Spinal stabilization systems and methods using minimally invasive surgical procedures

• US 7,491,218 B2
• Filed: 10/30/2003
• Issued: 02/17/2009
• Est. Priority Date: 10/30/2002
• Status: Active Grant

• Current Assignee: Zimmer Biomet Spine, Inc. (Zimvie Incorporated)
• Original Assignee: Abbott Spine Inc. (Zimmer Biomet Holdings, Inc.)
• Inventors: Jones, Robert, Landry, Michael E., Wagner, Erik, Khoo, Larry, Forton, Charles
• Primary Examiner(s): Robert; Eduardo C
• Assistant Examiner(s): Swiger, III; James L
• Application Number:
  US10/698,010
• Publication Number:
  US 20040143265A1
• Time in Patent Office: 1,937 Days
• Field of Search: 606/61, 606/72, 606/73, 606/246, 606250-265, 606/270, 606278-279, 606300-301, 606/319, 606/99, 606/104, 606/86.A, 606/266, 606/304, 606/308, 606/272
• US Class Current: 606/246
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1655 for tapping
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/701 Longitudinal elements with a non-circular, e.g. rectangular, cross-section A61B17/7005, A61B17/7007 take precedence
• CPC Class Codes: A61B 17/7011 Longitudinal element being non-straight, e.g. curved, angled or branched adjustable length longitudinal elements A61B17/7014; A61B17/7019 takes precedence, e.g. coil springs
• CPC Class Codes: A61B 17/7032 Screws or hooks with U-shaped head or back through which longitudinal rods pass
• CPC Class Codes: A61B 17/7035 Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
• CPC Class Codes: A61B 17/7037 wherein pivoting is blocked when the rod is clamped
• CPC Class Codes: A61B 17/708 with tubular extensions coaxially mounted on the bone anchors
• CPC Class Codes: A61B 17/7082 for driving, i.e. rotating, screws or screw parts specially adapted for spinal fixation, e.g. for driving polyaxial or tulip-headed screws driving other bone screws A61B17/8875
• CPC Class Codes: A61B 17/7083 Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements
• CPC Class Codes: A61B 17/7085 for insertion of a longitudinal element down one or more hollow screw or hook extensions, i.e. at least a part of the element within an extension has a component of movement parallel to the extension's axis
• CPC Class Codes: A61B 17/7091 for applying, tightening or removing longitudinal element-to-bone anchor locking elements, e.g. caps, set screws, nuts or wedges
• CPC Class Codes: A61B 17/8605 Heads, i.e. proximal ends projecting from bone
• CPC Class Codes: A61B 17/861 specially shaped for gripping driver
• CPC Class Codes: A61B 17/8863 Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• CPC Class Codes: A61B 17/8866 for gripping or pushing bones, e.g. approximators joint distractors A61B17/025
• CPC Class Codes: A61B 17/8875 : Screwdrivers, spanners or wrenches
• CPC Class Codes: A61B 17/8897 : Guide wires or guide pins
• CPC Class Codes: A61B 2017/0256 : for the spine
• CPC Class Codes: A61B 2090/031 : torque limiting
• CPC Class Codes: A61B 2090/037 : with a frangible part, e.g. by reduced diameter
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/062 : penetration depth
• CPC Class Codes: Y10S 606/914 : Toolkit for installing or removing spinal positioner or stabilizer

Abstract

A spinal stabilization system may be formed in a patient. In some embodiments, a minimally invasive procedure may be used to form a spinal stabilization system in a patient. Bone fastener assemblies may be coupled to vertebrae. Each bone fastener assembly may include a bone fastener and a collar. The collar may be rotated and/or angulated relative to the bone fastener. Detachable members may be coupled to the collar to allow for formation of the spinal stabilization system through a small skin incision. The detachable members may allow for alignment of the collars to facilitate insertion of an elongated member in the collars. An elongated member may be positioned in the collars and a closure member may be used to secure the elongated member to the collars.

Claims

1. A system for performing spine surgery, said system comprising:

a first bone screw configured to be screwed into a first vertebra;

a first collar rotatably coupled to the first bone screw, said first collar comprising a first slot having a slot width;

a second bone screw configured to be screwed into a second vertebra;

a second collar rotatably coupled to the second bone screw, said second collar comprising a second slot;

a rod, said rod having a width less than the slot width;

a first sleeve comprising a first channel, said first sleeve having a length longer than a length of the first bone screw, said first sleeve comprising a distal end at one end of the first sleeve and a proximal end at a second end of the first sleeve, said first channel being formed in an opening of a sleeve wall of the first sleeve, and said first channel extending along at least a portion of the length of the first sleeve;

a first closure member configured to be secured to the first collar for securing the rod within the first slot;

a second sleeve, said second sleeve having a length longer than a length of the second bone screw;

a second closure member configured to be secured to the second collar for securing the rod within the second slot,

wherein the distal end of the first sleeve detachably couples to the first collar so that the proximal end of the first sleeve extends away from the first collar and the first channel is aligned with the first slot, and

wherein after the rod, the first closure member and the first bone screw are implanted, the distal end of the first sleeve is decoupled from the first collar.

2. The system of claim 1, wherein the second sleeve comprises a second channel, said second channel being formed in an opening of a sleeve wall of the second sleeve and said second channel extending along at least a portion of a length of the second sleeve,

wherein the second sleeve and the second collar are configured to couple together so that the second channel is aligned with the second slot.

3. The system of claim 1, wherein the first closure member is threaded for threaded engagement with the first collar.

4. The system of claim 1, wherein the rod is curved for complimenting a curvature of a spine.

5. The system of claim 1, wherein the first channel extends a full length of the first sleeve.

6. The system of claim 1, wherein the first sleeve comprises two first channels, such that the first sleeve is a multi-channel sleeve.

7. The system of claim 6, wherein the two first channels are on opposite ends of the first sleeve'"'"'s longitudinal axis, such that the rod can be inserted through both channels while intersecting the longitudinal axis of the first sleeve.

8. The system of claim 1, wherein the first channel is a linear opening parallel to a longitudinal axis of the first sleeve.

9. The system of claim 1, wherein the first channel comprises a non-linear shape.

10. The system of claim 9, wherein the non-linear shape is a helical pattern, an arc, an “

L”

shape, or an “

S”

shape.

11. The system of claim 1, wherein the first collar further comprises a notch configured to engage the first sleeve, wherein the notch may establish or inhibit rotation of the first collar relative to the first sleeve.

12. The system of claim 1, wherein the first sleeve further comprises a passage, said passage extending longitudinally from the distal end of the first sleeve to the proximal end of the first sleeve.

13. The system of claim 12, wherein the passage is sized to permit the passage of a tool for securing the first closure member to the first collar.

14. The system of claim 1, further comprising a frame, said frame configured to engage the first sleeve and the second sleeve for achieving distraction, translation, or compression of the first vertebra relative to the second vertebra.

15. The system of claim 14, wherein the frame enables the first sleeve and second sleeve to pivot toward or away from each other.

16. The system of claim 14, wherein the frame is configured to provide a rigid coupling between the first sleeve and the second sleeve.

17. The system of claim 14, wherein the frame comprises a slidable element configured to translate the first sleeve relative to the second sleeve.

18. The system of claim 14, wherein the frame allows angular or translational movement between the first sleeve and the second sleeve.

19. The system of claim 1, wherein the first bone screw is cannulated.

20. The system of claim 1, wherein detachably coupling the first sleeve and the first collar comprises engaging a flange on the first sleeve with a flange on the first collar.

21. The system of claim 1, wherein the rod is dumbbell-shaped.

22. The system of claim 1, wherein detachably coupling the first sleeve and the first collar inhibits translational motion of the first sleeve relative to the first collar.

23. A surgical system for securing a rod to two bone screws, each bone screw being secured to a different vertebra, said system comprising:

a first bone screw, said first bone screw comprising a first slot having a slot width;

a second bone screw, said second bone screw comprising a second slot;

a first sleeve comprising a first channel, said first sleeve having a length longer than a length of the first bone screw, said first sleeve comprising a distal end at one end of the first sleeve and a proximal end at a second end of the first sleeve, said first channel being formed in an opening of a sleeve wall of the first sleeve and said first channel extending along at least a portion of the length of the first sleeve;

a second sleeve, said second sleeve having a length longer than a length of the second bone screw, wherein said second sleeve detachably couples to the second bone screw;

a rod, said rod having a width less than the slot width;

wherein the distal end of the first sleeve detachably couples to the first bone screw, such that the proximal end of the first sleeve extends away from the first bone screw, such that the first channel is aligned with a first slot in the first bone screw, and such that the first bone screw and first sleeve are substantially coaxial, and

wherein after the rod and the first bone screw are implanted, the distal end of the first sleeve is decoupled from the first bone screw.

24. The system of claim 23, wherein the second sleeve comprises a second channel, said second channel being formed in an opening of a sleeve wall of the second sleeve and said second channel extending along at least a portion of a length of the second sleeve, and

wherein when the second sleeve is coupled to the second bone screw attached to a second vertebra, the second channel is aligned with the second slot in the second bone screw and the second bone screw and second sleeve are substantially coaxial.

25. The system of claim 23, further comprising a curved rod, wherein said curve compliments a curvature of a spine.

26. The system of claim 23, wherein the first channel extends a hill length of the first sleeve.

27. The system of claim 23, wherein the first sleeve comprises two first channels, such that the first sleeve is a multi-channel sleeve.

28. The system of claim 27, wherein the two first channels are on opposite ends of the first sleeve'"'"'s longitudinal axis, such that the rod can be inserted through both channels while intersecting the longitudinal axis of the first sleeve.

29. The system of claim 27, wherein the first channel is a linear opening parallel to a longitudinal axis of the first sleeve.

30. The system of claim 27, wherein the first channel comprises a non-linear shape.

31. The system of claim 30, wherein the non-linear shape is a helical pattern, an arc, an “

L”

shape, or an “

S”

shape.

32. The system of claim 23, wherein the first bone screw further comprises a notch configured to engage the first sleeve, wherein the notch may establish or inhibit rotation of the first bone screw relative to the first sleeve.

33. The system of claim 23, wherein the first sleeve further comprises a passage, said passage extending longitudinally from the proximal end of the first sleeve to the distal end of the first sleeve.

34. The system of claim 33, wherein the passage is sized to permit the passage of a tool for securing the first closure member to the first bone screw.

35. The system of claim 23, further comprising a frame, said frame configured to engage the first sleeve and the second sleeve for achieving distraction, translation, or compression of the first vertebra relative to the second vertebra.

36. The system of claim 35, wherein the frame comprises a slidable element configured to translate the first sleeve relative to the second sleeve.

37. The system of claim 35, wherein the frame is configured to provide a rigid coupling between the first sleeve and the second sleeve.

38. The system of claim 35, wherein the frame enables the first sleeve and second sleeve to pivot toward or away from each other.

39. The system of claim 35, wherein the frame allows angular or translational movement between the first sleeve and the second sleeve.

40. The system of claim 23, wherein detachably coupling the first sleeve to the first bone screw comprises engaging a flange on the first sleeve with a flange on the first bone screw.

41. The system of claim 23, wherein the rod is dumbbell-shaped.

42. The system of claim 23, wherein detachably coupling the first sleeve to the first bone screw inhibits translational motion of the first sleeve relative to the first bone screw.

43. A system for performing spine surgery, said system comprising:

a first bone fastener configured to be fastened to a first vertebra, said first bone fastener comprising a first slot having a slot width;

a second bone fastener configured to be fastened to a second vertebra, said second bone fastener comprising a second slot;

a rod, said rod having a width less than the slot width;

a first sleeve comprising a first channel, said first sleeve having a length longer than a length of the first bone fastener, said first sleeve comprising a distal end at one end of the first sleeve and a proximal end at a second end of the first sleeve, said first channel being formed in an opening of a sleeve wall of the first sleeve and said first channel extending along at least a portion of the length of the first sleeve;

a first closure member configured to be secured to the first bone fastener for securing the rod within the first slot;

a second sleeve, said second sleeve having a length longer than a length of the second bone fastener, wherein the second sleeve and the second bone fastener detachably couple together;

a second closure member configured to be secured to the second bone fastener for securing the rod within the second slot,

wherein the distal end of the first sleeve detachably couples to the first bone fastener so that the proximal end of the first sleeve extends away from the first bone fastener and so that the first channel is aligned with the first slot, and

wherein after the rod, the first closure member, and the first bone fastener are implanted, the distal end of the first sleeve is decoupled from the first bone fastener.

44. The system of claim 43, wherein the second sleeve comprises a second channel, said second channel being formed in an opening of a sleeve wall of the second sleeve and said second channel extending along at least a portion of a length of the second sleeve, and

wherein the second sleeve and the second bone fastener are configured to couple together so that the second channel is aligned with the second slot.

45. The system of claim 43, wherein the first bone fastener is a bone screw.

46. The system of claim 43, wherein the first closure member is threaded for threaded engagement with the first bone fastener.

47. The system of claim 43, wherein the rod is curved for complimenting a curvature of a spine.

48. The system of claim 43, wherein the first channel extends a full length of the first sleeve.

49. The system of claim 43, wherein the first sleeve comprises two first channels, such that the first sleeve is a multi-channel sleeve.

50. The system of claim 49, wherein the two first channels are on opposite ends of the first sleeve'"'"'s longitudinal axis, such that the rod can be inserted through both channels while intersecting the longitudinal axis of the first sleeve.

51. The system of claim 43, wherein the first channel is a linear opening parallel to a longitudinal axis of the first sleeve.

52. The system of claim 43, wherein the first channel comprises a non-linear shape.

53. The system of claim 52, wherein the non-linear shape is a helical pattern, an arc, an “

L”

shape, or an “

S”

shape.

54. The system of claim 43, wherein the first bone fastener further comprises a notch configured to engage the first sleeve, wherein the notch may establish or inhibit rotation of the first bone fastener relative to the first sleeve.

55. The system of claim 43, wherein the first sleeve further comprises a passage, said passage extending longitudinally from the proximal end of the first sleeve to the distal end of the first sleeve.

56. The system of claim 55, wherein the passage is sized to permit the passage of a tool for securing the first closure member to the first bone fastener.

57. The system of claim 43, further comprising a frame, said frame configured to engage the first sleeve and the second sleeve for achieving distraction, translation, or compression of the first vertebra relative to the second vertebra.

58. The system of claim 57, wherein the frame is configured to provide a rigid coupling between the first sleeve and the second sleeve.

59. The system of claim 57, wherein the frame comprises a slidable element configured to translate the first sleeve relative to the second sleeve.

60. The system of claim 57, wherein the frame enables the first sleeve and second sleeve to pivot toward or away from each other.

61. The system of claim 57, wherein the frame allows angular or translational movement between the first sleeve and the second sleeve.

62. The system of claim 43, wherein the bone fastener is a ring shank fastener.

63. The system of claim 43, wherein the bone fastener is a barb.

64. The system of claim 43, wherein the bone fastener is a nail.

65. The system of claim 43, wherein the bone fastener is a trocar.

66. The system of claim 43, wherein the bone fastener is a brad.

67. The system of claim 43, wherein the bone fastener is cannulated.

68. The system of claim 43, wherein detachably coupling the first sleeve and the first bone fastener comprises engaging a flange on the first sleeve with a flange on the first bone fastener.

69. The system of claim 43, wherein the rod is dumbbell-shaped.

70. The system of claim 43, wherein detachably coupling the first sleeve and the first bone fastener inhibits translational motion of the first sleeve relative to the first bone fastener.