Methods and devices for minimally invasive spinal fixation element placement

• US 7,527,638 B2
• Filed: 12/16/2003
• Issued: 05/05/2009
• Est. Priority Date: 12/16/2003
• Status: Active Grant

• Current Assignee: Depuy Synthes Products Incorporated (Johnson & Johnson)
• Original Assignee: Depuy Spine Incorporated (Johnson & Johnson)
• Inventors: Sicvol, Christopher W., Ruberte, Ramon Alberto, Anderson, David Greg, Selover, Sean P., Ross, George Joseph
• Primary Examiner(s): Robert; Eduardo C
• Assistant Examiner(s): Swiger; James L.
• Application Number:
  US10/738,130
• Publication Number:
  US 20050131421A1
• Time in Patent Office: 1,967 Days
• Field of Search: 606/53, 606/60, 606/61, 606/99, 606/104, 606/86.A, 606/323, 606/246, 606250-265, 606278-279, 606300-301, 606/914, 606/916, 623/17.11
• US Class Current: 606/279
• 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 17/7011 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 17/7035 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 17/7074 Tools specially adapted for spinal fixation operations other than for bone removal or filler handling A61B17/7062, A61B17/808, A61B17/8858 take precedence; for spinal image producing devices A61B90/36, A61B34/20; markers A61B90/39
• 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: Y10S 606/914 Toolkit for installing or removing spinal positioner or stabilizer

Abstract

Minimally invasive methods and devices for introducing a spinal fixation element into a surgical site in a patient'"'"'s spinal column are provided. In general, the method involves advancing a spinal fixation element in a first, lengthwise orientation along a pathway extending from a minimally invasive percutaneous incision to a spinal anchor site. As the spinal fixation element approaches the spinal anchor site, the fixation element can be manipulated to extend in a second orientation, which is preferably substantially transverse to the first orientation, to position the fixation element in relation to one or more spinal anchors.

Claims

1. A minimally invasive method for delivering a spinal fixation rod to a spinal anchor site, comprising:

percutaneously delivering a spinal screw to a vertebra with a percutaneous access device mated to the spinal screw, the percutaneous access device including a lumen extending therethrough and defining a longitudinal axis;

manipulating a spinal fixation rod extending lengthwise through the lumen in the percutaneous access device in a first orientation substantially parallel to the longitudinal axis of the percutaneous access device to extend in a second orientation angled with respect to the first orientation to position the spinal fixation rod in relation to the spinal screw.

2. The method of claim 1, wherein the spinal screw and percutaneous access device are percutaneously delivered to the vertebra through a cannula.

3. The method of claim 2, wherein the cannula is positioned through a minimally invasive percutaneous incision and the cannula forms a minimally invasive pathway to the spinal anchor site.

4. The method of claim 1, wherein the spinal fixation rod extends substantially parallel to a patient'"'"'s spinal column in the second orientation.

5. The method of claim 1, wherein the method further includes the step of percutaneously delivering a second spinal screw to a vertebra with a second percutaneous access device mated thereto, and wherein the spinal fixation rod extends between the first and second spinal screws in the second orientation.

6. The method of claim 1, further comprising manipulating the spinal fixation rod to extend from an opening in the percutaneous access device.

7. The method of claim 1, wherein the percutaneous access device comprises an elongate, generally cylindrical member having at least one sidewall opening formed therein adjacent to the distal end thereof for allowing the spinal fixation rod to transition from the first orientation to the second orientation.

8. The method of claim 7, wherein the percutaneous access device includes opposed sidewall openings formed therein adjacent to the distal end thereof.

9. The method of claim 7, wherein a distal portion of the lumen in the percutaneous access device includes a guide member that is adapted to direct the spinal fixation rod from the first orientation to the second orientation.

10. The method of claim 9 wherein the guide member comprises a sloped shelf formed within the lumen in the percutaneous access device.

11. The method of claim 10, wherein the percutaneous access device includes a single sidewall opening formed therein, and wherein the sloped shelf is positioned opposite to the single sidewall opening such that it is effective to direct a leading end of the spinal fixation rod toward the sidewall opening.

12. The method of claim 1, wherein the percutaneous access device is threadably coupled to the spinal screw.

13. The method of claim 1, wherein the step of manipulating the spinal fixation rod into the second orientation comprises the step of providing and coupling a manipulator device to the spinal fixation rod for manipulating the spinal fixation rod.

14. The method of claim 1, further comprising the step of fixedly coupling the spinal fixation rod to one or more spinal screws.

15. The method of claim 1, wherein an outer diameter of the percutaneous access device is substantially the same as or greater than an outer diameter of the spinal screw.

16. A minimally invasive method for delivering a spinal fixation rod to a spinal anchor site in a patient'"'"'s spinal column, comprising:

implanting a spinal screw having a percutaneous access device coupled thereto in a patient'"'"'s vertebra;

manipulating a spinal fixation rod extending lengthwise through the lumen in a first orientation substantially parallel to a longitudinal axis of the percutaneous access device to extend into a second orientation substantially parallel to the patient'"'"'s spinal column; and

positioning the spinal fixation rod in a position relative to one or more spinal screws.

17. The method of claim 16, wherein the percutaneous access device comprises an elongate, generally cylindrical member having at least one sidewall opening formed therein adjacent to the distal end thereof for allowing the spinal fixation rod to transition from the first orientation to the second orientation.

18. The method of claim 17, wherein the percutaneous access device includes opposed sidewall openings formed therein adjacent to the distal end thereof.

19. The method of claim 17, wherein a distal portion of the lumen in the percutaneous access device includes a guide member that is adapted to direct the spinal fixation rod from the first orientation to the second orientation.

20. The method of claim 19, wherein the guide member comprises a sloped shelf formed within the lumen in the percutaneous access device.

21. The method of claim 16, wherein the percutaneous access device is threadably coupled to the spinal screw.

22. The method of claim 16, wherein the spinal screw and percutaneous access device are implanted through a minimally invasive percutaneous incision.

23. The method of claim 16, wherein the step of manipulating the spinal fixation rod to cause the spinal fixation rod to extend in the second orientation comprises coupling a manipulator device to the spinal fixation rod for manipulating the spinal fixation rod.

24. A minimally invasive surgical method, comprising:

making a first percutaneous incision in a patient;

creating a first pathway from the first percutaneous incision to a single anchor site on a first vertebra;

placing a first spinal screw through the first percutaneous incision, the first spinal screw having a percutaneous access device mated thereto;

advancing the first spinal screw with the percutaneous access device mated thereto along the first pathway to the single anchor site; and

placing a fixation rod lengthwise through the first pathway in an orientation substantially parallel to a longitudinal axis of the first pathway.

25. The method of claim 24, further comprising:

making a second percutaneous incision in a patient;

creating a second pathway from the second percutaneous incision to a single anchor site on a second vertebra;

placing a second spinal screw through the second percutaneous incision; and

advancing the second spinal screw along the second pathway to the anchor site on the second vertebra.

26. The method of claim 25, further comprising manipulating the fixation rod into a position relative to the first and second spinal screws.

27. The method of claim 26, further comprising coupling the fixation rod to the first and second spinal screws.

28. A minimally invasive surgical method, comprising:

making a first percutaneous incision in a patient;

creating a first pathway from the first percutaneous incision to a first anchor site on a first vertebra;

advancing a first spinal screw with a percutaneous access device mated thereto along the first pathway to the first anchor site; and

manipulating a fixation rod extending lengthwise through the first pathway in an orientation substantially parallel to a longitudinal axis of the percutaneous access device to position the fixation rod through a slot formed in the percutaneous access device.

29. The method of claim 28, further comprising:

making a second percutaneous incision in a patient;

creating a second pathway having a substantially uniform width from the second percutaneous incision to a second anchor site on a second vertebra; and

advancing a second spinal screw along the second pathway to the second anchor site on the second vertebra.

30. The method of claim 29, further comprising manipulating the fixation rod into a position relative to the first and second spinal screws.

31. The method of claim 30, further comprising coupling the fixation rod to the first and second spinal screws.

32. A minimally invasive surgical method, comprising:

making a first percutaneous incision in a patient;

creating a first pathway from the first percutaneous incision to a first anchor site on a first vertebra, the first pathway having a width that is substantially equal to or less than a width of the first percutaneous incision;

advancing a first spinal screw with a percutaneous access device mated thereto along the first pathway to the first anchor site; and

manipulating a fixation rod disposed lengthwise within the percutaneous access device to move from an orientation substantially parallel to a longitudinal axis of the percutaneous access device to an orientation angled with respect to the longitudinal axis of the percutaneous access device.

33. The method of claim 32, further comprising:

making a second percutaneous incision in a patient;

creating a second pathway from the second percutaneous incision to a second anchor site on a second vertebra, the second pathway having a width that is substantially equal to or less than a width of the second percutaneous incision; and

advancing a second spinal screw along the second pathway to the second anchor site on the second vertebra.

34. The method of claim 33, further comprising manipulating the fixation rod into a position relative to the first and second spinal screws.

35. The method of claim 34, further comprising coupling the fixation rod to the first and second spinal screws.

36. A minimally invasive surgical method, comprising:

making a first percutaneous incision in a patient;

delivering a first spinal screw to a first vertebra through the first percutaneous incision, the first spinal screw having an access device coupled thereto and creating a first pathway from the first percutaneous incision to the first spinal screw; and

manipulating a fixation rod extending lengthwise along the first pathway in an orientation substantially parallel to a longitudinal axis of the first pathway to position the fixation rod substantially parallel to the patient'"'"'s spinal column.

37. The method of claim 36, further comprising:

making a second percutaneous incision in a patient;

delivering a second spinal screw to a second vertebra through the second percutaneous incision, the second spinal screw having an access device coupled thereto and creating a second pathway from the second percutaneous incision to the second spinal screw.

38. The method of claim 37, further comprising manipulating the fixation rod into a position relative to the first and second spinal screws.

39. The method of claim 38, further comprising coupling the fixation rod to the first and second spinal screws.

40. A minimally invasive surgical method, comprising:

making a first percutaneous incision in a patient;

implanting a first spinal screw at a first anchor site on a first vertebra, the first spinal screw having a percutaneous access device mated thereto that creates a first pathway from the first percutaneous incision to the first anchor site on the first vertebra; and

manipulating a fixation rod extending lengthwise through the first pathway in an orientation substantially parallel to a longitudinal axis of the first pathway to cause the fixation rod to extend at an angle relative to the longitudinal axis.

41. The method of claim 40, further comprising:

making a second percutaneous incision in a patient;

creating a second pathway from the second percutaneous incision to a second anchor site on a second vertebra, the second pathway having a width that is substantially equal to or less than a width of a second spinal screw; and

advancing the second spinal screw along the second pathway to the second anchor site on the second vertebra.

42. The method of claim 41, further comprising manipulating the fixation rod into a position relative to the first and second spinal screws.

43. The method of claim 42, further comprising coupling the fixation rod to the first and second spinal screws.