Method and apparatus for performing spine surgery

• US 9,351,845 B1
• Filed: 03/31/2011
• Issued: 05/31/2016
• Est. Priority Date: 04/16/2009
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Shoshtaev, Eugene, Pimenta, Luiz, Serra, Michael, Morris, Andrew, Lovell, Nathan, Oi, Nelson
• Primary Examiner(s): Peffley, Michael
• Assistant Examiner(s): Fowler, Daniel
• Application Number:
  US13/077,977
• Time in Patent Office: 1,888 Days
• Field of Search: 606201-219, 606/279, 606/33, 606/41, 606/45, 606/86.A, 606/99, 623 1711- 1716, 600201-246
• US Class Current: 1/1
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/0218 for minimally invasive surgery A61B17/0281, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/025 Joint distractors
• 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 17/3423 Access ports, e.g. toroid shape introducers for instruments or hands access sites for liquids A61M39/0247
• CPC Class Codes: A61B 17/8863 Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• 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 2018/00601 Cutting
• 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 2002/30774 : 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 2250/0098 : radio-opaque, e.g. radio-opaque markers
• 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 sagittal imbalance of a lumbar spine, comprising the steps of:

a) creating an operative corridor that provides access to a targeted spinal disc via a lateral approach by inserting an access system along a lateral, trans-psoas path to the targeted spinal disc, the access system comprising a stimulation electrode that 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;

b) inserting a cutting device through the lateral operative corridor and severing the Anterior Longitudinal Ligament (ALL); and

c) connecting an insertion instrument to a first retractor blade forming a portion of the border of the operative corridor, the insertion instrument having an implant for positioning between the adjacent vertebral bodies bordering the targeted disc space coupled thereto; and

d) advancing the insertion instrument along the retractor blade to position the implant between the adjacent vertebral bodies.

2. The method of claim 1, wherein the cutting device includes a blade.

3. The method of claim 2, wherein the blade is situated between two finger extensions.

4. The method of claim 1, wherein the cutting device includes an anode electrode.

5. The method of claim 4, wherein an insulated retractor is positioned between the ALL and the great vessels prior to activating electrical current that cuts the ALL.

6. The method of claim 1, wherein the implant has an upper surface to contact a first vertebra of the adjacent vertebrae when the implant is positioned within the interbody space, a lower surface to contact a second vertebra of the adjacent vertebrae 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, the implant further 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 at least 20 degrees.

7. The method of claim 6, including the additional step of anchoring the implant in position between the first vertebra and second vertebra.

8. The method of claim 7, wherein the proximal 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 and the step of anchoring the implant comprises advancing an anchor through the at least one aperture into one of the first and second vertebra.

9. The method of claim 8, wherein the extension tab includes an upper portion including a first aperture that abuts a lateral aspect of the first vertebra and a lower portion including a second aperture that abuts a lateral aspect of the second vertebra, 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 the second vertebra.

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

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

12. The method of claim 6, 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.

13. The method of claim 12, 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.

14. The method of claim 6, 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.

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

16. The method of claim 1, wherein the access system comprises at least one dilator having the stimulation electrode situated on a distal end and a retractor that slides over the at least one dilator in a first configuration, and thereafter adjusts to a second configuration to form the operative corridor, wherein the retractor includes the first retractor blade.

17. The method claim 16, wherein the nerve monitoring includes determining a proximity and direction to a nerve located in the psoas muscle.

18. The method of claim 17, wherein the nerve monitoring is used to position the initial dilator as posterior as possible while remaining anterior to the nerve.

19. The method of claim 18, wherein the retractor includes a plurality of blades, one of the plurality of blades being 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.

20. The method of claim 19, wherein the first retractor blade is the posterior retractor blade.

21. The method of claim 20, wherein connecting the insertion instrument to the first retractor blade includes slideably engaging a guide piece of the insertion instrument into a track of the first retractor blade.

22. The method of claim 21, wherein the guide piece rotates in two axes relative to a longitudinal axis of the insertion instrument such that the anterior-posterior position and cephalad-caudal position of the implant is adjustable relative to the first retractor blade.