Method and apparatus for providing posterior or anterior trans-sacral access to spinal vertebrae
First Claim
1. A method of providing access for introduction of instruments to a series of adjacent vertebrae located within a human lumbar and sacral spine having an anterior aspect, a posterior aspect and an axial aspect, the vertebrae separated by intact or damaged spinal discs, the method comprising:
- from a skin incision, accessing an anterior or posterior sacral position of a sacral vertebra that is aligned with a visualized, trans-sacral axial fusion/instrumentation line extending in said axial aspect through the series of adjacent vertebral bodies;
forming a percutaneous tract extending from the skin incision to an anterior or posterior sacral position of a sacral vertebra having a tract axis aligned with said visualized, trans-sacral axial instrumentation/fusion line providing axial guidance for said instruments introduced over or through said percutaneous tract to said anterior or posterior sacral position; and
positioning an instrumentation guide in the tract, to guide the instruments to the sacral position.
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0 Petitions
Accused Products
Abstract
Methods and apparatus for providing percutaneous access to vertebrae in alignment with a visualized, trans-sacral axial instrumentation/fusion (TASIF) line in a minimally invasive, low trauma, manner are disclosed. A number of related TASIF methods and surgical tool sets are provided by the present invention that are employed to form a percutaneous pathway from an anterior or posterior skin incision to a respective anterior or posterior target point of a sacral surface. The percutaneous pathway is generally axially aligned with an anterior or posterior axial instrumentation/fusion line extending from the respective anterior or posterior target point through at least one sacral vertebral body and one or more lumbar vertebral bodies in the cephalad direction. The provision of the percutaneous pathway described herein allows for the formation of the anterior or posterior TASIF bore(s) and/or the introduction of spinal implants and instruments.
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Citations
48 Claims
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1. A method of providing access for introduction of instruments to a series of adjacent vertebrae located within a human lumbar and sacral spine having an anterior aspect, a posterior aspect and an axial aspect, the vertebrae separated by intact or damaged spinal discs, the method comprising:
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from a skin incision, accessing an anterior or posterior sacral position of a sacral vertebra that is aligned with a visualized, trans-sacral axial fusion/instrumentation line extending in said axial aspect through the series of adjacent vertebral bodies; forming a percutaneous tract extending from the skin incision to an anterior or posterior sacral position of a sacral vertebra having a tract axis aligned with said visualized, trans-sacral axial instrumentation/fusion line providing axial guidance for said instruments introduced over or through said percutaneous tract to said anterior or posterior sacral position; and positioning an instrumentation guide in the tract, to guide the instruments to the sacral position. - View Dependent Claims (2, 3, 4, 5, 6, 7)
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8. A method of providing access to a series of adjacent vertebrae located within a human lumbar and sacral spine having an anterior aspect, a posterior aspect and an axial aspect, the vertebrae separated by intact or damaged spinal discs, the method comprising:
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from a skin incision, accessing an anterior or posterior sacral position of a sacral vertebra that is aligned with a visualized, trans-sacral axial fusion/instrumentation line extending in said axial aspect through the series of adjacent vertebral bodies; forming an anterior, presacral, percutaneous tract through the patient'"'"'s presacral space to access an anterior presacral position of a sacral vertebra in alignment with a visualized, anterior axial instrumentation/fusion line extending in said axial aspect through the series of adjacent vertebral bodies; and positioning a tubular sleeve in the tract. - View Dependent Claims (9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
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20. A surgical operating system for farming a percutaneous pathway from a skin incision generally axially aligned with a series of adjacent vertebrae located within a human lumbar and sacral spine having an anterior aspect, a posterior aspect and an axial aspect, the vertebrae separated by intact or damaged spinal discs, the system comprising:
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guide means operable from a skin incision for accessing an anterior or posterior sacral position of a sacral vertebra that is aligned with a visualized, trans-sacral axial instrumentation/fusion line extending in said axial aspect through the series of adjacent vertebral bodies; and tract means defining a percutaneous tract having a tract axis aligned with said visualized, trans-sacral axial instrumentation/fusion line and extending from the skin incision to the accessed sacral position to facilitate surgical procedures aligned with said visualized, trans-sacral axial instrumentation/fusion line.
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21. A surgical operating system for forming a percutaneous pathway from a skin incision generally axially aligned with a series of adjacent vertebrae located within a human lumbar and sacral spine having an anterior aspect, a posterior aspect and an axial aspect, the vertebrae separated by intact or damaged spinal discs, the system comprising:
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an elongated guide assembly extendible from a skin incision for accessing an anterior or posterior sacral position of a sacral vertebra that is aligned with a visualized, trans-sacral axial instrumentation/fusion line extending in said axial aspect through the series of adjacent vertebral bodies; and a dilator adapted to dilate tissue surrounding the elongated guide assembly to form an enlarged percutaneous tract that is aligned with a visualized, trans-sacral axial instrumentation/fusion line. - View Dependent Claims (22, 23)
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24. Apparatus for obtaining access to and through a series of adjacent vertebrae located within a human lumbar and sacral spine having an anterior aspect, a posterior aspect and an axial aspect, the vertebrae separated by intact or damaged spinal discs, the apparatus comprising:
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means for exposing a sacral position of a sacral vertebra in alignment with a visualized, trans-sacral axial instrumentation/fusion line extending in said axial aspect through the series of adjacent vertebral bodies; means operable from the exposed sacral position for boring a trans-sacral pilot hole extending along said axial instrumentation/fusion line cephalad and axially through the vertebral bodies of said series of adjacent vertebrae and any intervening spinal discs to a pilot hole cephalad end; and a guidewire having a guidewire body extending between a guidewire proximal end and a guidewire distal end having a guidewire fixation mechanism at the guidewire distal end adapted to be advanced into the pilot hole and affixed to vertebral bone at the cephalad end of the pilot hole.
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25. A surgical operating system for forming a percutaneous pathway from a skin incision generally axially aligned with a series of adjacent vertebrae located within a human lumbar and sacral spine having an anterior aspect, a posterior aspect and an axial aspect, the vertebrae separated by intact or damaged spinal discs, the system comprising:
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guide means operable from a skin incision through a patient'"'"'s skin and exposing a posterior, presacral position of a sacral vertebra in alignment with a visualized, curved, posterior axial instrumentation/fusion line extending in said axial aspect initially laterally through the sacral vertebra and then following the curvature of the spine through a series of adjacent cephalad vertebral bodies for accessing a posterior sacral position of a sacral vertebra that is aligned with the visualized, trans-sacral axial instrumentation/fusion line extending in said axial aspect through the series of adjacent vertebral bodies; and tract means defining a percutaneous tract having a tract axis aligned with said visualized, trans-sacral axial instrumentation/fusion line and extending from the skin incision to the accessed sacral position to facilitate surgical procedures aligned with said visualized, trans-sacral axial instrumentation/fusion line. - View Dependent Claims (26, 27)
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28. A method of providing access to a series of adjacent vertebrae located within a lumbar and sacral spine having an anterior aspect, a posterior aspect and an axial aspect, the vertebrae separated by intact or damaged spinal discs, the method comprising:
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making an incision through the patient'"'"'s dermal entry site aligned with a visualized curved, posterior axial instrumentation/fusion line extending in said axial aspect through the series of adjacent vertebral bodies; providing a guide assembly having a guide assembly body extending between guide assembly proximal and distal ends, said guide assembly comprising a guide tubular member having a tubular member lumen within a tubular member body extending between proximal and distal tubular member ends; advancing the guide assembly through the incision to locate the guide assembly distal end against the posterior surface of the sacrum; further advancing the guide assembly distal end under visualization until the guide assembly distal end is at a posterior target point of a selected sacral vertebrae and the guide assembly body is aligned with the visualized curved, posterior axial instrumentation/fusion line and extends percutaneously to the guide assembly proximal end; and advancing the tubular member distal end against the posterior target point, whereby the tubular member provides a percutaneous tract over or through the tubular member from the dermal entry site to the posterior target paint. - View Dependent Claims (29, 30, 31, 32, 33, 34, 35, 36, 37)
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38. A method of providing access to a series of adjacent vertebrae located within a lumbar and sacral spine having an anterior aspect, a posterior aspect and an axial aspect, the vertebrae separated by intact or damaged spinal discs, the method comprising:
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making an incision through the patient'"'"'s dermal entry site aligned with a visualized curved, posterior axial instrumentation/fusion line extending in said axial aspect through the series of adjacent vertebral bodies; providing a guide assembly having a guide assembly body extending between guide assembly proximal and distal ends, said guide assembly comprising; a guide tubular member having a tubular member lumen within a tubular member body extending between proximal and distal tubular member ends; and a guidewire having a guidewire body extending between a guidewire proximal end and a guidewire distal end having a guidewire fixation mechanism for penetrating and affixing to bone at the guidewire distal end; inserting the guidewire through said tubular member lumen to locate the guidewire distal end retracted within said tubular member lumen and said guidewire proximal end extending proximally from said tubular member proximal end; advancing the guide assembly through the incision to located the guide assembly distal end against the posterior surface of the sacrum; further advancing the guide assembly distal end under visualization until the guide assembly distal end is at a posterior target point of a selected sacral vertebrae and the guide assembly body is aligned with the visualized curved, posterior axial instrumentation/fusion line and extends percutaneously to the guide assembly proximal end; extending the guidewire through said tubular member lumen into contact with the sacrum; affixing the guidewire fixation mechanism to sacral bone at the posterior target point; and removing the tubular member, whereby the attached guidewire provides a percutaneous tract for over the wire passage extending from the dermal entry site to the posterior target point. - View Dependent Claims (39, 40, 41, 42, 43, 44, 45, 46, 47, 48)
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Specification