebrae by securing anchor members associated with the surgical retractor to the adjacent vertebrae; and

introducing surgical instrumentation within the opening of the surgical retractor to perform the surgical procedure adjacent the distracted vertebrae.