Methods and apparatus for performing spine surgery

• US 9,757,246 B1
• Filed: 10/20/2015
• Issued: 09/12/2017
• 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 C
• Application Number:
  US14/918,137
• Time in Patent Office: 693 Days
• Field of Search: 623 1711- 1716
• 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
• 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 system comprising:

a resector including

a sliding blade having a handle, a hollow shaft defining a central lumen, a head defining a first opening in communication with the central lumen, and a second opening in communication with the central lumen and opposingly positioned from the first opening;

an implant positionable within an interbody space defined by a first vertebra and a second vertebra, the implant including

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;

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; and

a 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 system of claim 1, wherein the 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.

3. The system of claim 1, further comprising a second fusion aperture extending through the upper surface and the 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.

4. The system of claim 3, wherein the second fusion aperture has a longitudinal aperture length extending generally parallel to a 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.

5. The system of claim 1, wherein the implant includes anti-migration elements on the upper surface.

6. The system of claim 5, wherein the anti-migration elements comprise a plurality of ridges extending perpendicularly to a longitudinal length of the implant.

7. The system of claim 5, wherein the anti-migration elements comprise a plurality of spike elements.

8. The system of claim 1, further comprising an osteoinductive material positioned within the first fusion aperture.

9. The system 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.

10. The system of claim 9, wherein the tab 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.

11. The system of claim 1, wherein the tab includes at least two fixation apertures.

12. The system of claim 1, wherein the fixation anchor is a screw.

13. The system of claim 1, further comprising a tissue retractor configured to travel through the central lumen to create an operative corridor.

14. The system of claim 13, further comprising at least one dilator configured to movably slide with the tissue retractor from a first configuration to a second configuration, wherein the movement to the second configuration enlarges the operative corridor.

15. The system of claim 13, wherein the tissue retractor comprises a barrier.

16. The system of claim 1, further comprising a stimulation electrode configured to deliver an electrical stimulation signal for nerve monitoring.

17. The system of claim 1, wherein the upper surface and the lower surface are each a planar surface.

18. The system of claim 1, wherein the upper surface and the lower surface are each a convex surface.

19. The system of claim 1, further comprising a tissue retractor including a barrier.

20. The system of claim 1, wherein the distal wall, the proximal wall, the anterior sidewall, and the posterior sidewall each comprise radiolucent material.

21. The system of claim 20, wherein the radiolucent material is PEEK.