Methods and devices for minimally invasive spinal fixation element placement

• US 7,708,763 B2
• Filed: 09/30/2004
• Issued: 05/04/2010
• Est. Priority Date: 12/16/2003
• Status: Active Grant

• Current Assignee: Depuy Spine Incorporated (Johnson & Johnson)
• Original Assignee: Depuy Spine Incorporated (Johnson & Johnson)
• Inventors: Selover, Sean P., Sheehy, Nancy M.
• Primary Examiner(s): Barrett; Thomas C
• Assistant Examiner(s): SWIGER III, JAMES L
• Application Number:
  US10/711,704
• Publication Number:
  US 20050154389A1
• Time in Patent Office: 2,042 Days
• Field of Search: 606/53, 606/60, 606/99, 606/246, 606250-264, 606278-279, 606/190, 600/219, 600/462, 604/104, 604/108, 604/164.01, 604/170.01, 128/657, 301/201, 452/17
• 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 one embodiment, a dissection tool is provided for separating muscles along a muscle plane without causing damage to the muscles. The dissection tool can also include a lumen extending therethrough for receiving a guide wire. The tool allows the guide wire to be positioned relative to a vertebra, and once properly positioned, the tool can be removed to allow a spinal anchor to be delivered along the guide wire and implanted into the vertebra.

Claims

1. A minimally invasive surgical method, comprising:

forming an incision through tissue located adjacent to a vertebra in a patient'"'"'s spinal column;

identifying a muscle plane between muscles;

inserting a substantially planar blunt tip of a tool through the incision while manipulating the blunt tip along the muscle plane extending between the incision and the vertebra to separate the muscles and thereby form a pathway;

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

advancing the spinal screw with the percutaneous access device mated thereto along the pathway to the vertebra; and

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

2. The method of claim 1, wherein the longissimus thoracis and multifidus muscles are separated.

3. The method of claim 1, wherein the incision is a minimally invasive percutaneous incision.

4. The method of claim 1, further comprising inserting a guide wire through a lumen extending through the tool.

5. The method of claim 4, wherein the guide wire extends into the vertebra.

6. The method of claim 4, further comprising removing the tool from the guide wire such that the guide wire extends between the incision and the vertebra.

7. The method of claim 6, wherein the spinal screw is delivered along the guide wire and implanted in the vertebra.

8. The method of claim 6, further comprising inserting a plurality of dilators over the guide wire to dilate tissue surrounding the guide wire.

9. The method of claim 8, further comprising inserting a cannula over the plurality of dilators and removing the dilators.

10. The method of claim 9, wherein the spinal screw is delivered through the cannula.

11. A minimally invasive surgical method, comprising:

making a first incision in a patient;

inserting a blunt tip of a tool through the first incision and manipulating the blunt tip to create a first pathway from the first incision, between a muscle plane, to a first site on a first vertebral body;

advancing a guide wire through the tool to position a distal end of the guide wire adjacent the first site;

removing the tool and advancing a first implant along the guide wire to the first site on the first vertebral body; and

placing a fixation element through the first pathway in an orientation substantially parallel to a longitudinal axis of the first pathway, and coupling a portion of the fixation element to the first implant.

12. The method of claim 11, further comprising:

making a second incision in a patient;

inserting a blunt tip of a tool through the second incision and manipulating the tool to create a second pathway from the second incision, between a muscle plane, to a second site on a second vertebral body; and

advancing a guide wire through the tool to position a distal end of the guide wire adjacent to the second site.

13. The method of claim 12, further comprising removing the tool and advancing a second implant along the second pathway to the second site on the second vertebral body.

14. The method of claim 13, further comprising placing a fixation element through the first pathway and coupling a portion of the fixation element to the first and second implants.

15. The method of claim 14, wherein the fixation element is inserted through the first pathway in an orientation substantially parallel to a longitudinal axis of the first pathway.

16. The method of claim 11, wherein a percutaneous access device is coupled to the first implant as the first implant is advanced along the guide wire to the first site on the first vertebral body.