Minimally invasive instruments and methods for inserting implants

• US 7,572,276 B2
• Filed: 07/25/2002
• Issued: 08/11/2009
• Est. Priority Date: 05/06/2002
• Status: Active Grant

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Inventors: Sherman, Michael C., Lim, Roy
• Primary Examiner(s): Robert; Eduardo C
• Assistant Examiner(s): COMSTOCK, DAVID C
• Application Number:
  US10/202,918
• Publication Number:
  US 20030208203A1
• Time in Patent Office: 2,574 Days
• Field of Search: 606/61, 606/99, 606/104, 606/60, 606/253, 606/256, 606/279, 606/280, 606/281, 606/86.R, 606/90, 606/105, 606/86.A, 606/86.B
• US Class Current: 606/246
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/7059 Cortical plates A61B17/7007, A61B17/7058 take precedence
• CPC Class Codes: A61B 17/7065 Devices with changeable shape, e.g. collapsible or having retractable arms to aid implantation; Tools therefor
• 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 17/808 Instruments for holding or positioning bone plates, or for adjusting screw-to-plate locking mechanisms
• CPC Class Codes: A61B 2017/00238 Type of minimally invasive operation A61B2017/00805 takes precedence

Abstract

Instruments and methods for inserting one or more implants to a surgical site in a patient in a surgical procedure, including minimally invasive surgical procedures are provided. The implant is mountable to the instrument in a reduced profile orientation and after insertion is manipulated with the insertion instrument to the desired orientation.

Claims

1. A system, comprising

an implant positionable adjacent a surgical space associated with a spinal column of a patient;

and

an insertion instrument including an articulating implant holder adjacent a distal end thereof releasably engageable to said implant, wherein said implant is moveable with said implant holder between a reduced profile orientation relative to said insertion instrument and an increased profile orientation relative to said insertion instrument, said implant holder being adapted to release said implant from said implant holder in the increased profile orientation when said implant is positioned adjacent to and substantially unconstrained in the surgical space, wherein said insertion instrument comprises;

an outer shaft coupled and an intermediate shaft extending distally from a proximal handle portion;

said implant holder is pivotally coupled to a distal end of said intermediate shaft; and

a linkage mechanism extends between and pivotally couples said articulating member to said outer shaft.

2. The system of claim 1, wherein said implant is a bone plate.

3. The system of claim 1, wherein said implant is a rod.

4. The system of claim 1, wherein said insertion instrument includes a handle assembly having a distal handle portion pivotally coupled to a proximal handle portion.

5. The system of claim 4, wherein said outer shaft is coupled to said distal handle portion and said intermediate shaft coupled to said proximal handle portion, wherein in said increased profile orientation a distal end of said outer shaft is positioned more proximally relative to said distal end of said intermediate shaft than when in said reduced profile orientation.

6. The system of claim 5, wherein said outer shaft and said intermediate shaft are biased relative to one another so that said implant holder normally assumes said reduced profile orientation.

7. The system of claim 1, wherein said insertion instrument comprises:

a control system;

a connector system extending distally from said control system and including said implant holder pivotally coupled adjacent a distal end thereof; and

a manipulator system associated with said implant holder.

8. The system of claim 1, wherein upon movement of said outer shaft and said inner shaft relative to one another said linkage mechanism causes said articulating member to pivot relative to said intermediate shaft.

9. The system of claim 8, wherein in said reduced profile orientation said linkage mechanism extends transversely to said outer shaft and in said increased profile orientation said linkage mechanism extends generally along said outer shaft.

10. The system of claim 1, wherein said implant includes a receptacle and said implant holder is releasably engageable in said receptacle.

11. The system of claim 10, wherein said implant holder includes an articulating member pivotally mounted adjacent a distal end of said insertion instrument.

12. The system of claim 11, wherein said implant holder further includes a pair of engagement members actuatable from said articulating member to releasably engage said implant in said receptacle.

13. The system of claim 12, wherein said insertion instrument includes a cam member extending therethrough engageable with said pair of opposite engagement members, said cam member moveable from a first position wherein said pair of engagement members are recessed in said articulating member to a second position wherein said cam member biases said pair of engagement members outwardly from said articulating member to releasably engage said implant.

14. The system of claim 11, wherein said articulating member includes a pair of distally extending fingers and a lip extending about a proximal end of said fingers, said lip positionable against a proximal surface of said implant with said pair of fingers positioned in said receptacle.

15. The system of claim 1, wherein said implant holder moves with said implant between said reduced profile orientation and said increased profile orientation.

16. A system, comprising

an implant positionable adjacent a surgical space associated with a spinal column of a patient;

and

an insertion instrument including an articulating implant holder adjacent a distal end thereof releasably engageable to said implant, wherein said implant is moveable with said implant holder between a reduced profile orientation relative to said insertion instrument and an increased profile orientation relative to said insertion instrument, said implant holder being adapted to release said implant from said implant holder in the increased profile orientation when said implant is positioned adjacent to and substantially unconstrained in the surgical space, wherein said implant holder includes an articulating member pivotally mounted to a distal end of said insertion instrument and a pair of clamping members mounted along opposite sides of said articulating member, said clamping members being moveable toward one another from a released position wherein said implant is positionable therebetween to an engaged position wherein said pair of clamping members engage said implant therebetween and includes a pair of engagement members actuatable from said articulating member to move said clamping members to said engaged position, wherein said articulating member includes a pair of opposite distally extending fingers and said clamping members extend between and are pivotally coupled to each of said distally extending fingers.

17. The system of claim 16, wherein insertion instrument comprises:

a shaft assembly including an outer shaft and an intermediate shaft extending through said outer shaft;

said articulating member is pivotally mounted to said intermediate shaft; and

a linkage mechanism extending between and pivotally coupled to each of said articulating member and said outer shaft.

18. The system of claim 17, further comprising:

a cam member extending through said intermediate shaft; and

said pair of engagement members in said articulating member being engageable with a distal end of said cam member, said cam member moveable from a first position wherein said pair of engagement members are recessed in said articulating member to a second position wherein said cam member biases said pair of engagement members outwardly from said articulating member into contact with said pair of clamping members to move said pair of clamping members to said engaged position.

19. The system of claim 18, wherein said cam member includes a lever at a proximal end thereof operable to move said cam member between said first position and said second position.

20. The system of claim 17, further comprising a mounting member on a distal end of said intermediate shaft and said articulating member is pivotally mounted to said mounting member.

21. The system of claim 20, wherein said implant holder includes a pair of engagement members movably captured in said mounting member and actuatable from said articulating member to move said clamping members to said engaged position.

22. A system, comprising

an implant positionable adjacent a surgical space associated with a spinal column of a patient;

and

an insertion instrument including an articulating implant holder adjacent a distal end thereof releasably engageable to said implant, wherein said implant is moveable with said implant holder between a reduced profile orientation relative to said insertion instrument and an increased profile orientation relative to said insertion instrument, said implant holder being adapted to release said implant from said implant holder in the increased profile orientation when said implant is positioned adjacent to and substantially unconstrained in the surgical space, wherein said implant holder includes an articulating member pivotally mounted to a distal end of said insertion instrument and a pair of clamping members mounted along opposite sides of said articulating member, said clamping members being moveable from a released position wherein said implant is positionable therebetween to an engaged position wherein said pair of clamping members engage said implant therebetween, wherein said articulating member includes a pair of opposite distally extending fingers and said clamping members extend between and are pivotally coupled to each of said distally extending fingers.

23. A system, comprising

an implant positionable adjacent a surgical space associated with a spinal column of a patient;

and

an insertion instrument including an articulating implant holder adjacent a distal end thereof releasably engageable to said implant, wherein said implant is moveable with said implant holder between a reduced profile orientation relative to said insertion instrument and an increased profile orientation relative to said insertion instrument, said implant holder being adapted to release said implant from said implant holder in the increased profile orientation when said implant is positioned adjacent to and substantially unconstrained in the surgical space, wherein said implant holder includes an articulating member pivotally mounted to a distal end of said insertion instrument and a pair of clamping members mounted along opposite sides of said articulating member, said clamping members being moveable from a released position wherein said implant is positionable therebetween to an engaged position wherein said pair of clamping members engage said implant therebetween, wherein insertion instrument comprises;

a shaft assembly including an outer shaft and an intermediate shaft extending through said outer shaft;

said articulating member is pivotally mounted to said intermediate shaft; and

a linkage mechanism extending between and pivotally coupled to each of said articulating member and said outer shaft.

24. The system of claim 23, further comprising:

a cam member extending through said intermediate shaft; and

a pair of engagement members in said articulating member engageable with a distal end of said cam member, said cam member moveable from a first position wherein said pair of engagement members are recessed in said articulating member to a second position wherein said cam member biases said pair of engagement members outwardly from said articulating member into contact with said pair of clamping members to move said pair of clamping members to said engaged position.

25. The system of claim 24, wherein said cam member includes a lever at a proximal end thereof operable to move said cam member between said first position and said second position.

26. The system of claim 23, further comprising a mounting member on a distal end of said intermediate shaft and said articulating member is pivotally mounted to said mounting member.

27. The system of claim 26, wherein said implant holder includes a pair of engagement members movably captured in said mounting member and actuatable from said articulating member to move said clamping members to said engaged position.

28. A system, comprising:

an implant positionable adjacent a surgical space associated with a spinal column of a patient; and

an insertion instrument including an articulating implant holder adjacent a distal end thereof releasably engageable to said implant, wherein said implant is moveable with said implant holder between a reduced profile orientation relative to said insertion instrument and an increased profile orientation relative to said insertion instrument, said implant holder being adapted to release said implant from said implant holder in the increased profile orientation when said implant is positioned adjacent to and substantially unconstrained in the surgical space, wherein said insertion instrument includes a handle assembly having a distal handle portion pivotally coupled to a proximal handle portion with a pivot pin and said distal and proximal handle portions are movable toward and way from one another about said pivot pin, wherein said insertion instrument includes an outer shaft coupled to said distal handle portion and an intermediate shaft coupled to said proximal handle portion and said implant holder is pivotally coupled to a distal end of said intermediate shaft, wherein in said increased profile orientation a distal end of said outer shaft is positioned more proximally relative to said distal end of said intermediate shaft than when in said reduced profile orientation, wherein said outer shaft and said intermediate shaft are biased relative to one another so that said implant holder normally assumes said reduced profile orientation and further comprising a linkage mechanism extending between and pivotally coupled to said articulating member to said outer shaft.

29. The system of claim 28, wherein upon movement of said outer shaft and said inner shaft relative to one another said linkage mechanism causes said articulating member to pivot relative to said intermediate shaft.

30. The system of claim 29, wherein in said reduced profile orientation said linkage mechanism extends transversely to said outer shaft and in said increased profile orientation said linkage mechanism extends generally along said outer shaft.

31. The system of claim 28, wherein said implant is a bone plate.

32. The system of claim 28, wherein said implant is a rod.

33. The system of claim 28, wherein said implant holder includes a pair of clamping members actuatable to engage said implant therebetween.

34. A system, comprising

an implant positionable adjacent a surgical space associated with a spinal column of a patient;

and

an insertion instrument including an articulating implant holder adjacent a distal end thereof releasably engageable to said implant, wherein said implant is moveable with said implant holder between a reduced profile orientation relative to said insertion instrument and an increased profile orientation relative to said insertion instrument, said implant holder being adapted to release said implant from said implant holder in the increased profile orientation when said implant is positioned adjacent to and substantially unconstrained in the surgical space, wherein said insertion instrument includes a handle assembly having a distal handle portion pivotally coupled to a proximal handle portion with a pivot pin and said distal and proximal handle portions are movable toward and way from one another about said pivot pin, wherein said implant includes a receptacle and said implant holder is releasably engageable in said receptacle, wherein said implant holder includes an articulating member pivotally mounted adjacent a distal end of said insertion instrument, wherein said implant holder further includes a pair of engagement members actuatable from said articulating member to releasably engage said implant in said receptacle, wherein said insertion instrument includes a cam member extending therethrough engageable with said pair of opposite engagement members, said cam member moveable from a first position wherein said pair of engagement members are recessed in said articulating member to a second position wherein said cam member biases said pair of engagement members outwardly from said articulating member to releasably engage said implant.

35. A system, comprising

an implant positionable adjacent a surgical space associated with a spinal column of a patient;

and

an insertion instrument including an articulating implant holder adjacent a distal end thereof releasably engageable to said implant, wherein said implant is moveable with said implant holder between a reduced profile orientation relative to said insertion instrument and an increased profile orientation relative to said insertion instrument, said implant holder being adapted to release said implant from said implant holder in the increased profile orientation when said implant is positioned adjacent to and substantially unconstrained in the surgical space, wherein said insertion instrument includes a handle assembly having a distal handle portion pivotally coupled to a proximal handle portion with a pivot pin and said distal and proximal handle portions are movable toward and way from one another about said pivot pin, wherein said implant includes a receptacle and said implant holder is releasably engageable in said receptacle, wherein said implant holder includes an articulating member pivotally mounted adjacent a distal end of said insertion instrument, wherein said articulating member includes a pair of distally extending fingers and a lip extending about a proximal end of said fingers, said lip positionable against a proximal surface of said implant with said pair of fingers positioned in said receptacle.