Method and apparatus for performing spine surgery

• US 8,287,597 B1
• Filed: 04/16/2010
• Issued: 10/16/2012
• Est. Priority Date: 04/16/2009
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Pimenta, Luiz, Morris, Andrew, Serra, Michael, Snider, Brian
• Primary Examiner(s): Stewart, Alvin
• Assistant Examiner(s): Palmer, James
• Application Number:
  US12/799,021
• Time in Patent Office: 914 Days
• Field of Search: 623 1711- 1716
• US Class Current: 623/17.16
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 17/320036 adapted for use within the carpal tunnel
• CPC Class Codes: A61B 17/3209 Incision instruments
• CPC Class Codes: A61B 17/3211 Surgical scalpels, knives; Accessories therefor
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/0262 with a provision for protecting nerves
• CPC Class Codes: A61B 2017/320052 Guides for cutting instruments by marking A61B2090/395
• CPC Class Codes: A61B 2090/08021 of the patient or his organs
• CPC Class Codes: A61B 2090/0817 Spatulas or spatula like extensions
• CPC Class Codes: A61F 2/30771 applied in original prostheses, e.g. holes or grooves
• CPC Class Codes: A61F 2/442 Intervertebral or spinal discs, e.g. resilient non-disc-shaped intervertebral inflatable pockets A61F2/441; non-disc-shaped intervertebral fusion implants A61F2/4455
• CPC Class Codes: A61F 2/4455 for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages intervertebral discs A61F2/442
• CPC Class Codes: A61F 2/447 substantially parallelepipedal, e.g. having a rectangular or trapezoidal cross-section
• CPC Class Codes: A61F 2/4611 of spinal prostheses
• CPC Class Codes: A61F 2002/2817 Bone stimulation by chemical reactions or by osteogenic or biological products for enhancing ossification, e.g. by bone morphogenetic or morphogenic proteins [BMP] or by transforming growth factors [TGF]
• CPC Class Codes: A61F 2002/2835 Bone graft implants for filling a bony defect or an endoprosthesis cavity, e.g. by synthetic material or biological material
• CPC Class Codes: A61F 2002/30062 (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/30176 : V-shaped
• CPC Class Codes: A61F 2002/30266 : wedge-shaped parallelepipeds
• CPC Class Codes: A61F 2002/30281 : wedge-shaped
• CPC Class Codes: A61F 2002/30433 : using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/30576 : with extending fixation tabs
• CPC Class Codes: A61F 2002/30578 : having apertures, e.g. for receiving fixation screws
• CPC Class Codes: A61F 2002/30593 : hollow
• CPC Class Codes: A61F 2002/30607 : Kits of prosthetic parts to be assembled in various combinations for forming different prostheses
• CPC Class Codes: A61F 2002/30616 : Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2002/30772 : Apertures or holes, e.g. of circular cross section
• CPC Class Codes: A61F 2002/30774 : internally-threaded
• CPC Class Codes: A61F 2002/30777 : Oblong apertures
• CPC Class Codes: A61F 2002/30784 : Plurality of holes
• CPC Class Codes: A61F 2002/30785 : parallel
• CPC Class Codes: A61F 2002/30787 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30828 : parallel
• CPC Class Codes: A61F 2002/30904 : serrated profile, i.e. saw-toothed
• CPC Class Codes: A61F 2002/3093 : for promoting ingrowth of bone tissue
• CPC Class Codes: A61F 2002/444 : for replacing the nucleus pulposus
• CPC Class Codes: A61F 2310/00011 : Metals or alloys
• CPC Class Codes: A61F 2310/00179 : Ceramics or ceramic-like structures
• CPC Class Codes: A61F 2310/00359 : Bone or bony tissue

Abstract

Systems and methods are described for correcting sagittal imbalance in a spine including instruments for performing the controlled release of the anterior longitudinal ligament through a lateral access corridor and hyper-lordotic lateral implants.

Claims

1. A method for correcting saggital imbalance of a lumbar spine, comprising the steps of:

inserting an access system along a lateral, trans-psoas path to a target site on the lumbar spine to create an operative corridor to the target site, wherein the access system comprises a stimulation electrode and is inserted under conditions wherein an electrical stimulation signal is delivered through said stimulation electrode for nerve monitoring when the stimulation electrode is positioned in the lateral, trans-psoas path;

preparing the intervertebral space between first and second vertebra of the lumbar spine for receipt of an intervertebral implant, the intervertebral space being at least partially defined by an anterior aspect, a posterior aspect, and opposing first and second lateral aspects;

inserting a cutting device through the operative corridor along the lateral, trans-psoas path and severing the Anterior Longitudinal Ligament (ALL); and

advancing the intervertebral implant through the operative corridor along the lateral, trans-psoas path into the intervertebral disc space between the first and second vertebra, the intervertebral implant having an upper surface to contact said first vertebra when the implant is positioned in the intervertebral space, a lower surface to contact the second vertebra when the implant is positioned in the intervertebral space, a first lateral wall and second lateral wall defining a longitudinal length therebetween, the longitudinal length being such that the implant extends from the apophyseal ring at the first lateral aspect to the apophyseal ring at the second lateral aspect when the implant is positioned in the intervertebral disc space, an anterior sidewall to face the anterior aspect of the intervertebral disc space when the implant is positioned in the intervertebral disc space, and a posterior sidewall to face the posterior aspect of the intervertebral disc space when the implant is positioned in the intervertebral disc space, the anterior sidewall and posterior sidewall defining a width therebetween, the anterior sidewall having a first height and the posterior sidewall having a second height smaller than the first height such that the upper and lower surfaces increase in slope from the posterior sidewall to the anterior sidewall forming an angle ranging from 20 degrees to 40 degrees.

2. The method of claim 1, comprising the additional step of anchoring the implant to at least one of said adjacent vertebra the first vertebra and the second vertebra.

3. The method of claim 2, wherein the second lateral sidewall includes an extension tab that abuts a lateral aspect of at least one of the first vertebra and second vertebra when the implant is positioned in the intervertebral space, the extension tab including at least one aperture that receives a fixation anchor therethrough, wherein the step of anchoring the implant comprises advancing an anchor through the at least one aperture into one of the first and second vertebra.

4. The method of claim 3, wherein the extension tab includes an upper portion including a first aperture that abuts a lateral aspect of first vertebra and a lower portion including a second aperture that abuts a lateral aspect of the second, and wherein the step of anchoring the implant comprises advancing an anchor through the first aperture into the first vertebra and advancing a second anchor through the second aperture into second vertebra.

5. The method of claim 1, wherein longitudinal length is between 40 mm and 60 mm.

6. The method of claim 1, wherein the upper surface and lower surface are planar surfaces.

7. The method of claim 6, wherein the upper surface and lower surfaces are convex surfaces.

8. The method of claim 1, wherein the implant is a fusion implant and includes at least one fusion aperture opening in the upper surface and lower surface to permit bone growth between the first vertebra and second vertebra.

9. The method of claim 8, comprising the additional step of depositing bone growth promoting substances within the at least one fusion aperture before, during, and/or, after advancing the implant into the intervertebral disc space.

10. The method of claim 1, wherein the top surface includes anti-migration features that contact the first vertebra and the bottom surface includes anti-migration features that contact the lower vertebra.

11. The method of claim 1, wherein the step of severing the ALL comprises protecting the great vessels while the ALL is being severed.

12. The method of claim 11, wherein protecting the great vessels comprising positioning a barrier between the Great Vessels and a cutting element of the cutting device.

13. The method of claim 12, wherein the barrier is part of the cutting device.

14. The method of claim 13, wherein the cutting device includes a distal head with an outer finger, and inner finger, and a cutting blade exposed between the outer finger and inner finger, each of the outer finger and inner finger extending beyond the cutting blade, the outer finger extending beyond the inner finger, wherein the step of severing the ALL comprises advancing the outer finger along the outer surface of the ALL until the cutting blade cuts completely through the ALL.

15. The method of claim 14, wherein at least the outer finger is curved.

16. The method claim 13, wherein the cutting device includes a tissue retractor and a sliding blade, the tissue retractor having a head with curvature that generally complements the curvature of the anterior aspect of the lumbar spine and the step of severing the ALL comprises positioning the tissue retractor such that the head nestles around the ALL forming the barrier and sliding the sliding blade distally along the inner surface of the retractor head.

17. The method of claim 1, wherein the access system comprises at least one dilator having a stimulation electrode situated on a distal end and a retractor that slides over the at least one dilator in a first configuration, and there after adjusts to a second configuration to enlarge the create the enlarge the operative corridor.

18. The method claim 17, wherein the nerve monitoring includes determining a proximity and direction to a nerve located in the psoas muscle.

19. The method of claim 18, wherein the nerve monitoring is used to position the initial dilator as posterior as possible while remaining anterior to the nerve.

20. The method of claim 19, wherein the plurality of blades includes a posterior blade and comprising the additional step of fixing the position of the posterior blade just anterior to the nerve prior to adjusting to the second configuration such that adjusting to the second configuration comprises moving at least one of the plurality of blades away from the posterior blade.