Device and method for lumbar interbody fusion

• US 6,666,891 B2
• Filed: 11/13/2001
• Issued: 12/23/2003
• Est. Priority Date: 11/13/2000
• Status: Active Grant

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Benedetta Delorenzo Melnick, Frank H. Boehm Jr
• Inventors: Melnick, Benedetta Delorenzo, Boehm, Frank H. Jr.
• Primary Examiner(s): Robert, Eduardo C.
• Assistant Examiner(s): BONDERER, DAVID A
• Application Number:
  US10/010,314
• Publication Number:
  US 20020107574A1
• Time in Patent Office: 770 Days
• Field of Search: 623/17.11, 623/17.15, 623/17.16, 606/60, 606/61, 606/62, 606/63, 604/104
• US Class Current: 623/17.16
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2050/005 with a lid or cover
• CPC Class Codes: A61B 50/33 Trays
• CPC Class Codes: A61F 2/0095 Packages or dispensers for prostheses or other implants for intraocular lenses A61F2/1691; for dental surgery A61C19/02
• CPC Class Codes: A61F 2/28 Bones joints A61F2/30
• CPC Class Codes: A61F 2/30771 applied in original prostheses, e.g. holes or grooves
• 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 2/447 substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
• 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 2002/30237 partial tubes
• CPC Class Codes: A61F 2002/30372 with additional means for limiting said translation
• CPC Class Codes: A61F 2002/30492 using a locking pin
• CPC Class Codes: A61F 2002/30507 using a threaded locking member, e.g. a locking screw or a set screw
• CPC Class Codes: A61F 2002/30538 for adjusting angular orientation
• CPC Class Codes: A61F 2002/30556 for adjusting thickness
• CPC Class Codes: A61F 2002/30579 with mechanically expandable devices, e.g. fixation devices
• CPC Class Codes: A61F 2002/30975 made of two halves
• 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 2002/4635 : 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 2220/0033 : made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2230/0069 : cylindrical
• CPC Class Codes: A61F 2250/0006 : for adjusting angular orientation
• CPC Class Codes: A61F 2250/0009 : for adjusting thickness
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00359 : Bone or bony tissue
• CPC Class Codes: Y10S 606/914 : Toolkit for installing or removing spinal positioner or stabilizer

Abstract

A method for performing percutaneous interbody fusion is disclosed. The method includes the steps of inserting a guide needle posteriorly to the disc space, inserting a dilator having an inner diameter slightly larger than the outer diameter of the guide needle over the guide needle to the disc space to enlarge the disc space, and successively passing a series of dilators, each having an inner diameter slightly larger than the outer diameter of the previous dilator, over the previous dilator to the disc space the gradually and incrementally increase the height of the disc space. Once the desired disc height is achieved, the guide needle and all the dilators, with the exception of the outermost dilator, are removed. An expandible intervertebral disc spacer is then passed through the remaining dilator and positioned in the disc space. Th disc spacer is expanded to the required disc height, and then a bone matrix is passed through the dilator to fill the disc space. The dilator is then removed. An expandible intervertebral disc spacer is also disclosed, having a tapered bore that causes greater expansion of one end of the spacer with respect to the other. A kit for performing the percutaneous interbody fusion procedure is also disclosed.

Claims

1. A method for performing a percutaneous interbody fusion procedure following a percutaneous discectomy procedure, comprising the steps of:

making an incision adjacent to a fusion site;

inserting a guide needle through the incision to a position in the disc space between a first and second vertebra at the fusion site, the guide needle having an outer diameter substantially the same as a length of the incision;

inserting at least one dilator over the guide needle to enlarge the disc space to a first desired height;

removing the guide needle from the dilator;

inserting an expandible intervertebral disc spacer into the disc space through the dilator;

expanding the disc spacer to enlarge the disc space to a second desired height;

inserting a bone matrix compound into the disc space through the dilator;

removing the dilator; and

closing the incision.

2. The method of claim 1, wherein the guide needle, the dilator, the disc spacer, and the bone matrix compound are inserted posteriorly of the spine of the patient.

3. The method of claim 1, wherein the steps of inserting the guide needle, the dilator, and the disc spacer are observed under imaging techniques including fluoroscopy.

4. The method of claim 1, wherein an inner diameter of the dilator is slightly larger than an outer diameter of the guide needle.

5. The method of claim 4, further comprising the step of successively inserting a plurality of dilators over a previous dilator to enlarge the disc space to the first desired height.

6. The method of claim 5, wherein each successive dilator has an inner diameter that is slightly larger than an outer diameter of a previous dilator.

7. A method for performing a percutaneous interbody fusion procedure after removal of a disc, comprising the steps of:

making an incision adjacent to a fusion site;

inserting a guide needle through the incision to a position in the disc space between a first and second vertebra on a first lateral side of the patient'"'"'s spine, the guide needle having an outer diameter similar to a length of the incision;

inserting a first dilator having an inner diameter that is slightly larger than an outer diameter of the guide needle over the guide needle to the disc space to enlarge the disc space;

determining if the disc space is at a first desired height;

if the disc space is not at the first desired height, successively inserting a plurality of dilators over the first dilator and guide needle, each successive dilator having an inner diameter that is slightly larger than an outer diameter of previous dilator to enlarge the disc space to the desired first height;

if the disc space is at the first desired height, removing the guide needle and each dilator except for an outermost dilator;

inserting an expandible intervertebral disc spacer through the outermost dilator to the disc space;

expanding the disc spacer to enlarge the disc space to a second desired height;

inserting a bone matrix compound through the outermost dilator to the disc space;

removing the outermost dilator; and

closing the incision.

8. The method of claim 7, further comprising repeating each step in the disc space on a second lateral side of the patient'"'"'s spine.

9. The method of claim 8, wherein the guide needle, the dilators, the disc spacer and the bone matrix compound are inserted posteriorly of the spine.

10. The method of claim 8, wherein the step of expanding the disc spacer enlarges an anterior side of the disc space a greater distance than the posterior side of the disc space to restore lordosis.

11. A method for performing a percutaneous interbody fusion procedure following a percutaneous discectomy procedure, comprising the steps of:

making an incision adjacent to a fusion site;

inserting a guide needle through the incision to a position in the disc space between a first and second vertebra;

inserting a plurality of dilators over the guide needle to enlarge a pathway from the incision to the disc space, a first dilator having an outer diameter that is substantially the same as a length of the incision;

removing the guide needle and the plurality of dilators from an outermost dilator;

inserting an expandible intervertebral disc spacer into the disc space through the outermost dilator;

expanding the disc spacer to enlarge the disc space to a desired height;

inserting a bone matrix compound into the disc space through the outermost dilator;

removing the outermost dilator; and

closing the incision.

12. The method of claim 11, wherein the step of inserting the plurality of dilators comprises successively inserting a dilator over a previous dilator to enlarge the pathway to the disc space.

13. The method of claim 12, wherein each successive dilator has an inner diameter that is slightly larger than an outer diameter of a previous dilator.