Method of performing a transforaminal posterior lumber interbody fusion procedure

• US 7,226,483 B2
• Filed: 02/26/2004
• Issued: 06/05/2007
• Est. Priority Date: 05/03/2001
• Status: Expired due to Term

• Current Assignee: Synthes USA LLC (Johnson & Johnson)
• Original Assignee: Synthes USA LLC (Johnson & Johnson)
• Inventors: Messerli, Dominique, Paul, David, Gerber, David
• Primary Examiner(s): Barrett; Tom
• Application Number:
  US10/788,015
• Publication Number:
  US 20040167538A1
• Time in Patent Office: 1,195 Days
• Field of Search: 623 1711- 1716
• US Class Current: 623/17.16
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1659 Surgical rasps, files, planes, or scrapers
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61F 2/28 Bones joints A61F2/30
• CPC Class Codes: A61F 2/4465 having a circular or kidney shaped cross-section substantially perpendicular to the axis of the spine
• CPC Class Codes: A61F 2/4611 of spinal prostheses
• CPC Class Codes: A61F 2/4684 Trial or dummy 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 2002/3008 radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: A61F 2002/30133 kidney-shaped or bean-shaped
• CPC Class Codes: A61F 2002/30383 made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
• 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 2002/30594 slotted, e.g. radial or meridian slot ending in a polar aperture, non-polar slots, horizontal or arcuate slots
• CPC Class Codes: A61F 2002/30604 modular
• CPC Class Codes: A61F 2002/30787 inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30797 internally-threaded
• CPC Class Codes: A61F 2002/30843 Pyramidally-shaped
• CPC Class Codes: A61F 2002/30904 serrated profile, i.e. saw-toothed
• CPC Class Codes: A61F 2002/30975 : made of two halves
• CPC Class Codes: A61F 2002/4628 : with linear motion along or rotating motion about an axis transverse to the instrument axis or to the implantation direction, e.g. clamping
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2230/0015 : Kidney-shaped, e.g. bean-shaped
• CPC Class Codes: A61F 2250/0006 : for adjusting angular orientation
• CPC Class Codes: A61F 2250/0098 : radio-opaque, e.g. radio-opaque markers
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00359 : Bone or bony tissue

Abstract

An intervertebral implant for fusing vertebrae is disclosed. The implant has a body with curved, substantially parallel posterior and anterior faces separated by two narrow implant ends, superior and inferior faces having a plurality of undulating surfaces for contacting upper and lower vertebral endplates, and at least one depression at a first end for engagement by an insertion tool. The arcuate implant configuration facilitates insertion of the implant from a transforaminal approach into a symmetric position about the midline of the spine so that a single implant provides balanced support to the spinal column. The implant may be formed of a plurality of interconnecting bodies assembled to form a single unit. An implantation kit and method are also disclosed.

Claims

1. A method for implanting an intervertebral implant into a disc space of a patient comprising:

distracting adjacent vertebra;

removing an inferior facet of the cranial vertebrae and a superior facet of the caudal vertebrae to create a transforaminal window from a posterior side of the patient'"'"'s spine;

removing substantially all of the disc material between the adjacent vertebra;

removing the superficial layers of the vertebra endplates to expose bleeding bone;

inserting and removing at least one trial fit spacer until a desired implant thickness is determined;

inserting an implant into the intervertebral disc space via the transforaminal window; and

guiding the implant through the transforaminal window into a desired position within the disc space

wherein the implant has a curved, concave posterior face and a curved, convex anterior face, both curved posterior and anterior faces extending along a longitudinal axis of the implant;

a pair of convex narrow ends separating the posterior and anterior faces;

superior and inferior faces for contacting upper and lower vertebral endplates, the superior and inferior surfaces defining a thickness of the implant; and

first and second non-threaded, horizontal channels configured and adapted for engagement by the insertion tool, the first channel disposed along at least a portion of the curved posterior face and the second channel disposed along at least a portion of the curved anterior face;

wherein the superior and inferior faces are convex and include a plurality of undulating surfaces thereon.

2. The method of claim 1, wherein the implant is guided through the transforaminal window using a guide tool having a curved blade with a curvature that substantially matches the curvature of the anterior face of the implant.

3. The method of claim 2, wherein the inserting and guiding steps comprise first inserting one of the end faces of the implant into the transforaminal window, rotating the implant so that an anterior face of the implant faces anteriorly and moving the implant around the dura.

4. The method of claim 1, further comprising inserting bone graft material into the disc space.

5. The method of claim 1, further comprising impacting the implant to properly locate the implant in the disc space, wherein a face of the impactor is concave to mate with a convex end of the implant.

6. The method of claim 5, wherein the impactor is angled to facilitate proper positioning of the implant within the disc space.

7. The method of claim 1, further comprising removing the inferior facet of the cranial vertebrae and the superior facet of the caudal vertebrae to create a transforaminal window that is approximately 9.0 mm wide.

8. The method of claim 1, wherein the insertion tool has a pair of tips formed on an end thereof for engaging the pair of channels located on the anterior and posterior faces of the implant.

9. The method of claim 8, wherein the insertion tool is angled to facilitate insertion of the implant via the transforaminal window.

10. The method of claim 1, wherein the implant has an arcuate configuration for facilitating insertion of the implant into a symmetric medial-lateral position about the midline of the spine so that a single implant provides balanced support to the spinal column.

11. The method of claim 1, wherein the first and second channels are curved with the anterior and posterior faces for facilitating the insertion of the implant through the transforaminal window into the disk space.

12. A method for implanting an intervertebral implant into a disc space of a patient comprising:

distracting adjacent vertebra;

removing an inferior facet of the cranial vertebrae and a superior facet of the caudal vertebrae to create a transforaminal window from a posterior side of the patient'"'"'s spine;

removing substantially all of the disc material between the adjacent vertebra;

removing the superficial layers of the vertebra endplates to expose bleeding bone;

inserting and removing at least one trial fit spacer until a desired implant thickness is determined;

inserting an implant into the intervertebral disc space via the transforaminal window; and

guiding the implant through the transforaminal window into a desired position within the disc space

wherein the implant has a curved, concave posterior face and a curved, convex anterior face, both curved posterior and anterior faces extending along a longitudinal axis of the implant;

a pair of convex narrow ends separating the posterior and anterior faces;

superior and inferior faces for contacting upper and lower vertebral endplates, the superior and inferior surfaces defining a thickness of the implant; and

first and second non-threaded, horizontal channels configured and adapted for engagement by an implant insertion tool, the first channel disposed along at least a portion of the curved posterior face and the second channel disposed along at least a portion of the curved anterior face;

wherein the implant is formed of a plurality of interconnecting bodies assembled to form a single unit.

13. A method for implanting an intervertebral implant into a disc space of a patient comprising:

distracting a pair of adjacent vertebra using at least one instrument selected from the group consisting of a lam ma spreader and a lateral distractor;

removing an inferior facet of a cranial vertebrae and a superior facet of a caudal vertebrae using an osteotome to create a transforaminal window from the posterior side of the spine;

removing substantially all of the disc material between the adjacent vertebra using a curette;

removing the superficial layers of the vertebra endplates using a bone rasp to expose bleeding bone;

inserting a trial fit spacer until a desired implant thickness is determined; and

inserting an implant into the intervertebral disc space via the transforaminal window using an insertion tool

wherein the implant has a curved, concave posterior face and a curved, convex anterior face, both curved posterior and anterior faces extending along a longitudinal axis of the implant;

a pair of convex narrow ends separating the posterior and anterior faces;

superior and inferior faces for contacting upper and lower vertebral endplates, the superior and inferior surfaces defining a thickness of the implant; and

first and second non-threaded, horizontal channels configured and adapted for engagement by the insertion tool, the first channel disposed along at least a portion of the curved posterior face and the second channel disposed along at least a portion of the curved anterior face;

wherein the superior and inferior faces are convex and include a plurality of undulating surfaces thereon.

14. The method of claim 13, further comprising inserting bone graft material into the disc space.

15. The method of claim 13, further comprising guiding the implant through the transforaminal window using a guide tool having a curved blade with a curvature that substantially matches the curvature of the anterior face of the implant.

16. The method of claim 15, wherein the inserting and guiding steps comprise first inserting one of the end faces of the implant into the transforaminal window, rotating the implant so that an anterior face of the implant faces anteriorly and moving the implant around the dura.

17. The method of claim 13, further comprising impacting the implant using an impactor to properly locate the implant in the disc space, wherein a face of the impactor is concave to mate with a convex end of the implant.

18. The method of claim 17, wherein the impactor is angled to facilitate proper positioning of the implant within the disc space.

19. The method of claim 13, further comprising removing the inferior facet of the cranial vertebrae and the superior facet of the caudal vertebrae to create a transforaminal window that is approximately 9.0 mm wide.

20. The method of claim 13, wherein the insertion tool has a pair of tips formed on an end thereof for engaging the pair of channels located on the anterior and posterior faces of the implant.

21. The method of claim 20, wherein the insertion tool is angled to facilitate insertion of the implant via the transforaminal window.

22. The method of claim 13, wherein the implant has an arcuate configuration for facilitating insertion of the implant into a symmetric medial-lateral position about the midline of the spine so that a single implant provides balanced support to the spinal column.

23. The method of claim 13,

wherein the first and second channels are curved with the anterior and posterior faces for facilitating the insertion of the implant through the transforaminal window into the disk space.

24. A method for implanting an intervertebral implant into a disc space of a patient comprising:

distracting a pair of adjacent vertebra using at least one instrument selected from the group consisting of a lamina spreader and a lateral distractor;

removing an inferior facet of a cranial vertebrae and a superior facet of a caudal vertebrae using an osteotome to create a transforaminal window from the posterior side of the spine;

removing substantially all of the disc material between the adjacent vertebra using a curette;

removing the superficial layers of the vertebra endplates using a bone rasp to expose bleeding bone;

inserting a trial fit spacer until a desired implant thickness is determined; and

inserting an implant into the intervertebral disc space via the transforaminal window using an insertion tool,

wherein the implant has a curved, concave posterior face and a curved, convex anterior face, both curved posterior and anterior faces extending along a longitudinal axis of the implant;

a pair of convex narrow ends separating the posterior and anterior faces;

superior and inferior faces for contacting upper and lower vertebral endplates, the superior and inferior surfaces defining a thickness of the implant; and

first and second non-threaded, horizontal channels configured and adapted for engagement by an implant insertion tool, the first channel disposed along at least a portion of the curved posterior face and the second channel disposed along at least a portion of the curved anterior face;

wherein the implant is formed of a plurality of interconnecting bodies assembled to form a single unit.

25. A method for implanting an intervertebral implant into a disc space of a patient around the patient'"'"'s dura comprising:

creating a transforaminal window from a posterior side of the spine;

inserting bone graft material into the disc space;

providing an implant having a body with curved, substantially parallel posterior and anterior faces separated by two narrow implant ends, superior and inferior faces having a plurality of projections for contacting upper and lower vertebral endplates;

inserting the implant into the affected disc space via the transforaminal window with an insertion tool;

guiding the implant around the dura through the transforaminal window using the insertion tool

wherein the implant has a curved, concave posterior face and a curved, convex anterior face, both curved posterior and anterior faces extending along a longitudinal axis of the implant;

a pair of convex narrow ends separating the posterior and anterior faces;

superior and inferior faces for contacting upper and lower vertebral endplates, the superior and inferior surfaces defining a thickness of the implant; and

first and second non-threaded, horizontal channels configured and adapted for engagement by the insertion tool, the first channel disposed along at least a portion of the curved posterior face and the second channel disposed along at least a portion of the curved anterior face.

26. The method of claim 25, further comprising positioning the implant symmetrically about the midline of the spine.

27. The method of claim 26, wherein the insertion tool is angled to facilitate insertion of the implant via the transforaminal window.

28. The method of claim 25, further comprising impacting the implant with an impactor tool to properly position the implant within the affected disc space.

29. The method of claim 28, wherein the impactor tool is angled to facilitate proper positioning of the implant within the affected disc space.

30. The method of claim of 25, further comprising using a curved guide to assist in locating the implant in the affected disc space behind the dura.

31. The method of claim 25, wherein the inserting and guiding steps comprise first inserting the narrow end of the implant into the transforaminal window, rotating the implant so that the anterior face of the implant faces anteriorly and moving the implant around the dura.

32. The method of claim 25, wherein the implant is formed of a plurality of interconnecting bodies assembled to form a single unit.