Methods and apparatus for performing spine surgery

• US 9,192,482 B1
• Filed: 12/19/2014
• Issued: 11/24/2015
• Est. Priority Date: 04/16/2009
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Pimenta, Luiz, Morris, Andrew, Snider, Brian, Serra, Michael
• Primary Examiner(s): Robert, Eduardo C
• Assistant Examiner(s): ECKMAN, MICHELLE CHRISTINE
• Application Number:
  US14/578,215
• Time in Patent Office: 340 Days
• Field of Search: 623 1711- 1716
• US Class Current: 1/1
• 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 spinal implant positionable within an interbody space between a first spinal vertebra and a second spinal vertebra from a lateral access pathway after cutting the Anterior Longitudinal Ligament (ALL), said implant comprising:

an upper surface to contact the first vertebra when the implant is positioned within the interbody space, a lower surface to contact the second vertebra when the implant is positioned within the interbody space, a distal wall, a proximal wall, an anterior sidewall that faces anteriorly when the implant is positioned within the interbody space, and a posterior sidewall that faces posteriorly when the implant is positioned within the interbody space;

wherein said implant has a maximum longitudinal length extending from a proximal end of the proximal wall to a distal end of the distal wall, a width extending from the anterior end of the anterior sidewall to the posterior end of the posterior sidewall, the maximum longitudinal length being at least 40 mm, an anterior height extending from the upper surface to the lower surface at the anterior sidewall and a posterior height extending from the upper surface to the lower surface at the posterior sidewall, the anterior height being greater than the posterior height such that the upper and lower surfaces increase in slope from the posterior sidewall to the anterior sidewall forming an angle greater than 20 degrees;

at least a first fusion aperture extending through the upper surface and lower surface and configured to permit bone growth between the first vertebra and the second vertebra when the implant is positioned within the interbody space, the first fusion aperture having;

a longitudinal aperture length extending generally parallel to the longitudinal length of the implant, and an aperture width extending from the anterior sidewall to the posterior sidewall, wherein the longitudinal aperture length is greater than the aperture width;

a tab associated with the proximal wall, the tab including at least one fixation aperture therethrough configured to receive a fixation anchor, and a locking mechanism configured to prevent disengagement of a fixation anchor from the fixation aperture.

2. The spinal implant of claim 1, further including a second fusion aperture extending through said upper surface and lower surface and configured to permit bone growth between the first vertebra and the second vertebra when the implant is positioned within the interbody space.

3. The spinal implant of claim 2, wherein the second fusion aperture has a longitudinal aperture length extending generally parallel to the longitudinal length of the implant, and an aperture width extending from the anterior sidewall to the posterior sidewall, wherein the longitudinal aperture length is greater than the aperture width.

4. The spinal implant of claim 1, wherein said implant includes anti-migration elements on said upper surface.

5. The spinal implant of claim 4, wherein said anti-migration elements include a plurality of ridges extending perpendicularly to said longitudinal length.

6. The spinal implant of claim 1, further comprising an osteoinductive material positioned within said first aperture.

7. The spinal implant of claim 1, wherein the tab extends above the upper surface and is configured to engage an exterior surface of the first vertebra when the implant is positioned within the interbody space.

8. The spinal implant of claim 7, wherein the tab also extends below the lower surface and is configured to engage an exterior surface of the second vertebra when the implant is positioned within the interbody space.

9. The spinal implant of claim 8, wherein the tab includes two fixation apertures.

10. The spinal implant of claim 1, wherein the fixation anchor is a screw.

11. 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;

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 an upper surface that contacts the first vertebra a lower surface that contacts the second vertebra, a distal wall, a proximal wall, an anterior sidewall that faces anteriorly, and a posterior sidewall that faces posteriorly, the implant having a maximum longitudinal length extending from a proximal end of the proximal wall to a distal end of the distal wall, a width extending from the anterior end of the anterior sidewall to the posterior end of the posterior sidewall, the maximum longitudinal length being at least 40 mm, an anterior height extending from the upper surface to the lower surface at the anterior sidewall and a posterior height extending from the upper surface to the lower surface at the posterior sidewall, the anterior height being greater than the posterior height such that the upper and lower surfaces increase in slope from the posterior sidewall to the anterior sidewall forming an angle greater than 20 degrees.

12. The method of claim 11, comprising the additional step of anchoring the implant to at least one of said adjacent vertebra the first vertebra and the second vertebra.

13. The method of claim 12, wherein the proximal end includes an extension tab that abuts a lateral aspect of at least one of the first vertebra and second vertebra, 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.

14. The method of claim 13, 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.

15. The method of claim 11, 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.

16. The method of claim 15, comprising the additional step of depositing bone growth promoting substances within the at least one fusion aperture at least one of before, during, and after advancing the implant into the intervertebral disc space.

17. The method of claim 11, wherein the step of severing the ALL comprises protecting the great vessels with a barrier positioned between the Great Vessels and a cutting element while the ALL is being severed.

18. The method of claim 17, wherein the cutting element and the barrier are integrated elements of a cutting device.

19. The method of claim 11, wherein the access system comprises at least one dilator 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 operative corridor.

20. The method claim 19, wherein at least the at least one dilator of the access system includes a stimulation electrode and is advanced through the psoas muscle with stimulation signals being emitted from the stimulation electrode to detect nerves located in the psoas muscle.