Method for the endoscopic correction of spinal disease

• US 7,207,991 B2
• Filed: 03/18/2002
• Issued: 04/24/2007
• Est. Priority Date: 02/27/1995
• Status: Expired due to Fees

• Current Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Original Assignee: Warsaw Orthopedic Incorporated (Medtronic Plc)
• Inventors: Michelson, Gary Karlin
• Primary Examiner(s): Brown; Michael A.
• Application Number:
  US10/100,701
• Publication Number:
  US 20020091390A1
• Time in Patent Office: 1,863 Days
• Field of Search: 606 60- 61, 606 72- 79, 623/16.11, 623/17.11, 623/17.16
• US Class Current: 606/86.00A
• CPC Class Codes: A61B 17/025 Joint distractors
• 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 17/1671 for the spine
• CPC Class Codes: A61B 17/17 Guides or aligning means for drills , mills, pins or wires
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/32 Surgical cutting instruments A61B18/042 takes precedence; suture cutters A61B17/0467; instruments for ligaturing or cutting A61B17/128; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133
• 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 17/7059 Cortical plates A61B17/7007, A61B17/7058 take precedence
• CPC Class Codes: A61B 17/809 with bone-penetrating elements, e.g. blades or prongs bone staples A61B17/0642; intramedullary nails with a plate at an end A61B17/7233
• CPC Class Codes: A61B 17/86 Pins or screws or threaded wires; nuts therefor A61B17/72 take precedence
• CPC Class Codes: A61B 17/8665 Nuts
• CPC Class Codes: A61B 17/8875 Screwdrivers, spanners or wrenches
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable, resorptive for implantable prostheses A61F2210/0004
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/0641 having at least three legs as part of one single body
• CPC Class Codes: A61B 2017/0647 having one single leg, e.g. tacks
• CPC Class Codes: A61B 2017/0648 threaded, e.g. tacks with a screw thread
• CPC Class Codes: A61B 2017/922 Devices for impaction, impact element
• CPC Class Codes: A61B 2090/036 : abutting on tissue or skin
• CPC Class Codes: A61F 2/30744 : End caps, e.g. for closing an endoprosthetic cavity
• CPC Class Codes: A61F 2/30767 : Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30965 : Reinforcing the prosthesis by embedding particles or fibres during moulding or dipping
• 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 2/446 : having a circular or elliptical cross-section substantially parallel to the axis of the spine, e.g. cylinders or frustocones
• CPC Class Codes: A61F 2/4603 : for insertion or extraction of endoprosthetic joints or of accessories thereof
• CPC Class Codes: A61F 2/4611 : of spinal prostheses
• 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 2002/30143 : hexagonal
• CPC Class Codes: A61F 2002/30224 : cylindrical
• CPC Class Codes: A61F 2002/30235 : tubular, e.g. sleeves
• CPC Class Codes: A61F 2002/30329 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2002/30405 : made by screwing complementary threads machined on the parts themselves
• CPC Class Codes: A61F 2002/30426 : Bayonet coupling
• CPC Class Codes: A61F 2002/30433 : using additional screws, bolts, dowels, rivets or washers e.g. connecting screws
• CPC Class Codes: A61F 2002/30593 : hollow
• 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 2002/30785 : parallel
• CPC Class Codes: A61F 2002/30787 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/30797 : internally-threaded
• CPC Class Codes: A61F 2002/30836 : knurled
• CPC Class Codes: A61F 2002/3085 : with a threaded, e.g. self-tapping, bone-engaging surface, e.g. external surface
• CPC Class Codes: A61F 2002/30904 : serrated profile, i.e. saw-toothed
• CPC Class Codes: A61F 2002/448 : comprising multiple adjacent spinal implants within the same intervertebral space or within the same vertebra, e.g. comprising two adjacent spinal implants
• CPC Class Codes: A61F 2002/449 : comprising multiple spinal implants located in different intervertebral spaces or in different vertebrae
• CPC Class Codes: A61F 2002/4619 : for extraction
• CPC Class Codes: A61F 2002/4627 : with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
• CPC Class Codes: A61F 2002/4629 : connected to the endoprosthesis or implant via a threaded connection
• CPC Class Codes: A61F 2002/4649 : Bone graft or bone dowel harvest sites
• CPC Class Codes: A61F 2002/4681 : by applying mechanical shocks, e.g. by hammering
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0041 : using additional screws, bolts, dowels or rivets, e.g. connecting screws
• CPC Class Codes: A61F 2230/0017 : Angular shapes
• CPC Class Codes: A61F 2230/0069 : cylindrical
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00059 : Chromium or Cr-based alloys
• CPC Class Codes: A61F 2310/00796 : Coating or prosthesis-covering structure made of a phosphorus-containing compound, e.g. hydroxy(l)apatite

Abstract

An improved method and instrumentation for performing spinal surgery, including discectomy, interbody fusion and rigid internal fixation of the spine, from the lateral aspect of the spine is disclosed. The surgical procedure can be performed through a very small incision. The instrumentation of the present invention, all of which is inserted from a lateral position into the spine in the preferred embodiment, comprises a guide pin, a distractor, an extended outer sleeve, an inner sleeve an adjustable drill and an implant driver. The distractor of the present invention is driven into the disc for spacing apart and realigning the adjacent vertebrae. It further functions as an alignment rod for inserting the extended outer sleeve which is a hollow tubular member capable of maintaining said spacing and alignment of two adjacent vertebrae and defines a protected space through which subsequent instruments which may include, but are not limited to, a drill and a diameter reducing inner sleeve may be passed, as well as a spinal implant. The remainder of the surgical procedure consisting of the removal of spinal material across the disc, fusion, and rigid internal stabilization via the implant may all be performed via the closed space within the extended outer sleeve.

Claims

1. A method for performing surgery on a spinal segment including a disc space and two vertebral bodies adjacent the disc space, the method comprising the steps of:

positioning one end of a hollow guard in contact with the adjacent vertebral bodies, said guard having at least one projection extending distally from a distal end of said guard, said distal end adapted to contact each of the vertebral bodies adjacent the disc space to be fused, said at least one projection adapted to penetrate the disc space so as to be located at least in part between the perimeters of the vertebral bodies where adjacent to the disc space, said at least one projection having opposed portions adapted to contact at least a portion of each of the adjacent vertebral bodies, respectively, from within the disc space;

removing, through said guard, bone from the adjacent vertebral bodies to form an opening across the surgically corrected height of the disc space and into a portion of each of the two adjacent vertebral bodies;

inserting, through said guard and into the opening, an implant having opposed surfaces each adapted to contact one each of the adjacent vertebral bodies, each of said opposed surfaces having at least one opening to permit for the growth of bone from adjacent vertebral body to adjacent vertebral body through said implant; and

utilizing an endoscope to visualize the position of at least a portion of at least one of said implant and said guard relative to the vertebral bodies.

2. The method of claim 1, wherein the utilizing step includes utilizing an endoscope that is a thorascope.

3. The method of claim 1, wherein the positioning step includes the step of engaging said one end of said guard to the two adjacent vertebral bodies.

4. The method of claim 1, wherein the positioning step includes the substep of positioning said guard having at least a second projection extending distally from the distal end of said guard, said at least second projection adapted to penetrate the disc space so as to be located at least in part between the perimeters of the vertebral bodies where adjacent the disc space, said at least second projection having opposed portions adapted to contact at least a portion of each of the adjacent vertebral bodies, respectively, from within the disc space.

5. The method of claim 1, wherein said projection is at least in part co-linear with an outer perimeter of said guard.

6. The method of claim 1, wherein said projection is a tooth.

7. The method of claim 1, wherein the positioning step includes the substep of positioning said guard that is a tubular sleeve.

8. The method of claim 1, further comprising the step of using a distractor to position the adjacent vertebral bodies relative to one another.

9. The method of claim 8, wherein the utilizing step includes visualizing the position of at least a portion of said distractor with said endoscope relative to the vertebral bodies.

10. The method of claim 1, wherein the removing step includes the use of a bone removal device to form the opening and the utilizing step includes visualizing the position of at least a portion of said bone removal device with said endoscope relative to the vertebral bodies.

11. The method of claim 1, wherein the removing step includes the substep of one of milling and drilling the opening.

12. The method of claim 1, further comprising the step of tapping the opening through said guard and the utilizing step includes visualizing the position of at least a portion of said tap with said endoscope relative to the vertebral bodies.

13. The method of claim 1, wherein the inserting step includes the substep of screwing said implant into the opening through said guard.

14. The method of claim 1, wherein the inserting step includes using an insertion instrument to insert said implant into the opening and the utilizing step includes visualizing the position of at least a portion of said insertion instrument with said endoscope relative to the vertebral bodies.

15. The method of claim 1, wherein the inserting step includes inserting said implant comprising a fusion-promoting substance.

16. The method of claim 1, wherein said implant includes at least in part one of bone, coral, and artificial material.

17. The method of claim 1, wherein said implant is in the shape of one of a cylinder, a partial cylinder, and a dowel.

18. The method of claim 1, further comprising the step of combining said implant with a fusion promoting substance.

19. The method of claim 18, wherein the fusion promoting substance includes at least one of bone, bone morphogenetic protein, hydroxyapatite, hydroxyapatite tricalcium phosphate, and coral.

20. The method of claim 19, wherein said implant is at least in part hollow, the step of combining including loading said implant with the fusion promoting substance.

21. The method of claim 19, wherein the step of combining includes coating said implant with the fusion promoting substance.

22. The method of claim 1, wherein the method is performed without distracting the adjacent vertebral bodies between the removing step and the inserting step.

23. The method of claim 1, wherein the method is performed without removing the guard between the positioning step and the inserting step.

24. The method of claim 1, wherein the inserting step includes the substep of providing said implant having upper and lower portions having at least one protrusion on said upper and lower portions for engaging the adjacent vertebral bodies.

25. The method of claim 24, wherein said protrusion is at least a portion of a thread.

43. The method of claim 1, further comprising the step of combining said implant with a fusion promoting substance.

44. The method of claim 43, wherein the fusion promoting substance includes at least one of bone, bone morphogenetic protein, hydroxyapatite, hydroxyapatite tricalcium phosphate, and coral.

45. The method of claim 43, wherein said implant is at least in part hollow, the step of combining including loading said implant with the fusion promoting substance.

46. The method of claim 43, wherein the step of combining includes coating said implant with the fusion promoting substance.

26. A method for performing surgery on a spinal segment including a disc space and two vertebral bodies adjacent the disc space, the method comprising the steps of:

positioning one end of a hollow guard in contact with the adjacent vertebral bodies said guard having at least one projection extending distally from a distal end of said guard, said distal end adapted to contact each of the vertebral bodies adjacent the disc space to be fused, said at least one projection adapted to penetrate the disc space so as to be located at least in part between the perimeters of the vertebral bodies where adjacent to the disc space, said at least one projection having opposed portions adapted to contact at least a portion of each of the adjacent vertebral bodies, respectively, from within the disc space;

removing, through said guard, bone from the adjacent vertebral bodies to form an opening across the disc space and into a portion of each of the two adjacent vertebral bodies;

inserting, through said guard and into the opening, an implant having rigid opposed surfaces each adapted to contact one each of the adjacent vertebral bodies; and

utilizing an endoscope to visualize the position of at least a portion of at least one of said implant and said guard relative to the vertebral bodies.

27. The method of claim 26, wherein the utilizing step includes utilizing an endoscope that is a thorascope.

28. The method of claim 26, wherein the positioning step includes the step of engaging said one end of said guard to the two adjacent vertebral bodies.

29. The method of claim 26, wherein the positioning step includes the substep of positioning said guard having at least a second projection extending distally from the distal end of said guard, said at least second projection adapted to penetrate the disc space so as to be located at least in part between the perimeters the vertebral bodies where adjacent the disc space, said at least second projection having opposed portions adapted to contact at least a portion of each of the adjacent vertebral bodies, respectively, from within the disc space.

30. The method of claim 26, wherein said projection is at least in part co-linear with an outer perimeter of said guard.

31. The method of claim 26, wherein said projection is a tooth.

32. The method of claim 26, wherein the positioning step includes the substep of positioning said guard that is a tubular sleeve.

33. The method of claim 26, further comprising the step of using a distractor to position the adjacent vertebral bodies relative to one another.

34. The method of claim 33, wherein the utilizing step includes visualizing the position of at least a portion of said distractor with said endoscope relative to the vertebral bodies.

35. The method of claim 26, wherein the removing step includes the use of a bone removal device to form the opening and the utilizing step includes visualizing the position of at least a portion of said bone removal device with said endoscope relative to the vertebral bodies.

36. The method of claim 26, wherein the removing step includes the substep of one of milling and drilling the opening.

37. The method of claim 26, further comprising the step of tapping the opening through said guard and the utilizing step includes visualizing the position of at least a portion of said tap with said endoscope relative to the vertebral bodies.

38. The method of claim 26, wherein the inserting step includes the substep of screwing said implant into the opening through said guard.

39. The method of claim 26, wherein the inserting step includes using an insertion instrument to insert said implant into the opening and the utilizing step includes visualizing the position of at least a portion of said insertion instrument with said endoscope relative to the vertebral bodies.

40. The method of claim 26, wherein the inserting step includes inserting said implant comprising a fusion-promoting substance.

41. The method of claim 26, wherein said implant includes at least in part one of bone, coral, and artificial material.

42. The method of claim 26, wherein said implant is in the shape of one of a cylinder, a partial cylinder, and a dowel.

47. The method of claim 26, wherein the method is performed without distracting the adjacent vertebral bodies between the removing step and the inserting step.

48. The method of claim 26, wherein the method is performed without removing the guard between the positioning step and the inserting step.

49. The method of claim 26, wherein the inserting step includes the substep of providing said implant having upper and lower portions having at least one protrusion on said upper and lower portions for engaging the adjacent vertebral bodies.