Minimal exposure posterior spinal interbody instrumentation and technique
First Claim
1. A guide used in conjunction with the preparation of a vertebral body for spinal surgery, comprising:
- a sleeve defining a longitudinal axis and having a body;
said body defining a first longitudinal passage having a first transverse cross sectional area;
said body also defining a second longitudinal passage having a second transverse cross sectional area, said second longitudinal passage in communication with said first longitudinal passage, said second transverse cross sectional area being less than said first transverse cross sectional area; and
said sleeve is positionable adjacent the vertebral body to allow removal of vertebral tissue laterally adjacent said second longitudinal passage by an axially displacable cutting tool extending through said first longitudinal passage.
2 Assignments
0 Petitions
Accused Products
Abstract
A surgical method for preparing a site for implantation of a spinal implant into a disc space in which the disc space is first distracted by a novel stepped distractor, followed by insertion of a novel guide sleeve including a proximal portion having an uninterrupted side wall and a distal portion having a side wall defining a longitudinal opening extending along its entire length. The guide sleeve is seated adjacent the disc space with the longitudinal opening positioned opposite the dural region of the spine to provide a working channel to the disc space. A cutting tool is then inserted through the guide sleeve to remove tissue and bone laterally extending into the interior of the guide sleeve through the longitudinal opening, but only as much as necessary for passage of the spinal implant. In a further embodiment, a protective barrier, including a pair of overlapping, flexible leaf members, is operably attached to the inside surface of the guide sleeve and positioned across the longitudinal opening to separate the inner region of the guide sleeve from the outer surgical environment.
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Citations
70 Claims
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1. A guide used in conjunction with the preparation of a vertebral body for spinal surgery, comprising:
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a sleeve defining a longitudinal axis and having a body;
said body defining a first longitudinal passage having a first transverse cross sectional area;
said body also defining a second longitudinal passage having a second transverse cross sectional area, said second longitudinal passage in communication with said first longitudinal passage, said second transverse cross sectional area being less than said first transverse cross sectional area; and
said sleeve is positionable adjacent the vertebral body to allow removal of vertebral tissue laterally adjacent said second longitudinal passage by an axially displacable cutting tool extending through said first longitudinal passage. - View Dependent Claims (2, 3, 4)
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5. A guide used in conjunction with the preparation of a vertebral body for spinal surgery, comprising:
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a sleeve defining a longitudinal axis and having a cylindrical side wall;
said side wall including a circumferentially uninterrupted portion defining a first longitudinal passage having a diameter;
said side wall also including a circumferentially interrupted portion defining a second longitudinal passage having a maximum width, said width being less than said diameter; and
wherein said sleeve is positionable adjacent the vertebral body to allow removal of vertebral tissue laterally adjacent said second longitudinal passage by an axially displacable cutting tool extending through said first longitudinal passage. - View Dependent Claims (6, 7)
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8. A guide used in conjunction with the preparation of a vertebral body for spinal surgery, comprising:
a sleeve defining a longitudinal axis and having a proximal portion and an opposing distal portion, said proximal portion having a continuous side wall, said distal portion having a side wall defining an opening extending longitudinally from a distal end of said sleeve toward said proximal portion, said distal portion being positionable adjacent the vertebral body with vertebral tissue extending transversely into said opening. - View Dependent Claims (9, 10, 11, 12, 13)
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14. A guide used in conjunction with spinal surgery, comprising:
a sleeve defining a longitudinal axis and having a proximal portion and an opposing distal portion, said proximal portion having a continuous side wall, said distal portion having a side wall defining an opening extending longitudinally from a distal end of said sleeve toward said proximal portion, said sleeve including a protective barrier positioned across at least a portion of said opening. - View Dependent Claims (15, 16, 17)
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18. A guide used in conjunction with spinal surgery, comprising:
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a sleeve defining a longitudinal axis and having a proximal portion and an opposing distal portion, said proximal portion having an uninterrupted side wall, said distal portion having a side wall defining an opening extending longitudinally along the entire length of said distal portion, said sleeve including a barrier means positioned across said opening for separating an inner region of said sleeve from the outer environment; and
retention means for retaining adjacent vertebra in position relative to said sleeve.
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19. A guide used in conjunction with the preparation of a vertebral body for spinal surgery comprising:
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a sleeve defining a longitudinal axis and having a cylindrical side wall;
said side wall including a circumferentially uninterrupted portion; and
said side wall also including a circumferentially interrupted portion defining an opening extending longitudinally from a distal end of said circumferentially interrupted portion toward said circumferentially uninterrupted portion, said circumferentially interrupted being positionable adjacent the vertebral body with vertebral tissue extending transversely into said opening. - View Dependent Claims (20, 21, 22, 23, 24, 25, 26, 32)
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27. A guide used in conjunction with the preparation of a vertebral body for spinal surgery, comprising:
a sleeve defining a longitudinal axis and having a guiding portion defining an uninterrupted inner guiding surface and a protecting portion including a protective side wall defining an opening extending longitudinally from a distal end of said protecting portion toward said guiding portion, said protecting portion being positioned adjacent the vertebral body with vertebral tissue extending transversely into said opening. - View Dependent Claims (28, 29, 30, 31, 33, 34)
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35. A system for lateral removal of tissue in preparation for spinal surgery, comprising:
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a sleeve defining a longitudinal axis and having a side wall, said side wall defining a first longitudinal passage and a second longitudinal passage; and
a cutting tool sized to be received within said first longitudinal passage and having a cutting end for removal of tissue laterally adjacent said second longitudinal passage when said cutting end is axially displaced generally along said longitudinal axis. - View Dependent Claims (36, 37, 38, 39, 40)
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41. A guide used in conjunction with spinal surgery comprising:
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a sleeve having a cylindrical side wall;
said side wall including a circumferentially uninterrupted portion, said side wall also including a circumferentially interrupted portion defining an opening extending along the entire length of said circumferentially interrupted portion;
an elongated flange projecting from the end of said circumferentially interrupted portion and positioned generally opposite said opening; and
a protective barrier positioned across said opening. - View Dependent Claims (42, 43, 44)
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45. A guide sleeve for placement of a spinal implant within a disc space between an upper vertebral surface and a lower vertebral surface, comprising:
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a proximal portion extending along a longitudinal axis and having an uninterrupted side wall;
a distal portion extending along said longitudinal axis and having a side wall defining an interior sized to receive the spinal implant therethrough, said side wall defining an opening extending in a longitudinal direction from a distal end of said distal portion toward said proximal portion and in communication with said interior, said opening being positioned adjacent a lateral vertebral surface with vertebral tissue extending transversely into said opening; and
a distracting portion comprising an elongated flange projecting from said distal end in a longitudinal direction and having a height corresponding to said disc space, said flange projecting between said upper and lower vertebral surface to maintain distraction of said disc space. - View Dependent Claims (46, 47)
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48. A surgical method for implanting a spinal implant into a disc space between an upper and a lower vertebra, comprising:
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providing a boring tool and a guide sleeve defining a longitudinal axis and having a proximal portion and an opposing distal portion, said proximal portion having an uninterrupted side wall, said distal portion having a side wall defining an opening extending in a longitudinal direction from a distal end of said sleeve toward said proximal portion;
positioning the distal portion adjacent a vertebral body with vertebral tissue extending transversely into the opening;
inserting the boring tool through the guide sleeve and forming an implant bore within the disc space;
removing the boring tool from the guide sleeve;
inserting a spinal implant through the guide sleeve and implanting the spinal implant into the implant bore; and
removing the guide sleeve. - View Dependent Claims (49, 50, 51, 52, 53, 54, 55, 56, 57, 58)
further including inserting a cutting tool through the guide sleeve and removing vertebral tissue extending into the interior of the guide sleeve prior to forming the implant bore.
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50. The surgical method of claim 48 further including inserting a tapping tool through the guide sleeve to tap a female thread within the implant bore prior to inserting and implanting the spinal implant.
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51. The surgical method of claim 48 including positioning a protective barrier across the opening.
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52. The surgical method of claim 51 further including expanding the protective barrier during the inserting of the boring tool or spinal implant.
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53. The surgical method of claim 48 wherein the guide sleeve has at least two engagement members projecting from the distal end of the distal portion, and wherein the surgical method further includes anchoring at least one of the engagement members into each of the upper and lower vertebra.
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54. The surgical method of claim 48 wherein the guide sleeve has an elongated flange projecting from the distal end of the distal portion, the flange having a width approximately equal to the predetermined spacing between the upper and lower vertebrae and positioned generally opposite the opening, and wherein the surgical method further includes positioning the flange between the upper and lower vertebrae.
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55. The surgical method of claim 48 wherein the side wall of the distal portion has an inner diameter, the spinal implant having an outer diameter substantially equal to the inner diameter.
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56. The surgical method of claim 48 wherein said opening is positioned generally opposite the dural region of the spine.
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57. The surgical method of claim 48 further comprising:
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providing a spinal distractor;
inserting the distractor into the disc space to spread apart the upper and lower vertebra to a predetermined spacing;
placing the guide sleeve over the distractor with the opening positioned generally opposite the dural region of the spine; and
extracting the distractor from the disc space prior to inserting the boring tool.
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58. The surgical method of claim 57 wherein the spinal distractor includes a leading portion and a trailing portion, the trailing portion having an outer diameter slightly less than the inner diameter of the proximal portion of the guide sleeve, the leading portion having a reduced outer cross section relative to the trailing portion.
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59. A surgical method for preparing an upper and lower vertebra for implantation of a spinal implant into the disc space, comprising:
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providing a cutting tool and a guide sleeve defining a longitudinal axis and having a proximal portion and an opposing distal portion, said proximal portion having an uninterrupted side wall, said distal portion having a side wall defining an interior and an opening extending in a longitudinal direction from a distal end of the sleeve toward the proximal portion and in communication the interior;
positioning the distal portion adjacent a vertebral body with vertebral tissue extending transversely thorough the opening and into the interior of the distal portion; and
inserting the cutting tool through the guide sleeve to remove the vertebral tissue extending into the interior of the distal portion. - View Dependent Claims (60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70)
providing a spinal distractor;
inserting the distractor into the disc space to spread apart the upper and lower vertebra to a predetermined spacing;
placing the guide sleeve over the distractor with the opening positioned generally opposite the dural region of the spine; and
extracting the distractor from the disc space prior to inserting the cutting tool.
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Specification