Systems and methods for posterior dynamic stabilization of the spine

• US 9,039,742 B2
• Filed: 04/09/2012
• Issued: 05/26/2015
• Est. Priority Date: 10/20/2004
• Status: Active Grant

• Current Assignee: Board of Trustees of the Leland Stanford Junior University (Stanford Management Co.)
• Original Assignee: Board of Trustees of the Leland Stanford Junior University (Stanford Management Co.)
• Inventors: Altarac, Moti, Tebbe, Shawn, Kim, Daniel H., Flaherty, J. Christopher
• Primary Examiner(s): Prone, Christopher D
• Application Number:
  US13/442,751
• Publication Number:
  US 20130012998A1
• Time in Patent Office: 1,142 Days
• Field of Search: 623/17.11, 623/17.15, 623/17.16, 606246-249
• US Class Current: 606/249
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1697 specially adapted for wire insertion
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/7062 Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs rib fixation devices A61B17/8076; Tools for such devices
• CPC Class Codes: A61B 17/7065 Devices with changeable shape, e.g. collapsible or having retractable arms to aid implantation; Tools therefor
• CPC Class Codes: A61B 17/848 Kirschner wires, i.e. thin, long nails
• CPC Class Codes: A61B 17/8866 for gripping or pushing bones, e.g. approximators joint distractors A61B17/025
• CPC Class Codes: A61B 17/8897 Guide wires or guide pins
• CPC Class Codes: A61B 2017/00004 (bio)absorbable, (bio)resorbable, resorptive for implantable prostheses A61F2210/0004
• CPC Class Codes: A61B 2017/0023 disposable
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/681 Alignment, compression, or distraction mechanisms
• CPC Class Codes: A61B 2090/033 Abutting means, stops, e.g. abutting on tissue or skin
• CPC Class Codes: A61B 2090/034 abutting on parts of the device itself
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61F 2/0077 : Special surfaces of prostheses, e.g. for improving ingrowth A61F2/30767 takes precedence

Abstract

Devices, systems and methods for dynamically stabilizing the spine are provided. The devices include an expandable spacer having an undeployed configuration and a deployed configuration, wherein the spacer has axial and radial dimensions for positioning between the spinous processes of adjacent vertebrae. The systems include one or more spacers and a mechanical actuation means for delivering and deploying the spacer. The methods involve the implantation of one or more spacers within the interspinous space.

Claims

1. A method for stabilizing at least one spinal motion segment comprising a first vertebra and a second vertebra, the method comprising:

moving an interspinous device between a first spinous process of the first vertebra and a second spinous process of the second vertebra, wherein the interspinous device includes

a main body,

a first receiver pivotally coupled to the main body and having a pair of first arms and a first bridging portion between the first arms, and

a second receiver pivotally coupled to the main body and having a pair of second arms and a second bridging portion between the second arms;

rotating the first receiver relative to the main body such that the first arms and the first bridging portion move together away from a longitudinal axis of the main body to position the first spinous process between the first arms and against the first bridging portion; and

rotating the second receiver relative to the main body such that the second arms and the second bridging portion move together away from the longitudinal axis of the main body to position the second spinous process between the second arms and against the second bridging portion.

2. The method of claim 1 wherein moving the interspinous device between the first spinous process and the second spinous process includes positioning the main body such that the longitudinal axis of the main body extends in a direction substantially parallel to an anterior-to-posterior direction relative to the at least one spinal motion segment.

3. The method of claim 1 wherein rotating the first receiver relative to the main body includes moving the first arms superiorly, and wherein rotating the second receiver relative to the main body includes moving the second arms inferiorly.

4. The method of claim 1 wherein rotating the first receiver relative to the main body includes rotating the first receiver about an axis of rotation that is substantially perpendicular to a sagittal plane.

5. The method of claim 1 wherein rotating the first receiver relative to the main body includes rotating the first receiver about 90 degrees relative to the main body.

6. The method of claim 1, further comprising contacting an end of the first spinous process facing the second spinous process by rotating the first receiver while the main body is spaced apart from both the first spinous process and the second spinous process.

7. A method for stabilizing at least one spinal motion segment comprising a first vertebra and a second vertebra, the method comprising:

moving an interspinous device between the first vertebra and the second vertebra, wherein the interspinous device includes a first receiver and a main body, wherein the main body has a proximal portion and a distal portion, and wherein the first receiver has a U-shaped portion in an undeployed position and is rotatably coupled to the distal portion; and

rotating the first receiver relative to the main body using a delivery instrument coupled to the main body such that the U-shaped portion moves from the undeployed position to a deployed position to contact a first spinous process and to position arms of the U-shaped portion on opposite sides of the first spinous process.

8. The method of claim 7, further comprising rotating a second receiver relative to the main body using the delivery instrument such that a second spinous process is contacted by a U-shaped portion of the second receiver and arms of the U-shaped portion of the second receiver are positioned on opposite sides of the second spinous process.

9. The method of claim 7 wherein moving the interspinous device between the first vertebra and the second vertebra includes delivering the interspinous device using a mid-line approach.

10. The method of claim 7 wherein moving an interspinous device between the first vertebra and the second vertebra includes delivering the interspinous device through a cannula.

11. The method of claim 7, further comprising positioning the delivery instrument along the at least one spinal motion segment such that a portion of the delivery instrument within the subject extends in a direction substantially parallel to an anterior-to-posterior orientation relative to the at least one spinal motion segment while the first receiver rotates relative to the main body.

12. The method of claim 7 wherein after rotating the first receiver and a second receiver of the interspinous device so as to space apart the first spinous process and a second spinous process of a subject, the method further comprising:

decoupling the delivery instrument and the interspinous device, and

removing the delivery instrument from the subject.

13. A method for stabilizing at least one spinal motion segment comprising a first vertebra and a second vertebra, the method comprising:

moving an interspinous device between the first vertebra and the second vertebra, wherein the interspinous device includes a first receiver and a main body, wherein the main body has a proximal portion and a distal portion, and wherein the first receiver is rotatably coupled to the distal portion;

rotating the first receiver relative to the main body using a delivery instrument coupled to the main body such that a first spinous process is contacted by a U-shaped portion of the first receiver and arms of the U-shaped portion of the first receiver are positioned on opposite sides of the first spinous process; and

rotating a second receiver relative to the main body using the delivery instrument such that a second spinous process is contacted by a U-shaped portion of the second receiver and arms of the U-shaped portion of the second receiver are positioned on opposite sides of the second spinous process,

wherein rotating the first receiver and the second receiver includes moving a delivery rod of the delivery instrument such that the first receiver and the second receiver each move from an anterior-to-posterior orientation to a superior-to-inferior orientation.

14. A method for stabilizing at least one spinal motion segment comprising a first vertebra and a second vertebra, the method comprising:

moving an interspinous device between the first vertebra and the second vertebra, wherein the interspinous device includes a first receiver and a main body, wherein the main body has a proximal portion and a distal portion, and wherein the first receiver is rotatably coupled to the distal portion; and

rotating the first receiver relative to the main body using a delivery instrument coupled to the main body such that a first spinous process is contacted by a U-shaped portion of the first receiver and arms of the U-shaped portion of the first receiver are positioned on opposite sides of the first spinous process,

wherein moving the interspinous device between the first vertebra and the second vertebra includes positioning the interspinous device such that a longitudinal axis of the interspinous device extends in a substantially anterior-to-posterior direction relative to the at least one spinal motion segment.

15. The method of claim 14, wherein moving the interspinous device between the first vertebra and the second vertebra includes delivering the interspinous device using a mid-line approach.

16. A method for stabilizing at least one spinal motion segment comprising a first vertebra and a second vertebra, the method comprising:

moving an interspinous device between the first vertebra and the second vertebra, wherein the interspinous device includes a first receiver and a main body, wherein the main body has a proximal portion and a distal portion, and wherein the first receiver is rotatably coupled to the distal portion; and

rotating the first receiver relative to the main body using a delivery instrument coupled to the main body such that a first spinous process is contacted by a U-shaped portion of the first receiver and arms of the U-shaped portion of the first receiver are positioned on opposite sides of the first spinous process,

wherein rotating the first receiver includes moving the arms from a substantially anterior-to-posterior orientation to a substantially superior-to-inferior orientation.

17. A method for stabilizing at least one spinal motion segment comprising a first vertebra and a second vertebra, the method comprising:

moving an interspinous device in a direction substantially parallel to a sagittal plane of the subject the spinal motion segment such that the interspinous device moves toward an interspinous space located between the first and second vertebrae;

moving the interspinous device between the first vertebra and the second vertebra, wherein the interspinous device includes a first receiver and a main body, wherein the main body has a proximal portion and a distal portion, and wherein the first receiver is rotatably coupled to the distal portion; and

rotating the first receiver relative to the main body using a delivery instrument coupled to the main body such that a first spinous process is contacted by a U-shaped portion of the first receiver and arms of the U-shaped portion of the first receiver are positioned on opposite sides of the first spinous process.

18. The method of claim 17, wherein moving the interspinous device between the first vertebra and the second vertebra includes delivering the interspinous device using a mid-line approach.

19. A method for stabilizing at least one spinal motion segment comprising a first vertebra and a second vertebra, the method comprising:

positioning a longitudinal axis of an interspinous device and a longitudinal axis of a delivery instrument in a substantially anterior-to-posterior direction relative to the at least one spinal segment to rotate a first receiver about an axis of rotation that is substantially perpendicular to a sagittal plane of a subject;

moving the interspinous device between the first vertebra and the second vertebra, wherein the interspinous device includes the first receiver and a main body, wherein the main body has a proximal portion and a distal portion, and wherein the first receiver is rotatably coupled to the distal portion; and

rotating the first receiver relative to the main body using a delivery instrument coupled to the main body such that a first spinous process is contacted by a U-shaped portion of the first receiver and arms of the U-shaped portion of the first receiver are positioned on opposite sides of the first spinous process.

20. A method for stabilizing at least one spinal motion segment comprising a first vertebra and a second vertebra, the method comprising:

moving an interspinous device between the first vertebra and the second vertebra, wherein the interspinous device includes a first receiver and a main body, wherein the main body has a proximal portion and a distal portion, and wherein the first receiver is rotatably coupled to the distal portion

rotating the first receiver relative to the main body using a delivery instrument coupled to the main body such that a first spinous process is contacted by a U-shaped portion of the first receiver and arms of the U-shaped portion of the first receiver are positioned on opposite sides of the first spinous process;

rotating a second receiver relative to the main body using the delivery instrument such that a second spinous process is contacted by a U-shaped portion of the second receiver and arms of the U-shaped portion of the second receiver are positioned on opposite sides of the second spinous process; and

decoupling the delivery instrument from the interspinous device such that a longitudinal axis of the main body extends in an anterior-to-posterior direction and the main body is positioned anterior to a supraspinous ligament of the spinal motion segment.

21. A method for stabilizing at least one spinal motion segment comprising a first vertebra and a second vertebra, the method comprising:

moving an interspinous device between a first spinous process of the first vertebra and a second spinous process of the second vertebra, wherein the interspinous device includes a main body, a first receiver having a pair of first arms, and a second receiver having a pair of second arms;

rotating the first receiver relative to the main body such that the first spinous process is positioned between the first arms; and

rotating the second receiver relative to the main body such that the second spinous process is positioned between the second arms,

wherein a delivery instrument is used to rotate the first and second receivers relative to the main body, the method further comprising;

decoupling the delivery instrument from the interspinous device, and

removing the delivery instrument from a subject such that a longitudinal axis of the main body of the interspinous device extends in a substantially anterior-to-posterior direction relative to the at least one spinal motion segment and the main body is positioned anterior to a supraspinous ligament while the first and second receivers hold and space apart the first and second spinous processes.

22. The method of claim 21, wherein rotating the first receiver relative to the main body includes moving the first arms superiorly, and wherein rotating the second receiver relative to the main body includes moving the second arms inferiorly.

23. The method of claim 21, wherein rotating the first receiver relative to the main body includes rotating the first receiver about an axis of rotation that is substantially perpendicular to a sagittal plane.