Systems and methods for performing spine surgery

• US 9,060,815 B1
• Filed: 03/15/2013
• Issued: 06/23/2015
• Est. Priority Date: 03/08/2012
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Gustine, Seth, Donahoe, Ryan, Shoshtaev, Eugene, Pettine, Spencer
• Primary Examiner(s): Philogene, Pedro
• Assistant Examiner(s): COMSTOCK, DAVID C
• Application Number:
  US13/831,696
• Time in Patent Office: 830 Days
• Field of Search: 606/246, 606264-270, 606/272, 606/278, 606/279, 606/75
• US Class Current: 1/1
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/7002 Longitudinal elements, e.g. rods
• 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 17/7041 with single longitudinal rod offset laterally from single row of screws or hooks A61B17/7044 takes precedence
• CPC Class Codes: A61B 17/7044 also having plates, staples or washers bearing on the vertebrae
• CPC Class Codes: A61B 17/705 for linking adjacent ends of longitudinal elements
• CPC Class Codes: A61B 17/7053 with parts attached to bones or to each other by flexible wires, straps, sutures or cables
• CPC Class Codes: A61B 17/7091 for applying, tightening or removing longitudinal element-to-bone anchor locking elements, e.g. caps, set screws, nuts or wedges

Abstract

This disclosure describes example an surgical fixation system and example methods for implanting the surgical fixation system on the spine. The surgical fixation system can be applied minimally invasively to the anterior column for both single level and multi-level constructs. The surgical system can be applied to the anterior column via lateral access approaches. The lateral access approach may traverse the psoas muscle. The fixation system includes a plurality of anchor assemblies connected by a spinal rod. The anchor assemblies each include a fixation body, bone anchor, rod-receiving member, anchor lock and rod lock. The rod-receiving member may be moveably coupled to the fixation body to facilitate rod insertion.

Claims

1. A spinal fixation system configured for implantation on a lateral aspect of a human spine for immobilizing at least two vertebral bodies relative to one another, comprising:

an elongated generally cylindrical spinal rod having a size sufficient to span the distance between a first anchor assembly implanted in a first vertebral body and a second anchor assembly implanted in a second vertebral body;

at least two adjustable anchor assemblies, each adjustable anchor assembly implantable on a vertebral body and configured to adjustably receive a portion of the spinal rod and thereafter further receive a rod locking element that when applied alters the state of the anchor assemblies from the adjustable state to a locked state, each anchor assembly comprising;

an anchor element configured to anchor the anchor assembly to the vertebral body, the anchor element including an elongated threaded shaft for gaining purchase within a vertebra and a head element positioned proximally from the shaft, the head element separated from the shaft by a neck region, the neck region having a diameter less than the largest diameter of the head element;

a fixation base having an anchor aperture configured to receive the head portion and at least a portion of the neck region of the anchor element, the aperture further configured to receive at least a portion of an anchor locking element;

an anchor locking element moveably coupled with the fixation base and configured to retain a portion of the anchor element to prevent disassociation of the anchor element from the fixation base;

a rod receiving element coupled with the fixation base and initially moveable relative to the fixation base, the rod receiving element comprising a base portion including a retaining flange having a generally T-shaped cross-section; and

a rod locking element introducible to the rod receiving element after coupling of the spinal rod and the rod receiving element, the rod locking element having a contact surface that contacts the spinal rod and exerts a force on the spinal rod that locks the spinal rod to the rod receiving element while simultaneously locking the previously moveable rod receiving element in position relative to the fixation base.

2. The spinal fixation system of claim 1, wherein the fixation base includes at least one supplemental anchor element extending generally perpendicularly from a bottom surface of the fixation base, the supplemental anchor element configured to penetrate a vertebral body.

3. The spinal fixation system of claim 1, wherein the anchor locking element is moveable within the anchor aperture from a first position in which the anchor element head element is able to move into and out of the anchor aperture to a second position in which the anchor element head element is retained within the anchor aperture by a portion of the anchor locking element, thereby locking the fixation base to the anchor element.

4. The spinal fixation system of claim 1, wherein the anchor aperture has a bottom opening having a diameter greater than the largest diameter of the anchor element head element.

5. The spinal fixation system of claim 4, wherein the anchor aperture has a inner circumferential conically tapered surface configured to inwardly deflect at least a portion of the deflectable extensions of the anchor locking element.

6. The spinal fixation system of claim 5, wherein advancement of the anchor locking element into the anchor aperture causes the deflectable extensions to contact the circumferential conically tapered surface and deflect inward.

7. The spinal fixation system of claim 6, wherein the inwardly deflected deflectable extensions act in concert to create a locking aperture having a diameter that is smaller than the largest diameter of the anchor element head element but larger than the diameter of the anchor element neck element, thereby effectively locking the fixation body to the bone anchor element.

8. The spinal fixation system of claim 1, wherein the wherein the base portion includes and a pair of opposing upstanding arms that act in concert to form a rod channel configured to receive the spinal rod therein.

9. The spinal fixation system of claim 1, wherein the retaining flange has a generally circular shaped footprint.

10. The spinal fixation system of claim 9, wherein the fixation base has an elongated recess formed in an upper facing surface, the elongated recess configured to moveably receive the retaining flange of the rod receiving element therein.

11. The spinal fixation system of claim 10, wherein the recess further includes a pair of overhangs configured to prevent movement of the retaining flange away from the fixation base.

12. The spinal fixation system of claim 11, wherein the retaining flange is sized and configured to rotate and translate within the recess.

13. A method for performing spine surgery, comprising:

establishing a minimally invasive operative corridor to a spinal target site, the spinal target site comprising at least a portion of a lateral aspect of a first vertebral body and at least a portion of a lateral aspect of a second vertebral body, the first and second vertebral bodies being adjacent one another;

implanting a first bone anchor in the lateral aspect of the first vertebral body, the first bone anchor including an elongated threaded shaft for gaining purchase within a vertebra and a head element positioned proximally from the shaft, the head element separated from the shaft by a neck region, the neck region having a diameter less than the largest diameter of the head element;

providing first and second fixation assemblies, the each of the first and second fixation assemblies including a fixation base, an anchor lock, and a rod housing, the fixation base having an anchor aperture configured to receive the head portion and at least a portion of the neck region of the bone anchor, the anchor aperture further configured to receive at least a portion of the anchor lock, the anchor lock moveably coupled with the fixation base and configured to retain a portion of the bone anchor to prevent disassociation of the bone anchor from the fixation base, the rod housing moveably coupled with the fixation base, the rod housing configured to receive a portion of a spinal rod therein;

implanting the first fixation assembly in the lateral aspect of the first vertebral body by advancing the first fixation assembly along the operative corridor until a lower bone engaging surface on the first fixation assembly contacts the vertebral body and the head element of the first bone anchor is received within the anchor aperture of the first fixation assembly;

actuating the anchor lock on the first fixation assembly to effect locking of the first bone anchor to the fixation base of the first fixation assembly;

implanting a second bone anchor in the lateral aspect of the second vertebral body, the second bone anchor including an elongated threaded shaft for gaining purchase within a vertebra and a head element positioned proximally from the shaft, the head element separated from the shaft by a neck region, the neck region having a diameter less than the largest diameter of the head element;

implanting the second fixation assembly in the lateral aspect of the second vertebral body by advancing the second fixation assembly along the operative corridor until a lower bone engaging surface on the second fixation assembly contacts the vertebral body and the head element of the second bone anchor is received within the anchor aperture of the second fixation assembly;

actuating the anchor lock on the second fixation assembly to effect locking of the second bone anchor to the fixation base of the second fixation assembly;

introducing a spinal rod segment such that a first portion of the spinal rod segment is placed within the rod housing of the first fixation assembly and a second portion of the spinal rod segment is placed within the rod housing of the second fixation assembly;

introducing a first rod lock element to the rod housing on the first fixation assembly and advancing the first rod lock element along the rod housing until a rod contact surface on the first rod lock element contacts the spinal rod, and further tightening the first rod lock element to lock the first spinal rod segment to the first anchor assembly and simultaneously causing the rod housing to lock in place relative to the fixation base of the first fixation assembly;

introducing a second rod lock element to the rod housing on the second fixation assembly and advancing the second rod lock element along the rod housing until a rod contact surface on the second rod lock element contacts the spinal rod, and further tightening the second rod lock element to lock the second spinal rod segment to the second anchor assembly and simultaneously causing the rod housing to lock in place relative to the fixation base of the second fixation assembly; and

closing the minimally invasive operative corridor.

14. The method of claim 13, wherein the minimally invasive operative corridor is established using a lateral trans-psoas approach.

15. The method of claim 13, comprising the further step of adjusting the first fixation assembly by translating the rod housing of the first fixation assembly relative to the fixation base of the first fixation assembly to accommodate the introduction of the spinal rod segment.

16. The method of claim 15, comprising the further step of adjusting the first fixation assembly by rotating the rod housing of the first fixation assembly relative to the fixation base of the first fixation assembly to accommodate the introduction of the spinal rod segment.

17. The method of claim 13, comprising the further step of adjusting the first fixation assembly by rotating the rod housing of the first fixation assembly relative to the fixation base of the first fixation assembly to accommodate the introduction of the spinal rod segment.

18. The method of claim 17, comprising the further step of adjusting the first fixation assembly by translating the rod housing of the second fixation assembly relative to the fixation base of the second fixation assembly to accommodate the introduction of the spinal rod segment.

19. The method of claim 13, comprising the further step of adjusting the first fixation assembly by rotating the rod housing of the first fixation assembly relative to the fixation base of the first fixation assembly to accommodate the introduction of the spinal rod segment.

20. The method of claim 19, wherein the fixation base of the first fixation assembly includes an elongated recess formed in an upper facing surface, the elongated recess configured to moveably receive the retaining flange of the rod housing therein.

21. The method of claim 13, wherein the rod housing of the first fixation assembly includes a retaining flange having a generally T-shaped cross-section.