APPARATUS, METHOD AND SYSTEM FOR THE TREATMENT OF SPINAL CONDITIONS AND FIXATION OF PELVIS AND LONG BONES

• US 20010016742A1
• Filed: 12/29/1998
• Published: 08/23/2001
• Est. Priority Date: 10/08/1993
• Status: Active Grant

• Current Assignee: Chaim Rogozinski
• Original Assignee: Chaim Rogozinski
• Inventors: ROGOZINSKI, CHAIM
• Granted Patent: US 6,336,927 B2
• Time in Patent Office: Days
• US Class Current: 606/61
• CPC Class Codes: A61B 17/7007 Parts of the longitudinal elements, e.g. their ends, being specially adapted to fit around the screw or hook heads
• CPC Class Codes: A61B 17/701 Longitudinal elements with a non-circular, e.g. rectangular, cross-section A61B17/7005, A61B17/7007 take precedence
• CPC Class Codes: A61B 17/7011 Longitudinal element being non-straight, e.g. curved, angled or branched adjustable length longitudinal elements A61B17/7014; A61B17/7019 takes precedence, e.g. coil springs
• CPC Class Codes: A61B 17/7019 Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
• 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 17/7038 to a different extent in different directions, e.g. within one plane only
• CPC Class Codes: A61B 17/7049 Connectors, not bearing on the vertebrae, for linking longitudinal elements together A61B17/7055, A61B17/7053, A61B17/7019 take precedence
• CPC Class Codes: A61B 17/7055 connected to sacrum, pelvis or skull
• CPC Class Codes: A61B 17/80 Cortical plates , i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
• CPC Class Codes: A61B 17/86 Pins or screws or threaded wires; nuts therefor A61B17/72 take precedence
• CPC Class Codes: A61B 17/8605 Heads, i.e. proximal ends projecting from bone
• CPC Class Codes: C07C 67/03 by reacting an ester group with a hydroxy group
• CPC Class Codes: C07C 67/52 by change in the physical state, e.g. crystallisation
• CPC Class Codes: C07C 67/54 by distillation
• CPC Class Codes: C07C 69/82 Terephthalic acid esters

Abstract

An apparatus, method and system for treating spinal conditions by moving or spatially fixing at least one vertebra relative to another vertebra. The invention includes a link member the ends of which are configured to be secured to adjacent vertebrae and which are offset from a central portion of the link member. The link members can be in the form of a C-shaped or V-shaped rod or plate to form the offset. The offset provides increased bone volume that can be used for grafts or fusion. Attachment structure in the form of bone screws, bolts, or hook members are provided to secure the link members to respective vertebrae or other bones. A plurality of link members can be connected in chain-like fashion to connect multiple points on a plurality of vertebrae or other bones even though those points are nonlinear. In another aspect of the invention, a multi-directional attachment member is provided and may be used with the link members to form a spinal implant or external bone fixation system.

Claims

1. A method for securing an external bone fixation device to a bone of a patient to stabilize the bone, the method comprising steps of:

providing a plurality of multi-directional attachment apparatus, each said apparatus comprising;

first and second portions attachable to each other;

the first portion including an elongated section extending between first and second ends, the elongated section having threads thereon for securing the section within a bore formed in a bone, one of said ends being hemispherically-shaped; and

the second portion attachable to said first portion and adjustable with respect thereto, the second portion including opposite ends, one of said opposite ends having threads thereon to form a bolt extension that may be engaged by a locking member, and the other of said opposite ends being hemispherically-shaped;

wherein said first and second portions may be secured together in any of various relative angular orientations with the respective hemispherically-shaped ends of said first and second portions joined so as to form a sphere having an equator;

providing a bone fixation member having two opposite ends and an aperture in each end;

securing the first portion of a first multi-directional attachment member within a bore formed in a first area of the bone, and attaching the second portion of said first multi-directional attachment member to the first portion of said first multi-directional attachment member at a desired relative angular orientation;

securing the first portion of a second multi-directional attachment member within a bore formed in a second area of the bone, and attaching the second portion of said second multi-directional attachment member to the first portion of said second multi-directional attachment member at a desired relative angular orientation; and

placing the apertures at each end of said bone fixation member, respectively, over the bolt extensions of said first and second multi-directional attachment members and locking said bone fixation member thereto at a location external to the patient'"'"'s body;

whereby the bolt extensions of said first and second multi-directional attachment members are angularly adjustable relative the first portions of said attachment members to permit the bone fixation device to be placed on the bolt extensions at a desired orientation substantially independent of the angular orientation of said first portions within said bores of the bone.

2. A method according to

claim 1

, wherein the respective hemispherically-shaped ends of said first and second portions of said first and second multi-directional attachment members include mating flat faces with interdigitating structure for locking said portions at a selected position.

3. A method according to

claim 1

, further comprising a screw member received in respective passages formed in the hemispherically-shaped ends of said first and second portions of said first and second multi-directional attachment members to lock said portions in a selected position.

4. A method according to

claim 3

, wherein said screw member is a lag-type set screw.

5. A method according to

claim 3

, wherein said screw member has an enlarged head and the passage in the hemispherically-shaped end of one of said first and second portions of said first and second multi-directional attachment members includes a stepped section which receives the head of the screw member so as to be flush with the surface of said one end.

6. A method according to

claim 1

, further comprising a locking nut received over the threaded bolt extension of said first and second multi-directional attachment members to lock the bone fixation member thereto.

7. A method according to

claim 1

, wherein the bone fixation member is a link member with first and second ends defining a space therebetween which space is disposed adjacent a middle portion and extends away from the middle portion to a line connecting the apertures in the ends of each link member.

8. A method according to

claim 2

, wherein one of the flat faces has a projection and the other flat face has a recess configured to receive the projection.

9. An apparatus for treating spinal conditions by moving or spatially fixing a first vertebra with respect to additional vertebrae, the apparatus comprising:

a plurality of attachment members having means for being attached to a vertebra; and

a plurality of link members adapted to be secured to adjacent vertebrae, each link member being an integral structure including opposite ends and a central portion connecting said ends, the opposite ends each having an aperture therein configured to receive the attachment members when said members are fixed to said adjacent vertebrae;

the central portion of each of said plurality of link members being offset from said opposite ends of the link member such that when the link member is fixed to adjacent vertebrae, a substantial portion of the surface of one of the vertebra is exposed between the opposite ends of the link member to provide a surface that can be utilized for a bone graft.

10. An apparatus according to

claim 9

, wherein at least some of said link members are in the form of a flat plate that is V-shaped with said central portion forming the apex of the V-shaped plate.

11. An apparatus according to

claim 9

, wherein at least some of said link members are in the form of a flat plate with said central portion being straight and the opposite end portions extending laterally away from the straight central portion to substantially form a C-shape.

12. An apparatus according to

claim 10

, wherein said attachment members are bone bolts each having at one end thereof a helical portion adapted to be fixed in bores disposed in respective vertebrae, and at an opposite end thereof a threaded portion which protrudes away from a vertebra when the bone screw is fixed thereto, the threaded portion being configured to engage one of the apertured ends of one of said link members.

13. An apparatus according to

claim 12

, further including locking nuts configured to be positioned over one of the link members on the threaded portion of one of the bone bolts to securely fix the link member to the bone bolt.

14. An apparatus according to

claim 12

, wherein each bone bolt has an annular shoulder formed between the threaded portion and the helical portion for supporting an end of one of said link members, said shoulder being provided with means for enhancing the engagement of the link member with the bone bolt.

15. An apparatus according to

claim 14

, further including at least one washer member configured to be positioned on the bone bolt between the vertebra and the link member, said washer being wedge-shaped so that the link member can be secured to the bone bolt at an angle of substantially 90°

.

16. An apparatus according to

claim 9

, wherein at least some of said link members are in the form of a rod that is V-shaped with said central portion formed by the apex of the V-shaped rod.

17. An apparatus according to

claim 9

, wherein at least some of said link members are in the form of a rod with the central portion being straight and the opposite end portions extending laterally away from the straight central portion to substantially form a C-shape.

18. A method for treating spinal conditions by moving or spatially fixing at least a first vertebra relative to a second vertebra while leaving exposed at least a lateral marginal area of the lamina of one of said vertebrae, the method including steps of:

fixing a first attachment member to the first vertebra at a selected position;

fixing a second attachment member to the second vertebra at a selected position;

providing at least one one-piece spinal implant link member having an apertured first end, an apertured second end, and an offset middle portion, the first and second ends of the link member defining an open space therebetween which space is disposed adjacent the middle portion and extends away from the middle portion to a line connecting the apertures in the ends of the link member;

attaching said first end of said at least one link member to said first attachment member which is fixed to the first vertebra; and

attaching said second end of said at least one link member to said second attachment member which is fixed to the second vertebra so that a force is exerted on the first vertebra by said at least one link member;

whereby a lateral marginal area of the lamina of one of said vertebrae is exposed by said space of said link member and provides an area for performing a bone graft.

19. The method of

claim 18

, wherein one of the steps of respectively fixing the first and second attachment members to the first and second vertebra includes fixing a threaded bolt to the vertebra, and said at least one link member is attached to the bolt by placing one of the apertured ends of the link member on said bolt and placing a locking nut over the link member.

20. A method for treating spinal conditions by moving or spatially fixing at least a first vertebra relative to a second vertebra while leaving exposed at least a lateral marginal area of the lamina of one of said vertebrae, the method including steps of:

positioning a first laminar hook member on the first vertebra at a selected position;

positioning a second laminar hook member on the first vertebra at another selected position;

providing at least first and second one-piece spinal implant link members, each member having an apertured first end, an apertured second end, and an offset middle portion, the first and second ends of each link member defining a space therebetween which space is disposed adjacent the middle portion and extends away from the middle portion to a line connecting the apertures in the ends of each link member;

attaching the first end of said first link member to the first laminar hook member and attaching the second end of said first link member to the second laminar hook member to capture a portion of the first vertebra between the respective hook members;

attaching one end of the second link member to the second vertebra; and

attaching the first link member to the second link member with one of the ends of the first link member overlying the other end of the second link member;

whereby a lateral marginal area of the lamina of one of said vertebra is exposed by the space defined by the offset middle portion of at least one of the link members to provide an area for performing a bone graft.

21. A method for treating spinal conditions according to

claim 20

, further including the step of positioning a spacer sleeve on an extended portion of at least one of the hook members to space the first link member on said extended portion a selected distance from a pad portion of the at least one hook member, said pad portion extending transversely from said extended portion and engaging the lamina of the first vertebra.

22. A system for treating spinal conditions such as spinal instability and deformities by applying force to selected vertebrae, the system comprising:

a plurality of links each configured to be secured to adjacent vertebrae to exert a desired force on at least one vertebra;

each link being in the form of an integral member having opposite ends with an aperture in each end, and a central portion extending between said opposite ends, each of said opposite ends having means for locking the end of one link to the end of another link at various desired angular positions with the end of one link overlying the end of an adjacent link;

said plurality of links being configured for attachment to each other with one of said opposite ends of a first link overlying one of said opposite ends of a second link to form a linked construct that extends between two distal points on said vertebrae, the individual links of said plurality of links each being connectible to selected points on adjacent vertebrae so as to permit said linked construct to follow a nonlinear path between said two distal points; and

means for securing each of said plurality of links to adjacent vertebrae and to at least one additional link of said plurality to form said linked construct which exerts the desired force on said selected vertebra.

23. A system for treating spinal conditions according to

claim 22

, wherein the securing means are attachment members configured to be fixed to respective vertebrae and for receiving the ends of respective links in locking engagement, and further including means for locking the respective links to the attachment members.

24. A system for treating spinal conditions according to

claim 23

, wherein at least some of said plurality of links have an offset middle portion between said first and second ends.

25. An apparatus for moving or spatially fixing a first vertebra with respect to a second vertebra, the apparatus comprising:

a plurality of hook members configured to engage the lamina of a vertebra, each hook member being substantially L-shaped and including a pad portion extending transversely from an extended portion and having an upper surface defining a support for receiving a lamina of a vertebra, the extended portion including a threaded shaft which extends upwardly from said transverse pad portion, the extended portion and the transverse pad portion forming the L-shape of said hook member, said extended portion being configured to receive thereon a spinal fixation device so that said device is spaced from the pad portion of said hook member with a lamina of a vertebra captured therebetween; and

at least one spinal fixation device;

whereby one hook member may be positioned on the lamina of a first vertebra with said lamina captured between the pad portion of the one hook member and a first end of the spinal fixation device which is disposed on the extended portion of the one hook member, and another hook member may be positioned on the lamina of a second vertebra which is adjacent to said first vertebra, with the lamina of said second vertebra captured between the pad portion of the other hook member and a second end of the spinal fixation device which is disposed over the extended portion the other hook member, and locking members may be secured over the extended portions of the respective hook members to lock the spinal fixation device thereto such that the first and second vertebra are rigidly connected.

26. An apparatus according to

claim 25

, further including a plurality of spacer sleeves each being configured for placement on the extended portion of a respective hook member so as to space the spinal fixation device from the pad portion of the hook member, wherein said plurality of spacer sleeves include sleeves having various lengths for forming various length spaces between the pad portion of a hook member and a spinal fixation device.