Methods for accessing the spinal column

• US 6,520,907 B1
• Filed: 11/30/1999
• Issued: 02/18/2003
• Est. Priority Date: 03/22/1996
• Status: Expired due to Term

• Current Assignee: SDGI Holdings Incorporated (Medtronic Plc)
• Original Assignee: SDGI Holdings Incorporated (Medtronic Plc)
• Inventors: Clayton, John B., Smith, Maurice Mell, Moctezuma, Joseph, Foley, Kevin Thomas
• Primary Examiner(s): Leubecker, John P.
• Application Number:
  US09/449,647
• Time in Patent Office: 1,176 Days
• Field of Search: 600/114, 600/208, 600/235, 600/204, 606/61, 606/86, 606/108, 606/191, 606/198
• US Class Current: 600/114
• CPC Class Codes: A61B 17/02 for holding wounds open; Tractors specula A61B1/32 ; drainage appliances for wounds A61M27/00
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/0046 with a releasable handle; with handle and operating part separable
• CPC Class Codes: A61B 2017/00469 for insertion of instruments, e.g. guide wire, optical fibre
• CPC Class Codes: A61B 2017/0262 with a provision for protecting nerves
• CPC Class Codes: A61B 2017/3445 used as instrument channel for multiple instruments
• CPC Class Codes: A61B 2017/347 Locking means, e.g. for locking instrument in cannula
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 2090/3614 using optical fibre
• CPC Class Codes: A61B 2090/373 using light, e.g. by using optical scanners
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61M 29/00 Dilators with or without means for introducing media, e.g. remedies instruments for performing visual medical inspections of cavities or tubes of the body A61B1/00
• CPC Class Codes: A61M 29/02 Dilators made of swellable material balloon catheters for angioplasty A61M25/104

Abstract

A method for accessing the spine includes making an incision in the skin of a patient. The skin and tissue can be dilated, and a cannula inserted through the dilated skin and tissue. The cannula includes a distal end positioned adjacent a first working space that includes paraspinous tissue. The cannula can be repositioned through the incision to a second working space adjacent the distal end of the cannula.

Claims

1. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space;

inserting an instrument through the cannula;

manipulating one or more neural elements with the instrument; and

repositioning through the incision the distal end of the cannula to a second working space, the second working space including an area occupied by the neural elements before manipulation.

2. The method of claim 1, further comprising supporting a proximal end of the cannula with respect to the patient.

3. The method of claim 1, further comprising positioning a viewing element with respect to the cannula to visualize the first and second working space.

4. The method of claim 1, wherein repositioning the distal end is performed with image guided technology.

5. The method of claim 1, wherein the instrument is a retractor and manipulating the neural elements includes retracting the neural elements with the retractor.

6. The method of claim 1, wherein dilating the skin and tissue includes:

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

7. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin through the incision;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space;

supporting a proximal end of the cannula;

inserting a retractor through the cannula;

retracting the tissue in the working space below the distal end of the cannula with the retractor; and

repositioning through the incision the distal end of the cannula to define a second working space adjacent the distal end of the cannula.

8. The method of claim 7, wherein at least one of the first working space and the second working space is between the distal end of the cannula and a vertebral body of the spine.

9. The method of claim 7, further comprising performing a surgical procedure through the cannula in at least one of the first working space and the second working space.

10. The method of claim 9, wherein the surgical procedure includes cutting paraspinous tissue.

11. The method of claim 9, wherein the surgical procedure includes retracting neural elements.

12. The method of claim 9, wherein the surgical procedure includes performing a discectomy.

13. The method of claim 9, wherein the surgical procedure includes inserting a fusion device in a spinal disc space.

14. The method of claim 13, wherein the fusion device is made of bone.

15. The method of claim 9, wherein the surgical procedure includes placing bony graft in a spinal disc space.

16. The method of claim 9, further comprising:

positioning a viewing element with respect to the cannula to visualize the surgical procedure.

17. The method of claim 16, further comprising securing the viewing element to a proximal end of the cannula.

18. The method of claim 7, further comprising positioning a viewing element with respect to the cannula to visualize the first working space and the second working space.

19. The method of claim 18, further comprising securing the viewing element to a proximal end of the cannula.

20. The method of claim 7, wherein repositioning the distal end is performed with image guided technology.

21. The method of claim 7, wherein dilating the skin and tissue includes:

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

22. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

sequentially inserting one over another a number of dilators of increasing diameter;

inserting a cannula through the incision over a final one of the number of dilators;

removing the number of dilators to define a first working space adjacent a distal end of the cannula; and

repositioning through the incision the distal end of the cannula to define a second working space adjacent the distal end of the cannula, wherein one of the first working space and the second working space is located in paraspinous tissue and the other of the first working space and the second working space includes bony structure.

23. The method of claim 22, further comprising supporting the proximal end of the cannula before repositioning the distal end of the cannula.

24. The method of claim 22, further comprising inserting a surgical instrument through the cannula to manipulate tissue as the distal end of the cannula is repositioned.

25. The method of claim 22, further comprising positioning a viewing element with respect to the cannula to visualize the first working space and the second working space.

26. The method of claim 22, wherein repositioning the distal end is performed using image guided technology.

27. The method of claim 22, further comprising inserting a bone screw through the cannula.

28. The method of claim 22, further comprising inserting a fusion device through the cannula.

29. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin through the incision;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space;

supporting a proximal end of the cannula;

inserting a surgical instrument through the cannula;

manipulating the tissue in the working space with the surgical instrument; and

repositioning through the incision the distal end of the cannula to define a second working space adjacent the distal end of the cannula, wherein one of the first working space and the second working space includes paraspinous tissue and the other of the first working space and the second working space includes bony structure.

30. The method of claim 29, further comprising performing a surgical procedure through the cannula in at least one of the first working space and the second working space.

31. The method of claim 30, wherein the surgical procedure includes cutting tissue.

32. The method of claim 30, wherein the surgical procedure includes retracting neural elements.

33. The method of claim 30, wherein the surgical procedure includes performing a discectomy.

34. The method of claim 30, wherein the surgical procedure includes inserting a bone dowel in a spinal disc space.

35. The method of claim 30, wherein the surgical procedure includes removing bone.

36. The method of claim 30, wherein the surgical procedure includes cutting bone.

37. The method of claim 30, further comprising:

positioning a viewing element with respect to the cannula to visualize the surgical procedure.

38. The method of claim 37, further comprising securing the viewing element to a proximal end of the cannula.

39. The method of claim 38, further comprising repositioning the viewing element with respect to the cannula to visualize at least one of the first working space and the second working space.

40. The method of claim 37, further comprising positioning the viewing element through the cannula.

41. The method of claim 29, wherein dilating the skin and tissue includes:

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

42. The method of claim 29, further comprising inserting a bone graft through the cannula.

43. The method of claim 29, further comprising inserting a fusion device through the cannula.

44. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin through the incision;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space;

supporting a proximal end of the cannula;

inserting a surgical instrument through the cannula;

manipulating the tissue in the working space with the surgical instrument;

repositioning through the incision the distal end of the cannula to define a second working space adjacent the distal end of the cannula; and

performing a surgical procedure through the cannula in at least one of the first working space and the second working space, wherein the surgical procedure includes retracting neural elements.

45. The method of claim 44, wherein one of the first working space and the second working space includes paraspinous tissue and the other of the first working space and the second working space includes bony structure.

46. The method of claim 44, further comprising:

positioning a viewing element with respect to the cannula to visualize the surgical procedure.

47. The method of claim 46, further comprising securing the viewing element to a proximal end of the cannula.

48. The method of claim 47, further comprising repositioning the viewing element with respect to the cannula to visualize at least one of the first working space and the second working space.

49. The method of claim 46, further comprising positioning the viewing element through the cannula.

50. The method of claim 44, wherein dilating the skin and tissue includes:

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

51. The method of claim 44, further comprising inserting a bone graft through the cannula.

52. The method of claim 44, further comprising inserting a fusion device through the cannula.

53. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin through the incision;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space;

supporting a proximal end of the cannula;

inserting a surgical instrument through the cannula;

manipulating the tissue in the working space with the surgical instrument;

repositioning through the incision the distal end of the cannula to define a second working space adjacent the distal end of the cannula; and

performing a surgical procedure through the cannula in at least one of the first working space and the second working space, wherein the surgical procedure includes removing bone.

54. The method of claim 53, wherein one of the first working space and the second working space includes paraspinous tissue and the other of the first working space and the second working space includes bony structure.

55. The method of claim 53, further comprising:

positioning a viewing element with respect to the cannula to visualize the surgical procedure.

56. The method of claim 55, further comprising securing the viewing element to a proximal end of the cannula.

57. The method of claim 56, further comprising repositioning the viewing element with respect to the cannula to visualize at least one of the first working space and the second working space.

58. The method of claim 55, further comprising positioning the viewing element through the cannula.

59. The method of claim 53, wherein dilating the skin and tissue includes:

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

60. The method of claim 53, further comprising inserting a bone graft through the cannula.

61. The method of claim 53, further comprising inserting a fusion device through the cannula.

62. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin through the incision;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space;

supporting a proximal end of the cannula;

inserting a surgical instrument through the cannula;

manipulating the tissue in the working space with the surgical instrument;

repositioning through the incision the distal end of the cannula to define a second working space adjacent the distal end of the cannula; and

performing a surgical procedure through the cannula in at least one of the first working space and the second working space, wherein the surgical procedure includes cutting bone.

63. The method of claim 62, wherein one of the first working space and the second working space includes paraspinous tissue and the other of the first working space and the second working space includes bony structure.

64. The method of claim 62, further comprising:

positioning a viewing element with respect to the cannula to visualize the surgical procedure.

65. The method of claim 64, further comprising securing the viewing element to a proximal end of the cannula.

66. The method of claim 65, further comprising repositioning the viewing element with respect to the cannula to visualize at least one of the first working space and the second working space.

67. The method of claim 64, further comprising positioning the viewing element through the cannula.

68. The method of claim 62, wherein dilating the skin and tissue includes:

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

69. The method of claim 62, further comprising inserting a bone graft through the cannula.

70. The method of claim 62, further comprising inserting a fusion device through the cannula.

71. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin through the incision;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space;

supporting a proximal end of the cannula;

inserting a surgical instrument through the cannula;

manipulating the tissue in the working space with the surgical instrument;

repositioning through the incision the distal end of the cannula to define a second working space adjacent the distal end of the cannula;

performing a surgical procedure through the cannula in at least one of the first working space and the second working space positioning a viewing element with respect to the cannula to visualize the surgical procedure; and

securing the viewing element to a proximal end of the cannula.

72. The method of claim 71, wherein one of the first working space and the second working space includes paraspinous tissue and the other of the first working space and the second working space includes bony structure.

73. The method of claim 71, wherein the surgical procedure includes cutting tissue.

74. The method of claim 71, wherein the surgical procedure includes retracting neural elements.

75. The method of claim 71, wherein the surgical procedure includes performing a discectomy.

76. The method of claim 71, wherein the surgical procedure includes inserting a bone dowel in a spinal disc space.

77. The method of claim 71, wherein the surgical procedure includes removing bone.

78. The method of claim 71, wherein the surgical procedure includes cutting bone.

79. The method of claim 71, further comprising repositioning the viewing element with respect to the cannula to visualize at least one of the first working space and the second working space.

80. The method of claim 71, further comprising positioning the viewing element through the cannula.

81. The method of claim 71, wherein dilating the skin and tissue includes:

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

82. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

inserting a guidewire through the incision into paraspinous tissue;

sequentially inserting one over another a number of dilators of increasing diameter, the guidewire guiding at least a first one of the number of dilators through the paraspinous tissue;

inserting a cannula through the incision over a final one of the number of dilators;

removing the guidewire and the number of dilators to define a first working space in the paraspinous tissue adjacent a distal end of the cannula;

repositioning through the incision the distal end of the cannula to define a second working space adjacent the distal end of the cannula; and

inserting an instrument through the cannula to work adjacent the spine as the distal end of the cannula is repositioned, wherein the instrument is a retractor and the work is retracting paraspinous tissue.

83. The method of claim 82, further comprising supporting a proximal end of the cannula before repositioning the distal end of the cannula.

84. The method of claim 82, wherein at least one of the first working space and the second working space is between the distal end of the cannula and a vertebral body.

85. The method of claim 82, wherein at least one of the first working space and the second working space is between the distal end of the cannula and a disc annulus.

86. The method of claim 82, further comprising positioning a viewing element with respect to the cannula to visualize the first working space and the second working space.

87. The method of claim 86, further comprising visualizing the paraspinous tissue at the distal end of the cannula while repositioning of the distal end of the cannula.

88. The method of claim 82, further comprising performing a surgical procedure through the cannula in at least one of the first working space and the second working space.

89. The method of claim 82, wherein repositioning the distal end is performed with image guided technology.

90. The method of claim 82, further comprising inserting a bone graft through the cannula.

91. The method of claim 82, further comprising inserting a fusion device through the cannula.

92. The method of claim 82, further comprising inserting a bone screw through the cannula.

93. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin through the incision;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space;

supporting the proximal end of the cannula;

positioning a viewing element with respect to the cannula to visualize the first working space;

repositioning through the incision the distal end of the cannula to a second working space adjacent the distal end of the cannula under visualization from the viewing element; and

inserting a retractor through the cannula to retract paraspinous tissue as the distal end of the cannula is repositioned.

94. The method of claim 93, wherein the first working space and the second working space are located distally of the distal end of the cannula.

95. The method of claim 93, further comprising performing a surgical procedure through the cannula in the first working space and the second working space.

96. The method of claim 93, wherein dilating the skin and tissue includes:

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

97. The method of claim 93, further comprising inserting a bone graft through the cannula.

98. The method of claim 93, further comprising inserting a fusion device through the cannula.

99. The method of claim 93, further comprising inserting a bone screw through the cannula.

100. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin through the incision;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space;

supporting the proximal end of the cannula;

positioning a viewing element with respect to the cannula to visualize the first working space; and

repositioning through the incision the distal end of the cannula to a second working space adjacent the distal end of the cannula under visualization from the viewing element, wherein dilating the skin and tissue includes;

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

101. The method of claim 100, wherein the first working space and the second working space are located distally of the distal end of the cannula.

102. The method of claim 100, further comprising:

inserting a retractor through the cannula to retract paraspinous tissue as the distal end of the cannula is repositioned.

103. The method of claim 100, further comprising performing a surgical procedure through the cannula in the first working space and the second working space.

104. The method of claim 100, further comprising inserting a bone graft through the cannula.

105. The method of claim 100, further comprising inserting a fusion device through the cannula.

106. The method of claim 100, further comprising inserting a bone screw through the cannula.

107. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space that includes paraspinous tissue;

repositioning through the incision the distal end of the cannula to a second working space adjacent the distal end of the cannula, the second working space including bony structure of the spine; and

inserting a retractor through the cannula to retract paraspinous tissue as the distal end of the cannula is repositioned.

108. The method of claim 107, further comprising securing a proximal end of the cannula to a flexible arm.

109. The method of claim 107, further comprising positioning a viewing element with respect to the cannula to visualize the first and second working space.

110. The method of claim 107, wherein repositioning the distal end is performed with image guided technology.

111. The method of claim 107, further comprising:

inserting an instrument through the cannula; and

manipulating a neural elements with the instrument, wherein the second working space includes an area occupied by the unmanipulated neural elements.

112. The method of claim 107, wherein dilating the skin and tissue includes:

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

113. The method of claim 107, further comprising inserting a bone graft through the cannula.

114. The method of claim 107, further comprising inserting a fusion device through the cannula.

115. The method of claim 107, further comprising inserting a bone screw through the cannula.

116. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space that includes paraspinous tissue;

repositioning through the incision the distal end of the cannula to a second working space adjacent the distal end of the cannula, the second working space including bony structure of the spine;

inserting an instrument through the cannula; and

manipulating a neural elements with the instrument, wherein the second working space includes an area occupied by the unmanipulated neural elements.

117. The method of claim 116, further comprising securing a proximal end of the cannula to a flexible arm.

118. The method of claim 116, further comprising positioning a viewing element with respect to the cannula to visualize the first and second working space.

119. The method of claim 116, wherein repositioning the distal end is performed with image guided technology.

120. The method of claim 116, further comprising:

a retractor through the cannula to retract paraspinous tissue as the distal end of the cannula is repositioned.

121. The method of claim 116, wherein dilating the skin and tissue includes:

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

122. The method of claim 116, further comprising inserting a bone graft through the cannula.

123. The method of claim 116, further comprising inserting a fusion device through the cannula.

124. The method of claim 116, further comprising inserting a bone screw through the cannula.

125. A method for accessing the spine, comprising:

making an incision in the skin of a patient;

dilating the skin and tissue below the skin;

inserting a cannula through the dilated skin and tissue, the cannula having a distal end positioned adjacent a first working space that includes paraspinous tissue; and

repositioning through the incision the distal end of the cannula to a second working space adjacent the distal end of the cannula, the second working space including bony structure of the spine, wherein dilating the skin and tissue includes;

sequentially inserting one over another a number of dilators of increasing diameter; and

inserting the cannula through the incision over a final one of the number of dilators.

126. The method of claim 125, further comprising securing a proximal end of the cannula to a flexible arm.

127. The method of claim 125, further comprising positioning a viewing element with respect to the cannula to visualize the first and second working space.

128. The method of claim 125, wherein repositioning the distal end is performed with image guided technology.

129. The method of claim 125, further comprising:

inserting a retractor through the cannula to retract paraspinous tissue as the distal end of the cannula is repositioned.

130. The method of claim 125, further comprising:

inserting an instrument through the cannula; and

manipulating a neural elements with the instrument, wherein the second working space includes an area occupied by the unmanipulated neural elements.

131. The method of claim 125, further comprising inserting a bone graft through the cannula.

132. The method of claim 125, further comprising inserting a fusion device through the cannula.

133. The method of claim 125, further comprising inserting a bone screw through the cannula.