Surgical instrumentation and method for forming a passage in bone having an enlarged cross-sectional portion

• US 7,749,225 B2
• Filed: 08/06/2004
• Issued: 07/06/2010
• Est. Priority Date: 06/18/2001
• Status: Active Grant

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Inventors: Veldman, Michael S., Taylor, Harold S., Chappuis, James L.
• Primary Examiner(s): Robert; Eduardo C
• Assistant Examiner(s): CARTER, TARA ROSE E
• Application Number:
  US10/913,755
• Publication Number:
  US 20050033303A1
• Time in Patent Office: 2,160 Days
• Field of Search: 606/80, 606/79, 606/84, 606/86.R, 606/167, 606/170, 606176-180, 606/183, 433/144, 433/197, 433/198, 604/19, 604/22, 604/44
• US Class Current: 606/79
• CPC Class Codes: A61B 17/1617 with mobile or detachable parts
• CPC Class Codes: A61B 17/1655 for tapping
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/3472 for bones, e.g. intraosseus injections
• CPC Class Codes: A61B 17/7098 wherein the implant is permeable or has openings, e.g. fenestrated screw hollow surgical screws A61B17/864
• CPC Class Codes: A61B 17/864 hollow, e.g. with socket or cannulated

Abstract

A surgical instrument and method for forming a passage in bone having an enlarged cross-sectional portion is provided. The instrument includes an elongate member and a cutting element engaged thereto and transitionable between a retracted configuration for extending through a first portion of the passage and an expanded configuration for forming a second portion of the passage having an enlarged cross-section. In one embodiment, the cutting element is transitioned between the retracted and expanded configurations by axially displacing the cutting element relative to the elongate member. In another embodiment, the elongate member includes a tapping thread configured to cut threads along the first portion of the passage, and the cutting element is a blade configured to form the enlarged cross-section when transitioned to the expanded configuration. In another embodiment, the cutting element is arranged in an axial orientation when in the retracted configuration and an angular orientation when in the expanded configuration.

Claims

1. A surgical method, comprising:

providing a surgical instrument including an elongate member and at least one cutting element engaged with the elongate member and being transitionable between a retracted configuration and an expanded configuration, wherein the elongate member defines a tapping thread; and

using said cutting element in said retracted configuration to form a passage in bone, wherein the using said cutting element in said retracted configuration comprises tapping at least a portion of the passage to form a threaded region of the passage;

displacing the cutting element along the passage while in the retracted configuration;

transitioning the cutting element to the expanded configuration by positioning the cutting element laterally beyond an outer profile of the tapping thread wherein the cutting element extends laterally outward from the tapping thread; and

enlarging a portion of the threaded region of the passage by rotating the cutting element about a longitudinal axis of the surgical instrument to form an enlarged cross-sectional portion of the threaded region of the passage; and

transitioning the cutting element to the retracted configuration and removing the surgical instrument from the passage.

2. The method of claim 1, further comprising:

providing a bone anchor;

inserting the bone anchor into the passage; and

at least partially filling the enlarged cross-section portion of the passage with an anchoring material.

3. The method of claim 2, wherein the bone anchor includes an axial opening extending at least partially therethrough and a least one fenestration opening communicating with the axial opening;

and

wherein the inserting comprises positioning the at least one fenestration opening adjacent the enlarged cross-sectional portion of the passage; and

wherein the filling comprises injecting the material through the axial passage and out the at least one fenestration opening.

4. The method of claim 3, wherein the anchoring material comprises bone cement.

5. The method of claim 2, wherein the bone anchor is a bone screw;

and

wherein the inserting comprises threading the bone screw into the passage.

6. The method of claim 1, wherein the elongate member includes a drilling portion;

and

wherein the using said cutting element in said retracted configuration comprises drilling at least a portion of the passage.

7. The method of claim 1, wherein the cutting element extends from a distal end of the elongate member;

and

wherein the using said cutting element in said retracted configuration comprises driving the cutting element into the bone.

8. The method of claim 1, wherein the transitioning results from axially displacing the at least one cutting element relative to the elongate member.

9. The method of claim 8, wherein the elongate member defines an axial channel including a ramped section, the at least one cutting element being at least partially disposed within the channel;

and

wherein the transitioning results from slidably displacing the at least one cutting element along the ramped section.

10. The method of claim 8, wherein the elongate member comprises a sleeve, the at least one cutting element being outwardly biased toward the expanded configuration and being at least partially disposed within the sleeve to selectively maintain the at least one cutting element in the retracted configuration;

and

wherein the transitioning results from axially displacing the at least one cutting element relative to the sleeve.

11. The method of claim 1, wherein the enlarged cross-sectional portion of the passage includes helical grooves extending about the longitudinal axis, the method further comprising:

providing a bone screw having external threads;

threading the bone screw into the threaded region of the passage;

positioning the bone screw such that the external threads are generally aligned with the helical grooves of the enlarged cross-sectional portion of the passage; and

at least partially filling the enlarged cross-section portion of the passage with an anchoring material.

12. A surgical method, comprising:

providing a surgical instrument including a tapping element and an expandable element;

tapping at least a portion of a passage in bone using the tapping element to form a threaded region of the passage;

displacing the expandable element along the passage while in a retracted configuration; and

transitioning the expandable element to an expanded configuration by positioning the expandable element laterally beyond an outer profile of the tapping element wherein the cutting element extends laterally outward from the tapping element; and

enlarging a portion of the threaded region of the passage by rotating the expandable element about a longitudinal axis of the surgical instrument to form an enlarged cross-sectional portion of the threaded region of the passage.

13. The method of claim 12, further comprising transitioning the expandable element back toward the retracted configuration and removing the surgical instrument from the passage.

14. The method of claim 12, further comprising:

providing an implant;

inserting the implant into the passage; and

at least partially filling the enlarged cross-sectional portion of the passage with a bio-compatible material.

15. The method of claim 14, wherein the bio-compatible material comprises an anchoring material to facilitate anchoring of the implant within the passage.

16. The method of claim 15, wherein the anchoring material comprises bone cement.

17. The method of claim 14, wherein the implant comprises a bone anchor configured for anchoring one or more devices to the bone.

18. The method of claim 14, wherein the implant includes an axial opening extending at least partially therethrough and at least one transverse opening communicating with the axial opening;

and

wherein the inserting includes positioning the at least one transverse opening adjacent the enlarged cross-sectional portion of the passage; and

wherein the filling comprises injecting the bio-compatible material through the axial passage and out the at least one transverse opening.

19. The method of claim 14, wherein the implant comprises a bone screw;

and

wherein the inserting comprises threading the bone screw into the passage.

20. The method of claim 12, wherein the expandable element comprises a distal end portion of the surgical instrument;

and

wherein the passage in bone is initially formed by driving the distal end portion of the surgical instrument into the bone.

21. The method of claim 12, wherein the transitioning results from axially displacing the expandable element along the surgical instrument.

22. The method of claim 21, wherein the surgical instrument includes an elongate member defining an axial channel including a ramped section, the expandable element comprising a cutting element at least partially disposed within the channel;

and

wherein the transitioning results from slidably displacing the cutting element along the ramped section.

23. The method of claim 21, wherein the surgical instrument includes a sleeve, the expandable element comprising a cutting element that is outwardly biased toward the expanded configuration and being at least partially disposed within the sleeve to selectively maintain the cutting element in the retracted configuration;

and

wherein the transitioning results from axially displacing the cutting element relative to the sleeve.

24. The method of claim 12, wherein the bone comprises a vertebrae and wherein the passage is formed in the pedicle region of the vertebrae.

25. The method of claim 12, wherein the enlarged cross-sectional portion of the passage includes helical grooves extending about the longitudinal axis, the method further comprising:

providing a bone screw having external threads;

threading the bone screw into the threaded region of the passage;

positioning the bone screw such that the external threads are generally aligned with the helical grooves of the enlarged cross-sectional portion of the passage; and

at least partially filling the enlarged cross-section portion of the passage with an anchoring material.

26. A surgical method, comprising:

providing a surgical instrument including a tapping element and an expandable element;

tapping at least a portion of a passage in bone using the tapping element to form a threaded region of the passage;

displacing the expandable element along the passage while in a retracted configuration; and

transitioning the expandable element to an expanded configuration and enlarging a cross-sectional portion of the threaded region of the passage; and

wherein the expandable element comprises a cutting element pivotally coupled to the surgical instrument, the cutting element being aligned in an axial orientation when in the retracted configuration; and

wherein the transitioning of the cutting element to the expanded configuration comprises pivoting the cutting element to an angular orientation.

27. A surgical method, comprising:

forming a passage in bone;

cutting threads along at least a portion of the passage to form a threaded region of the passage, and enlarging a cross-sectional portion of the threaded region of the passage laterally adjacent the threads;

wherein the cutting is performed using a tapping element and wherein the enlarging is performed using an expandable element;

displacing the expandable element along the passage while in a retracted configuration; and

transitioning the expandable element to an expanded configuration to provide the enlarging by positioning the expandable element laterally beyond an outer profile of the tapping element wherein the expandable element extends laterally outward from the tapping element, and by rotating the expandable element about a longitudinal axis.

28. The method of claim 27, further comprising transitioning the expandable element back toward the retracted configuration subsequent to the enlarging.

29. The method of claim 27, further comprising:

providing an implant;

inserting the implant into the passage; and

at least partially filling the enlarged cross-sectional portion of the passage with a bio-compatible material.

30. The method of claim 29, wherein the bio-compatible material comprises an anchoring material to facilitate anchoring of the implant within the passage.

31. The method of claim 29, wherein the implant comprises a bone anchor configured for anchoring one or more devices to the bone.

32. The method of claim 29, wherein the implant includes an axial opening extending at least partially therethrough and at least one transverse opening communicating with the axial opening;

and

wherein the inserting includes positioning the at least one transverse opening adjacent the enlarged cross-sectional portion of the passage; and

wherein the filling comprises injecting the bio-compatible material through the axial passage and out the at least one transverse opening.

33. The method of claim 29, wherein the implant comprises a bone screw;

and

wherein the inserting comprises threading the bone screw into the passage.

34. The method of claim 27, wherein the bone comprises a vertebrae and wherein the passage is formed in the pedicle region of the vertebrae.