Systems and methods that facilitate minimally invasive spine surgery

• US 7,494,489 B2
• Filed: 05/05/2005
• Issued: 02/24/2009
• Est. Priority Date: 05/07/2004
• Status: Expired due to Fees

• Current Assignee: Stryker European Operations Holdings, LLC (Stryker Corporation)
• Original Assignee: Jeffrey S. Roh
• Inventors: Roh, Jeffrey S.
• Primary Examiner(s): Philogene; Pedro
• Application Number:
  US11/122,514
• Publication Number:
  US 20050251139A1
• Time in Patent Office: 1,391 Days
• Field of Search: 606/60, 606/61, 606/71, 606/72, 606/99, 606/100, 606/104, 606/86, 606/86.A, 606/266, 606/279, 606/273, 600/210, 600/201, 600/214, 600/215, 600/233, 600/217, 403/107, 403/232.1
• US Class Current: 606/86.00A
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/0293 with ring member to support retractor elements
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1735 for rasps or chisels
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/7002 Longitudinal elements, e.g. rods
• CPC Class Codes: A61B 17/7037 wherein pivoting is blocked when the rod is clamped
• 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 17/864 hollow, e.g. with socket or cannulated
• CPC Class Codes: A61B 17/8863 Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• CPC Class Codes: A61B 2018/2025 with a pilot laser
• CPC Class Codes: A61B 2090/0811 for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
• CPC Class Codes: A61B 2562/17 Comprising radiolucent components
• CPC Class Codes: A61B 5/1076 for measuring dimensions inside body cavities, e.g. using catheters A61B3/1005 takes precedence

Abstract

A system and method that facilitates minimally invasive spine surgery. The system includes screw preparation instruments that include a targeted guide with a laser attached to a fluoroscope, at least one polyaxial screw and rod guidance instruments that selectively insert the at least one polyaxial screw within the spine. The screw preparation instruments include an awl, a hand-held drill or tap, a ball-tipped probe, a cannulated depth gauge ruler, and a hexagonal screwdriver. Each screw preparation instrument have respective handles marked with a targeting guide oriented along respective central axes of the instruments. The rod guidance instruments include a rod with a tapered tip, a T-handle rod holder, a T-handle alignment guide, an alignment marker sleeve, a flexible alignment marker with a polyaxial head, and a template rod.

Claims

1. A system that facilitates minimally invasive spine surgery, comprising:

sequential cannulated dilators that create a portal along a working axis;

a hinged retractor placed over the cannulated dilators that increases a field of vision, the hinged retractor comprising;

an upper cylinder that has a proximal end and a distal end and a first and second handle operatively connected to the proximal end, the first handle facilitates an angled expansion and the second handle facilitates symmetric expansion;

a lower cylinder that has a proximal end and a distal end and a handle operatively connected to the proximal end; and

two hinges operatively connected to the proximal end of the upper cylinder that facilitate expansion of the upper cylinder and the lower cylinder;

preparation instruments that include a targeted guide with a laser attached to a fluoroscope, the preparation instruments create a path along the working axis;

at least one anchor device;

guidance instruments that selectively insert the at least one anchor device within the spine along the working axis; and

a transconnecting tower that has an upper level fitted with alignment holes that include at least one rod-guidance entry funnel and at least one alignment guide hole and a lower level that includes rod-guidance entry funnels, the upper level accommodates a connecting rod and the lower level accommodates a spinal rod.

2. The system of claim 1, the hinged retractor further comprising:

a first position wherein the proximal and distal ends of the upper and lower cylinder are operatively touching;

a second position wherein the upper and lower cylinders are expanded equally at respective proximal and distal ends;

a third position wherein the distal end of the upper cylinder is expanded and the proximal end of the upper cylinder is operatively touching the lower cylinder; and

a fourth position wherein the upper and lower cylinders are expanded equally at both the proximal and distal ends and the distal end of the upper cylinder is expanded.

3. The system of claim 1, the preparation instruments comprising:

an awl, a hand-held drill or tap, a ball-tipped probe, a depth gauge ruler, and a hexagonal screwdriver.

4. The system of claim 1, the preparation instruments are cannulated to allow for passage over a guide pin or wire.

5. The system of claim 1, the targeting guide is oriented along respective central axes of the preparation system instruments.

6. The system of claim 1, the guidance instruments comprising:

a rod with a tapered tip, a T-handle rod holder, a T-handle alignment guide, an alignment marker sleeve, a flexible alignment marker with a polyaxial head, and a template rod.

7. The system of claim 1, the at least one anchor device having a head that accommodates a T-handle alignment guide, the T-handle alignment guide is secured in the head with at least one locking mechanism;

wherein the T-handle alignment guide includes two alignment windows to facilitate fluoroscopic assessment of orientation of the T-handle alignment guide during surgery.

8. The system of claim 6, wherein the alignment marker sleeve is placed within the T-handle alignment guide, and the flexible alignment marker is inserted within a cannula of the alignment marker sleeve.

9. The system of claim 8, further comprising a set screw that seats a connecting rod to a rod locking bolt and the rod locking bolt to the spinal rod.

10. The system of claim 1, the anchor device is a polyaxial screw with a rod guidance funnel face attached to its head.

11. The system of claim 10, the polyaxial screw is cannulated.

12. A method that facilitates minimally invasive spine surgery, comprising:

employing a laser in connection with fluoroscopy to find a working axis;

making an incision in a patient;

inserting a guide pin through the incision along the working axis;

creating a portal with sequential cannulated dilators;

exposing a working area with a hinged cylinder retractor placed over the cannulated dilators;

locating an entry point on the spine with the laser in connection with fluoroscopy;

creating a screw path along the working axis;

placing at least a first polyaxial screw along the screw path;

securing at least a first T-handle alignment guide on the at least a first polyaxial screw;

selectively placing the at least a first polyaxial screw within the spine;

placing at least a first alignment marker sleeve within the first T-handle alignment guide;

inserting at least a first flexible alignment marker within a cannula of the first alignment marker sleeve;

placing at least a second alignment marker sleeve within at least a second T-handle alignment guide, the second T-handle alignment guide secured to at least a second polyaxial screw;

inserting at least a second flexible alignment marker within a cannula of the second alignment marker sleeve; and

employing a template rod to connect the first flexible alignment marker with the second flexible alignment marker.

13. The method of claim 12, securing a T-handle alignment guide on the at least a first polyaxial screw further comprising:

placing the at least a first T-handle alignment guide into a head of the at least a first polyaxial screw; and

securing the at least a first T-handle alignment guide to the at least a first polyaxial screw.

14. The method of claim 12, the working axis is defined by a targeted guide laser attached to a fluoroscope;

the targeted guide laser is oriented along a central axis of a screw preparation instrument.

15. The method of claim 12, further comprising placing at least one transconnecting tower along the screw path between the first and second polyaxial screws, the at least one transconnecting tower having an upper level fitted with alignment holes that include at least one rod-guidance entry funnel and at least one alignment guide hole and a lower level that contain rod-guidance entry funnels.

16. The method of claim 15, further comprising

directing a spinal rod through the lower level of the at least one transconnecting tower, and

directing a connecting rod through the upper level of the upper level of the transconnecting tower.

17. The method of claim 12, further comprising:

contouring a spinal rod to match the tips of the at least a first alignment marker and the at least a second alignment marker.

18. The method of claim 17, farther comprising:

directing the spinal rod through respective rod-guidance entry funnels of the at least a first polyaxial screw and at least a second polyaxial screw with bimanual control.

19. A system that facilitates minimally invasive spine surgery, comprising:

a plurality of components to be inserted into a spine;

means for employing laser-guided fluoroscopy to selectively place a subset of the plurality of components within the spine;

means for exposing a working area with a hinged cylinder retractor placed over cannulated dilators, the hinged retractor comprising;

an upper cylinder that has a proximal end and a distal end and a first and second handle operatively connected to the proximal end, the first handle facilitates an angled expansion and the second handle facilitates symmetric expansion;

a lower cylinder that has a proximal end and a distal end and a handle operatively connected to the proximal end; and

two hinges operatively connected to the proximal end of the upper cylinder that facilitate expansion of the upper cylinder and the lower cylinder; and

means for placing connecting towers along a rod path prior to or following spinal rod placement, each connecting tower having an upper level fitted with alignment holes that include at least one rod-guidance entry funnel and at least one alignment guide hole and a lower level that includes rod-guidance entry funnels;

means for directing a connecting rod through the entry funnels of the upper level of the connecting towers; and

means for directing a spinal rod through the entry funnels of the lower level of the connecting towers.