Methods and instruments for interbody fusion

• US 6,206,922 B1
• Filed: 01/28/1998
• Issued: 03/27/2001
• Est. Priority Date: 03/27/1995
• Status: Expired due to Term

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: SDGI Holdings Incorporated (Medtronic Plc)
• Inventors: Zdeblick, Thomas, McGahan, Thomas
• Primary Examiner(s): Isabella, David J.
• Assistant Examiner(s): STEWART, ALVIN J
• Application Number:
  US09/014,901
• Time in Patent Office: 1,154 Days
• Field of Search: 623/17.11, 623/17.12, 623/17.13, 623/17-4-, 606/108, 606/192, 606/194, 606/195, 606/198
• US Class Current: 623/17.11
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 1/3135 for examination of the epidural or the spinal space
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/282 Jaws
• CPC Class Codes: A61B 17/7059 Cortical plates A61B17/7007, A61B17/7058 take precedence
• CPC Class Codes: A61B 17/86 Pins or screws or threaded wires; nuts therefor A61B17/72 take precedence
• CPC Class Codes: A61B 2017/00238 Type of minimally invasive operation A61B2017/00805 takes precedence
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2090/3904 specially adapted for marking specified tissue
• CPC Class Codes: A61B 2090/3937 Visible markers
• 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 2/4601 for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• 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 2002/2839 Bone plugs or bone graft dowels
• CPC Class Codes: A61F 2002/30123 : with two diametrically opposed lobes
• CPC Class Codes: A61F 2002/30153 : rectangular
• CPC Class Codes: A61F 2002/30179 : X-shaped
• CPC Class Codes: A61F 2002/3021 : frustoconical
• CPC Class Codes: A61F 2002/30217 : hollow cones, e.g. tubular-like cones
• CPC Class Codes: A61F 2002/30329 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2002/30433 : using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/30507 : using a threaded locking member, e.g. a locking screw or a set screw
• CPC Class Codes: A61F 2002/30593 : hollow
• CPC Class Codes: A61F 2002/30604 : modular
• CPC Class Codes: A61F 2002/30774 : internally-threaded
• CPC Class Codes: A61F 2002/30777 : Oblong apertures
• CPC Class Codes: A61F 2002/30785 : parallel
• CPC Class Codes: A61F 2002/30787 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30789 : perpendicular with respect to each other
• CPC Class Codes: A61F 2002/3082 : Grooves
• CPC Class Codes: A61F 2002/30858 : Threads interrupted by grooves or sidewalls, e.g. flat sidewalls
• CPC Class Codes: A61F 2002/30863 : the entry end surface having flutes, relief grooves, starter notches or bevelled indentations
• CPC Class Codes: A61F 2002/30871 : Trapezoidal threads
• CPC Class Codes: A61F 2002/30873 : Threadings machined on non-cylindrical external surfaces
• 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 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0041 : using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2230/0006 : circular
• CPC Class Codes: A61F 2230/0019 : rectangular
• CPC Class Codes: A61F 2230/0058 : X-shaped
• CPC Class Codes: A61F 2230/0067 : conical

Abstract

A laparoscopic surgical technique is provided for preparing a site for implantation of a novel fusion device or implant. In accordance with one embodiment of the technique, a laparoscope is provided having an outer sleeve with distraction fingers at one end to distract the disc space. The laparoscope provides a sealed working channel to the disc space, through which the disc space is distracted, the vertebral endplates and surrounding disc is reamed, and the fusion device inserted. A distraction plug is provided for centering the outer sleeve and for providing midline distraction of the disc space. In one embodiment, a fusion device includes diverging bone screws passing through an end wall and upper and lower walls of the device to engage the adjacent vertebrae. In another embodiment, a connector plate is engaged to bilaterally position fusion devices to prevent rotation and resist expulsion of the devices from the disc space.

Claims

1. An apparatus for implantation in the disc space between adjacent vertebrae, comprising:

at least two devices fixedly attached within the same disc space having elongated bodies and including surfaces for engaging the adjacent vertebrae, each of said devices having an end wall defining a threaded bore therethrough, said end wall of each of said devices defines a recess surrounding said threaded bore and a groove communicating with said recess;

an elongated plate sized to be fully contained within the disc space, said plate having at least two bores defined therethrough and spaced apart a distance, said plate configured to be at least partially received in said recess; and

at least two set screws having a threaded stem sized to extend through each of said at least two bores and configured for threaded engagement with said threaded bore of corresponding one of said devices.

2. The apparatus for implantation in the disc space between adjacent vertebrae according to claim 1, wherein;

said elongated plate includes an enlarged portion surrounding each of said at least two bores and sized to be retained within said recess of each of said devices with said plate passing through said groove in each of said devices.

3. The apparatus for implantation in the disc space between adjacent vertebrae according to claim 1, wherein:

said elongated plate includes an intermediate plate extending outward from said elongated plate between said at least two bores, said intermediate plate defining at least one screw bore therethrough; and

the apparatus further includes a bone screw sized for passage through said screw bore in said intermediate plate.

4. The apparatus of claim 3, wherein at least one of said two bores defines a slot configured to receive at least one of said set screws.

5. The apparatus of claim 2, wherein said recess is larger than said enlarged portion thereby permitting adjustment of the position of the enlarged portion within the recess.

6. The apparatus of claim 2, wherein said enlarged portion is substantially oval shaped and said recess substantially corresponds to said oval shape.

7. The apparatus of claim 1, wherein said recess has a depth and said plate has a thickness, said depth greater than or equal to said thickness.

8. An apparatus for implantation in the disc space between adjacent vertebrae, comprising:

at least two devices having elongated bodies fixedly attached within the same disc space and including surfaces for engaging the adjacent vertebrae, each of said devices having an end wall defining an thread opening therethrough,

an elongated plate sized to be fully contained within the disc space, said plate having at least two bores defined therethrough and spaced apart a distance;

said elongated plate includes an intermediate portion between said at least two bores, said intermediate portion defining at least one screw bore therethrough;

at least two fasteners sized to extend through each of said at least two plate bores and configured for engagement with said corresponding opening of each of said devices; and

a bone screw sized for passage through said screw bore in said intermediate portion.

9. The apparatus of claim 8, wherein said end wall of each device defines a recess surrounding said opening.

10. The apparatus of claim 9, wherein said elongated plate includes an enlarged portion adjacent said plate opening;

and

said recesses are adapted to receive said enlarged portions.

11. The apparatus of claim 10, wherein said plate has a thickness and said recess has a depth, said depth greater than or equal to said thickness.

12. The apparatus of claim 8, wherein at least one of said plate openings is a slot.

13. An apparatus for implantation in the disc space between adjacent vertebrae, comprising:

at least two devices having elongated bodies fixedly attached within the same disc space and including surfaces for engaging the adjacent vertebrae, said devices having an end wall defining a threaded opening therethrough,

a connection member sized to be contained within the disc space, said connection member having at least one slot and one bore defined therethrough and spaced apart a distance; and

at least two fasteners sized to extend through one of said slot and said bore and configured for engagement with said opening of corresponding one of said devices.

14. The apparatus of claim 13, wherein said connection member is a plate.

15. The apparatus of claim 14, wherein said plate has a longitudinal axis and said slot is oriented in substantial alignment with said longitudinal axis.

16. The apparatus of claim 13, wherein said end wall of each device defines a recess surrounding said opening and a portion of said connection member is received within said recess.

17. The apparatus of claim 16, wherein said connection member includes an enlarged portion adjacent each of said slot and said bore;

and said recesses are adapted to receive said enlarged portions.

18. The apparatus of claim 17, wherein said connection member has a thickness and said recess has a depth, said depth greater than or equal to said thickness.

19. The apparatus of claim 13, wherein said connection member includes an intermediate portion with at least one screw bore defined therein and further including a screw adapted to extend through said bore and extended into one of the adjacent vertebra.

20. An apparatus for implantation in the disc space between adjacent vertebrae, comprising:

at least two devices fixedly attached within the same disc space and including surfaces for contacting the endplates of the adjacent vertebrae, each of said devices having an end wall, said end wall defining a recess herein, and a threaded opening therethrough

a connection member configured to be received within said recess of each device to thereby interconnect said devices.

21. The apparatus of claim 20, wherein said recess has a depth and said plate has a thickness, said depth at least equal to said thickness.

22. The apparatus of claim 20, wherein said recess and said connection member cooperate to limit rotation of said devices.

23. An apparatus for implantation in the disc space between adjacent vertebrae, comprising:

at least two devices having elongated bodies fixedly attached within the same disc space and including surfaces for engaging the adjacent vertebrae, said devices having an end wall defining an threaded opening therethrough and a recess surrounding said opening,

a connection member sized to be contained within the disc space, said connection member having at least one slot and one bore defined therethrough and spaced apart a distance, wherein a portion of said connection member is received within said recess; and

at least two fasteners sized to extend through one of said slot and said bore and configured for engagement with said opening of corresponding one of said devices.

24. The apparatus of claim 23, wherein said connection member includes an enlarged portion adjacent each of said slot and said bore;

and

said recesses are adapted to receive said enlarged portions.

25. The apparatus of claim 24, wherein said connection member has a thickness and said recess has a depth, said depth greater than or equal to said thickness.

26. The apparatus of claim 23, wherein said connection member includes an intermediate portion with at least one screw bore defined therein and further including a screw adapted to extend through said bore and extended into one of the adjacent vertebra.

27. The apparatus of claim 23, wherein said connection member is a plate.

28. The apparatus of claim 27, wherein said plate has a longitudinal axis and said slot is oriented in substantial alignment with said longitudinal axis.