METHODS, SYSTEMS AND APPARATUSES FOR TORSIONAL STABILIZATION

• US 20090105761A1
• Filed: 10/16/2008
• Published: 04/23/2009
• Est. Priority Date: 10/17/2007
• Status: Active Grant

• Current Assignee: ARO Medical ApS u/stiftelse.
• Original Assignee: Robie Device Group LLC
• Inventors: Robie, Bruce
• Granted Patent: US 9,095,384 B2
• Time in Patent Office: Days
• US Class Current: 606/246
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0485 Devices or means, e.g. loops, for capturing the suture thread and threading it through an opening of a suturing instrument or needle eyelet
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/0642 for bones, e.g. for osteosynthesis or connecting tendon to bone
• CPC Class Codes: A61B 17/1604 Chisels; Rongeurs; Punches; Stamps
• CPC Class Codes: A61B 17/1606 of forceps type, i.e. having two jaw elements moving relative to each other
• CPC Class Codes: A61B 17/1664 for the hip
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1684 for the shoulder
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/3421 Cannulas
• 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 17/7067 Devices bearing against one or more spinous processes and also attached to another part of the spine; Tools therefor
• CPC Class Codes: A61B 17/8861 Apparatus for manipulating flexible wires or straps devices for inserting Kirschner wires A61B17/1697
• CPC Class Codes: A61B 17/8863 Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
• CPC Class Codes: A61B 2017/0404 Buttons
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/044 : with a threaded shaft, e.g. screws
• CPC Class Codes: A61B 2017/0458 : Longitudinal through hole, e.g. suture blocked by a distal suture knot
• CPC Class Codes: A61B 2017/0496 : for tensioning sutures
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 90/06 : Measuring instruments not otherwise provided for
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms

Abstract

Methods, systems and apparatuses are provided for torsionally stabilizing a spinal motion segment. One or more implants are placed between two vertebrae to provide torsional stabilization. In particular, one or more implants may be fixed between a superior vertebral body, such as at the spinous process, and an inferior vertebral body. The implants may be connected to the superior vertebral body using a fixation device such as a turnbuckle, an outrigger, a thimble, an endobutton, a suture plug or combinations thereof. The implant may also be connected to the inferior vertebral body using various types of hardware, including staples, screws and anchors. The implant may be kept in tension to provide torsional stabilization and may be comprised of one or more sutures. A multi-functional instrument having one or more arms having holes can be used to clamp onto the superior vertebral body and guide one or more implants to various locations for fixation in accordance with the methods described herein.

Claims

1. A system for providing torsional stabilization to a spine comprising:

at least one implant configured to extend between a superior vertebral body and an inferior vertebral body oriented in a plane generally aligned with the disc space to provide torsional stiffness to the spine;

a first fixation device configured to fix the at least one implant to the inferior vertebral body;

a second fixation device configured to fix the at least one implant to the spinous process of the superior vertebral body; and

a clamping mechanism configured to attach to the spinous process of the superior vertebral body comprising one or more arms, said one or more arms having one or more holes oriented to align with a location desirable for attaching the first and second fixation devices.

2. The system of claim 1, further comprising a measuring instrument for sizing one or more implants prior to insertion of the implants, wherein the measuring instrument comprises a frame and a measuring filament.

3. The system of claim 1, wherein the at least one implant is selected from the group consisting of polymeric fabrics, soft tissue grafts, wires, cables, sutures and combinations thereof.

4. The system of claim 1, wherein the first fixation device is selected from the group consisting of screws, staples, soft tissue anchors, suture anchors, and combinations thereof.

5. The system of claim 1, wherein the second fixation device is selected from the group consisting of a turnbuckle, an outrigger, a thimble, an endobutton and a suture plug.

6. The system of claim 1, wherein the first fixation device is configured to be placed at a lateral location relative to the second fixation device.

7. The system of claim 1, further comprising a third fixation device configured to fix the at least one implant to the inferior vertebral body, the first and third fixation devices configured to fix the at least one implant bilaterally to the inferior vertebral body.

8. A method for providing torsional stabilization to a spine, comprising:

clamping a surgical instrument to the spinous process of a superior vertebral body, wherein the surgical instrument comprises a clamping mechanism for attachment to the spinous process and one or more arms, each arm having one or more alignment holes oriented to align with a location desirable for attaching one or more fixation devices;

creating a hole in the spinous process of the superior vertebral body through a first alignment hole aligned with a desired location on the spinous process of the superior vertebral body;

inserting a stabilizing implant through a second alignment hole aligned to a desired location on an inferior vertebral body;

fixing a first portion of the stabilizing implant to the desired location of the inferior vertebral body;

capturing a portion of the stabilizing implant through the created hole in the spinous process and pulling the stabilizing implant towards the spinous process; and

attaching the stabilizing implant to the spinous process.

9. The method of claim 8, further comprising:

inserting a measuring instrument through the second alignment hole prior to inserting the stabilizing implant, wherein the measuring instrument comprises a frame and a measuring filament, the measuring filament having a series of markings to assist in measuring a stabilizing implant;

capturing the measuring filament through the created hole in the spinous process and pulling the measuring filament towards the spinous process to measure a distance between the spinous process of the superior vertebral body and the inferior vertebral body;

using the measuring filament to size a stabilizing implant.

10. The method of claim 8, wherein the stabilizing implant is a suture.

11. The method of claim 9, wherein the stabilizing implant is attached to the spinous process by securing a portion of the suture to an endobutton with the suture being placed under tension, and attaching the endobutton to the created hole in the spinous process.

12. A method for providing torsional stabilization to a spine, comprising:

extending an implant in tension between a first vertebral body and a second vertebral body, the implant being attached to a fixation device engaged to the spinous process of the second vertebral body and extending laterally outwardly to attach to a location on the first vertebral body.

13. The method of claim 12, wherein the implant is attached to a pedicle of the first vertebral body.

14. The method of claim 12, wherein the implant is attached to a mamillary process of the first vertebral body.

15. The method of claim 12, wherein the implant is attached to a location on the first vertebral body by a screw, staple, soft tissue anchor, suture anchor or adhesive.

16. The method of claim 12, wherein the implant comprises a polymeric surgical fabric, autograft soft tissue or allograft soft tissue.

17. The method of claim 12, wherein the implant comprises one or more sutures.

18. The method of claim 12, wherein the fixation device is engaged to the spinous process through a hole in the spinous process.

19. The method of claim 12, wherein the fixation device comprises a turnbuckle, an outrigger, a thimble, an endobutton or a suture plug.

20. The method of claim 12, comprising extending an implant in tension from the fixation device engaged to the spinous process of the second vertebral body to bilateral locations on the first vertebral body.

21. A method for providing torsional stabilization to a spine, comprising:

creating a hole through the spinous process of a superior vertebral body;

attaching a suture to a first location on an inferior vertebral body;

extending the suture from the inferior vertebral body to the spinous process of the superior vertebral body along a plane generally aligned with the disc space; and

securing the suture to the spinous process of the superior vertebral body via an endobutton secured to the hole in the spinous process, the suture being tensioned to provide torsional stabilization to the spine.

22. The method of claim 21, wherein the first location comprises a pedicle of the inferior vertebral body.

23. The method of claim 21, wherein the first location comprises a mamillary process of the inferior vertebral body.

24. A surgical instrument for delivering hardware to the spine, comprising:

a clamping mechanism configured to be inserted into a patient and attached to the spinous process of a first vertebral body; and

at least one arm extending laterally outwardly from the clamping mechanism and configured to be positioned outside of the patient, the at least one arm having at least one hole oriented to align with a location on either the spinous process of the first vertebral body or a lateral location on a second vertebral body, the at least one hole configured to guide an instrument to either the spinous process or to the lateral location on the second vertebral body.

25. An apparatus comprising a suture anchor loaded with one or more sutures, the suture anchor comprising:

a threaded shaft; and

a suture head connected to the threaded shaft comprising an eyelet hole and a rounded post, wherein said eyelet hole transitions smoothly into the rounded post, and wherein said one or more sutures loaded to the suture anchor make contact with the suture anchor only via the rounded post.