Method and apparatus for endoscopic spinal surgery

• US 6,851,430 B2
• Filed: 11/30/2001
• Issued: 02/08/2005
• Est. Priority Date: 05/01/2000
• Status: Expired due to Fees

• Current Assignee: Paul M. Tsou
• Original Assignee: Paul M. Tsou
• Inventors: Tsou, Paul M.
• Primary Examiner(s): O'Connor, Cary E.
• Assistant Examiner(s): STOKES, CANDICE CAPRI
• Application Number:
  US09/997,361
• Publication Number:
  US 20020077632A1
• Time in Patent Office: 1,166 Days
• Field of Search: 606/79, 128/898
• US Class Current: 128/898
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3439 with means for changing the inner diameter of the cannula, e.g. expandable A61B17/3423, A61B17/3431 take precedence; catheters A61M25/0662
• CPC Class Codes: A61B 17/3472 for bones, e.g. intraosseus injections
• CPC Class Codes: A61B 17/72 Intramedullary pins, nails or other devices A61B17/744 takes precedence
• CPC Class Codes: A61B 17/88 Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices A61B17/7074 takes precedence
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/0256 for the spine
• 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

Abstract

A method of performing percutaneous transforaminal endoscopic lumbar surgery on a patient, includes the steps of creating an opening in the patient'"'"'s skin, passing at least one tubular cannula through the opening so as to create a soft tissue tunnel, placing a semi-tubular spreader over the at least one tubular cannula inside the soft tissue tunnel, placing a flat blade spreader into an opening formed by the semi-tubular spreader, dilating the opening by spreading apart blades of the flat blade spreader, inserting bone grafts through the opening and into an intervertebral space of the patient.

Claims

1. A method of performing percutaneous transforaminal endoscopic lumbar surgery on a patient, comprising the steps of:

creating an opening in said patent'"'"'s skin;

passing at least one tubular cannula through said opening so as to create a soft tissue tunnel;

placing a semi-tubular spreader over a said at least one tubular cannula inside said soft tissue tunnel;

placing a flat blade spreader into an opening formed by said semi-tubular spreader;

dilating said opening by spreading apart blades of said flat blade spreader;

inserting bone grafts through said opening and into an intervertebral space of said patient.

2. The method of claim 1, wherein said at least at least one tubular cannula has a first end, and said first end passes through said opening and stops substantially adjacent to said invertervebral space of said patient.

3. The method of claim 1, further comprising, after said step of placing said semi-tubular spreader, the step of removing said at least one cannula.

4. The method of claim 1, further comprising, after said step of dilating said opening, the step of rotating said flat blade spreader and said semi-tubular spreader in unison.

5. The method of claim 4, further comprising, after said rotating step, the step of removing said semi-tubular spreader.

6. The method of claim 4, wherein said flat blade spreader is rotated through an angle of approximately ninety degrees.

7. The method of claim 4, wherein said flat blade spreader is rotated through an angle such that blades of said flat blade spreader are oriented substantially cephalad-caudad.

8. The method of claim 1, wherein when said flat blade spreader is dilated, a cross section of said soft tissue tunnel is changed to be substantially rectangular in shape, and said intervertebral space is increased.

9. The method of claim 1 further comprising, prior to said step of inserting bone grafts, the step of debriding nucleus pulposus in said intervertebral space.

10. The method of claim 1, wherein said bone grafts are substantially rectangular in shape.

11. The method of claim 1, wherein said bone grafts have the shape of a flat disc.

12. A method of performing percutaneous transforaminal lumbar surgery in a patient, comprising the steps of:

creating a skin window in said patient'"'"'s skin;

defining a foraminal window substantially adjacent to said a discal space of said patient;

inserting a needle through said skin window and guiding a tip of said needle to said foraminal annular window;

passing an obturator over a said needle so as to create a soft tissue tunnel in said patient, said soft tissue tunnel beginning at said skin window and terminating at said foraminal window;

removing said needle;

placing a first cannula over said obturator, within said soft tissue tunnel;

removing said obturator;

placing a plurality of progressively larger cannulae within said soft tissue tunnel so as to dilate said skin window and said soft tissue tunnel, each of said cannulae being removed after said next larger cannula is inserted;

inserting a semi-tubular spreader over one of said tubular cannulae, said semi-tubular spreader having a tube portion comprised of an upper arm and lower arm, said semi-tubular spreader being oriented such that an opening between said upper arm and said lower arm is substantially horizontal;

dilating said annular fenestration and vertebral separation by using circular rods of progressively increasing diameter inserted within said tube portion of said semi-tubular spreader;

debriding nucleus pulposus within said intervertebral space;

inserting a flat blade spreader into said semi-tubular spreader, said flat blade spreader having at least two blade portions, said blade portions fitting into said opening between said upper and lower arms of said semi-tubular spreader;

rotating said semi-tubular spreader and said flat blade spreader in unison;

removing said semi tubular spreader;

spreading said blade portions of said flat blade spreader so as to dilate said soft tissue tunnel and spread apart vertebrae adjacent to said intervertebral space;

inserting at least one substantially rectangular graft substantially anteriorly in said intervertebral space;

filling lattices of the block graft and void spaces of the interspace with osteoinductive agents.

13. The met hod of claim 12, wherein said skin window constitutes an annular fenestration.

14. The method of claim 12, wherein said semi-tubular spreader and said flat blade spreader are rotated through an angle of approximately ninety degrees.

15. A flat blade spreader for use in endoscopic lumbar surgery, comprising:

a first handle and a second handle joined together by at least one pivot point, each of said handles including a grip;

each handle having attached to it a flat surface blade extending outward at an angle from a planar surface of the first and second handle grips.

16. The device of claim 15 wherein said flat surface blades are grooved.