Methods and instruments for interbody fusion

• US 7,300,440 B2
• Filed: 05/21/2003
• Issued: 11/27/2007
• Est. Priority Date: 03/27/1995
• Status: Expired due to Fees

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Inventors: Boyd, Lawrence M., Zdeblick, Thomas, Ray, Eddie III
• Primary Examiner(s): Robert; Eduardo C.
• Assistant Examiner(s): Araj; Michael J.
• Application Number:
  US10/442,822
• Publication Number:
  US 20030195519A1
• Time in Patent Office: 1,651 Days
• Field of Search: 600/204, 600/210, 600/214, 600/235, 600/154, 600/159, 606/80, 606/86, 606/90, 606/99, 606/96
• US Class Current: 606/80
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 1/3135 for examination of the epidural or the spinal space
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/282 Jaws
• CPC Class Codes: A61B 17/7059 Cortical plates A61B17/7007, A61B17/7058 take precedence
• CPC Class Codes: A61B 17/86 Pins or screws or threaded wires; nuts therefor A61B17/72 take precedence
• CPC Class Codes: A61B 17/8883 the driver bit acting on the periphery of the screw head
• CPC Class Codes: A61B 17/8891 at its periphery
• CPC Class Codes: A61B 2017/00238 Type of minimally invasive operation A61B2017/00805 takes precedence
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/3488 Fixation to inner organ or inner body tissue
• CPC Class Codes: A61B 2090/3904 specially adapted for marking specified tissue
• CPC Class Codes: A61B 2090/3937 Visible markers
• CPC Class Codes: A61F 2/30744 End caps, e.g. for closing an endoprosthetic cavity
• CPC Class Codes: A61F 2/30767 Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/442 Intervertebral or spinal discs, e.g. resilient non-disc-shaped intervertebral inflatable pockets A61F2/441; non-disc-shaped intervertebral fusion implants A61F2/4455
• CPC Class Codes: A61F 2/4455 for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages intervertebral discs A61F2/442
• 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 2/4601 : for introducing bone substitute, for implanting bone graft implants or for compacting them in the bone cavity
• CPC Class Codes: A61F 2/4611 : of spinal prostheses
• CPC Class Codes: A61F 2/4637 : for connecting or disconnecting two parts of a prosthesis
• 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 2002/30123 : with two diametrically opposed lobes
• CPC Class Codes: A61F 2002/30136 : undulated or wavy, e.g. serpentine-shaped or zigzag-shaped
• CPC Class Codes: A61F 2002/30143 : hexagonal
• CPC Class Codes: A61F 2002/30153 : rectangular
• CPC Class Codes: A61F 2002/30158 : trapezoidal
• CPC Class Codes: A61F 2002/30179 : X-shaped
• CPC Class Codes: A61F 2002/3021 : frustoconical
• CPC Class Codes: A61F 2002/30217 : hollow cones, e.g. tubular-like cones
• CPC Class Codes: A61F 2002/30329 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2002/30433 : using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/305 : Snap connection
• CPC Class Codes: A61F 2002/30507 : using a threaded locking member, e.g. a locking screw or a set screw
• CPC Class Codes: A61F 2002/30593 : hollow
• CPC Class Codes: A61F 2002/30774 : internally-threaded
• CPC Class Codes: A61F 2002/30777 : Oblong apertures
• CPC Class Codes: A61F 2002/30785 : parallel
• CPC Class Codes: A61F 2002/30787 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30789 : perpendicular with respect to each other
• CPC Class Codes: A61F 2002/3082 : Grooves
• CPC Class Codes: A61F 2002/3085 : with a threaded, e.g. self-tapping, bone-engaging surface, e.g. external surface
• CPC Class Codes: A61F 2002/30858 : Threads interrupted by grooves or sidewalls, e.g. flat sidewalls
• CPC Class Codes: A61F 2002/30863 : the entry end surface having flutes, relief grooves, starter notches or bevelled indentations
• CPC Class Codes: A61F 2002/30871 : Trapezoidal threads
• CPC Class Codes: A61F 2002/30873 : Threadings machined on non-cylindrical external surfaces
• 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 2002/4627 : with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2002/4641 : for disconnecting
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0041 : using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2230/0004 : Rounded shapes, e.g. with rounded corners
• CPC Class Codes: A61F 2230/0006 : circular
• CPC Class Codes: A61F 2230/0017 : Angular shapes
• CPC Class Codes: A61F 2230/0019 : rectangular
• CPC Class Codes: A61F 2230/0026 : trapezoidal
• CPC Class Codes: A61F 2230/0058 : X-shaped
• CPC Class Codes: A61F 2230/0067 : conical
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00095 : Niobium or Nb-based alloys
• CPC Class Codes: A61F 2310/00131 : Tantalum or Ta-based alloys
• CPC Class Codes: A61F 2310/00161 : Carbon; Graphite
• CPC Class Codes: A61F 2310/00179 : Ceramics or ceramic-like structures
• CPC Class Codes: A61F 2310/00796 : Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite
• CPC Class Codes: A61L 27/227 : Other specific proteins or polypeptides not covered by A61L27/222, A61L27/225 or A61L27/24
• CPC Class Codes: A61L 31/047 : Other specific proteins or polypeptides not covered by A61L31/044 - A61L31/046

Abstract

A laparoscopic surgical technique is provided for preparing a site for implantation of a fusion device or implant. In accordance with one embodiment of the technique, a laparoscope is provided having an outer sleeve with distraction fingers at one end to distract the disc space. The laparoscope includes a laparoscopic port at its opposite end through which instruments and implants are inserted. The laparoscope provides a sealed working channel to the disc space, through which the disc space is distracted, the vertebral endplates and surrounding disc is reamed, and the fusion device inserted. The laparoscope is alternately engaged within bilateral locations in the disc space for insertion of a pair of fusion implants. A switching sleeve extends through the laparoscope to protect the tissue at the surgical site as the laparoscope is moved between the bilateral fusion locations.

Claims

1. A method for performing a spinal procedure, comprising:

making an incision in a patient'"'"'s skin adjacent a vertebral disc space;

providing a laparoscope having a sleeve with oppositely disposed fingers extending from one end of the sleeve and a laparoscopic port positioned adjacent an opposite end of the sleeve, the fingers configured to maintain distraction of the vertebrae adjacent the vertebral disc space, the laparoscopic port including a number of seals;

providing an insertion member including a distal tip portion;

inserting the insertion member into the laparoscopic port and through the number of seals to provide sealing engagement between the insertion member and the sleeve with the distal tip portion extending beyond the distal end of the sleeve;

advancing the sleeve through the incision with the port positioned outside the patient;

engaging the distal tip portion of the insertion member with the vertebrae;

inserting the fingers into the vertebral disc space to define a protected channel between the vertebral disc space and the laparoscopic port;

inserting a surgical cutting instrument through the seals of the laparoscopic port and through the sleeve; and

cutting into at least one of the vertebral disc material and one or both of the adjacent vertebrae with the surgical cutting instrument adjacent the vertebral disc space.

2. The method of claim 1, wherein the distal tip portion of the insertion member is tapered.

3. The method of claim 1, wherein distal tip portion of the insertion member extends beyond the fingers of the sleeve during the engaging.

4. The method of claim 1, further comprising:

providing a removable cylindrical member defining an interior passage;

inserting the removable cylindrical member into the laparoscopic port and through the number of seals to provide sealing engagement between the removable cylindrical member and the sleeve;

introducing a surgical instrument through the interior passage of the removable cylindrical member.

5. The method of claim 4, wherein the removable cylindrical member precludes contact between the surgical instrument and the number of seals.

6. The method of claim 1, wherein the number of seals are provided by a seal member including an annular flange portion positioned in abutment against a proximally-facing end surface of the sleeve.

7. The method of claim 1, wherein the cutting comprises at least one of drilling and tapping.

8. The method of claim 1, further comprising delivering an implant through the sleeve and into an opening in the vertebral disc space.

9. A method for performing a spinal procedure, comprising:

providing a laparoscopic vertebral distractor including an elongated member having proximal and distal end portions and defining a longitudinal opening, the distal end portion including two spaced apart arms, the proximal end portion including a laparoscopic port and having a number of seals;

providing a removable sleeve member defining an interior passage;

inserting the spaced apart arms into a vertebral disc space to distract the adjacent vertebrae;

inserting the removable sleeve member into the laparoscopic port and through the number of seals to provide sealing engagement between the removable sleeve member and the elongated member;

introducing a surgical instrument through the interior passage of the removable sleeve member and the opening of the elongated member; and

cutting into at least one of the vertebral disc material and one or both of the adjacent vertebrae with a cutting instrument adjacent the vertebral disc space.

10. The method of claim 9, wherein the removable sleeve member includes an annular flange portion positioned in abutment against a proximally-facing surface of the proximal end portion of the elongated member.

11. The method of claim 10, wherein the removable sleeve member includes an axial sleeve portion extending from the annular flange portion and into the proximal end portion of the elongated member.

12. The method of claim 11, wherein the annular flange portion of the removable sleeve member is positioned external to the proximal end portion of the elongated member.

13. The method of claim 9, wherein the removable sleeve member precludes contact between the surgical instrument and the number of seals.

14. The method of claim 9, wherein the interior passage of the removable sleeve member includes an inner diameter sized in relatively close tolerance with an outer diameter of the surgical instrument to guide the surgical instrument.

15. The method of claim 9, further comprising:

providing an insertion member including a distal tip portion;

inserting the insertion member into the laparoscopic port and through the number of seals to provide sealing engagement between the insertion member and the elongated member with the distal tip portion of the insertion member extending beyond the distal end portion of the elongated member; and

engaging the distal tip portion of the insertion member with the adjacent vertebrae prior to inserting the spaced apart arms of the elongated member into the vertebral disc space.

16. The method of claim 15, wherein the distal tip portion of the insertion member is tapered.

17. The method of claim 9, wherein the cutting comprises at least one of drilling and tapping.

18. The method of claim 9, further comprising delivering an implant through the elongated member and into an opening in the vertebral disc space.