Methods and apparatus for performing spine surgery

• US 9,827,109 B2
• Filed: 10/30/2007
• Issued: 11/28/2017
• Est. Priority Date: 03/07/1999
• Status: Active Grant

• Current Assignee: Nuvasive Incorporated
• Original Assignee: Nuvasive Incorporated
• Inventors: Steinberg, Amiram
• Primary Examiner(s): Ngyuen, Anhtuan T
• Assistant Examiner(s): BOLER, RYNAE E
• Application Number:
  US11/928,940
• Publication Number:
  US 20080058837A1
• Time in Patent Office: 3,682 Days
• Field of Search: 600101, 600 12, 600104, 600117, 600118, 606 86 A, 606 86 B, 606 86 R, 606 99, 606106, 606108, 606110, 606304, 606279, 623 1611, 623 1711- 1716, 623 2212, 623923, 604 28, 60416411
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/1631 Special drive shafts, e.g. flexible shafts A61B17/1642, A61B17/164 take precedence
• CPC Class Codes: A61B 17/1671 for the spine
• CPC Class Codes: A61B 17/1757 for the spine
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2017/1602 Mills
• CPC Class Codes: A61B 2034/104 Modelling the effect of the tool, e.g. the effect of an implanted prosthesis or for predicting the effect of ablation or burring
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/742 Joysticks
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/30 Surgical robots
• CPC Class Codes: A61B 34/70 Manipulators specially adapted for use in surgery
• CPC Class Codes: A61B 6/506 for diagnosis of nerves
• CPC Class Codes: A61B 90/11 with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/14 Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
• CPC Class Codes: A61F 2/08 Muscles; Tendons; Ligaments sutures A61B17/04
• CPC Class Codes: A61F 2/28 Bones joints A61F2/30
• CPC Class Codes: A61F 2/30742 Bellows or hose-like seals; Sealing membranes A61B17/8808 takes precedence; sealing membranes for retaining bone substitute A61F2/2846
• CPC Class Codes: A61F 2/30749 : Fixation appliances for connecting prostheses to the body
• 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 2/32 : for the hip
• CPC Class Codes: A61F 2/36 : Femoral heads ; Femoral endoprostheses
• CPC Class Codes: A61F 2/3601 : for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices non-prosthetic internal fixation devices for the femoral head or neck A61B17/74
• CPC Class Codes: A61F 2/3662 : Femoral shafts
• CPC Class Codes: A61F 2/38 : for elbows or knees
• CPC Class Codes: A61F 2/44 : for the spine, e.g. vertebrae, spinal discs
• CPC Class Codes: A61F 2/441 : made of inflatable pockets or chambers filled with fluid, e.g. with hydrogel
• 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 2/4609 : of acetabular cups
• 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 2002/30009 : differing in fibre orientations
• CPC Class Codes: A61F 2002/30014 : differing in elasticity, stiffness or compressibility
• CPC Class Codes: A61F 2002/30062 : (bio)absorbable, biodegradable, bioerodable, (bio)resorbable, resorptive
• CPC Class Codes: A61F 2002/3007 : Coating or prosthesis-covering structure made of elastic material, e.g. of elastomer
• CPC Class Codes: A61F 2002/30133 : kidney-shaped or bean-shaped
• CPC Class Codes: A61F 2002/30136 : undulated or wavy, e.g. serpentine-shaped or zigzag-shaped
• CPC Class Codes: A61F 2002/30156 : triangular
• CPC Class Codes: A61F 2002/30197 : Omega-shaped
• CPC Class Codes: A61F 2002/30242 : spherical
• CPC Class Codes: A61F 2002/30289 : helically-coiled
• CPC Class Codes: A61F 2002/30354 : Cylindrically-shaped protrusion and recess, e.g. cylinder of circular basis
• CPC Class Codes: A61F 2002/30369 : Limited lateral translation of the protrusion within a larger recess
• CPC Class Codes: A61F 2002/3037 : Translation along the common longitudinal axis, e.g. piston
• CPC Class Codes: A61F 2002/30383 : made by laterally inserting a protrusion, e.g. a rib into a complementarily-shaped groove
• CPC Class Codes: A61F 2002/30398 : Sliding
• CPC Class Codes: A61F 2002/30426 : Bayonet coupling
• CPC Class Codes: A61F 2002/30448 : using adhesives
• CPC Class Codes: A61F 2002/305 : Snap connection
• CPC Class Codes: A61F 2002/30515 : using a locking wedge or block
• CPC Class Codes: A61F 2002/30563 : having elastic means or damping means, different from springs, e.g. including an elastomeric core or shock absorbers
• CPC Class Codes: A61F 2002/30574 : with an integral complete or partial collar or flange
• CPC Class Codes: A61F 2002/30579 : with mechanically expandable devices, e.g. fixation devices
• CPC Class Codes: A61F 2002/30581 : having a pocket filled with fluid, e.g. liquid
• CPC Class Codes: A61F 2002/30593 : hollow
• CPC Class Codes: A61F 2002/30594 : slotted, e.g. radial or meridian slot ending in a polar aperture, non-polar slots, horizontal or arcuate slots
• CPC Class Codes: A61F 2002/30599 : stackable
• CPC Class Codes: A61F 2002/30604 : modular
• CPC Class Codes: A61F 2002/30639 : having rolling elements between both articulating surfaces
• CPC Class Codes: A61F 2002/30642 : having a single rolling (or sliding) ball articulating between two cups
• CPC Class Codes: A61F 2002/30652 : Special cut-outs, e.g. flat or grooved cut-outs
• CPC Class Codes: A61F 2002/30662 : with rotation-limiting means
• CPC Class Codes: A61F 2002/30673 : Lubricating means, e.g. synovial pocket
• CPC Class Codes: A61F 2002/30733 : Inserts placed into an endoprosthetic cavity, e.g. for modifying a material property
• CPC Class Codes: A61F 2002/30777 : Oblong apertures
• CPC Class Codes: A61F 2002/30795 : Blind bores, e.g. of circular cross-section
• CPC Class Codes: A61F 2002/3082 : Grooves
• CPC Class Codes: A61F 2002/30878 : with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
• CPC Class Codes: A61F 2002/30879 : Ribs
• CPC Class Codes: A61F 2002/30884 : Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
• CPC Class Codes: A61F 2002/30919 : Sleeves
• CPC Class Codes: A61F 2002/30934 : Special articulating surfaces
• CPC Class Codes: A61F 2002/30971 : Laminates, i.e. layered products
• CPC Class Codes: A61F 2002/30973 : Two joined adjacent layers having complementary interlocking protrusions and recesses
• CPC Class Codes: A61F 2002/3208 : Bipolar or multipolar joints, e.g. having a femoral head articulating within an intermediate acetabular shell whilst said shell articulates within the natural acetabular socket or within an artificial outer shell
• CPC Class Codes: A61F 2002/3216 : tripolar
• CPC Class Codes: A61F 2002/3412 : with pins or protrusions, e.g. non-sharp pins or protrusions projecting from a shell surface
• CPC Class Codes: A61F 2002/3429 : with an integral peripheral collar or flange, e.g. oriented away from the shell centre line
• CPC Class Codes: A61F 2002/3611 : Heads or epiphyseal parts of femur
• CPC Class Codes: A61F 2002/3613 : with lateral or oblique apertures, holes or openings
• CPC Class Codes: A61F 2002/3631 : with an integral complete or partial peripheral collar or bearing shoulder at its base
• CPC Class Codes: A61F 2002/3652 : Connections of necks to shafts
• CPC Class Codes: A61F 2002/3694 : with longitudinal bores
• 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 2002/4619 : for extraction
• CPC Class Codes: A61F 2002/4632 : using computer-controlled surgery, e.g. robotic surgery
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2210/0004 : bioabsorbable
• CPC Class Codes: A61F 2220/0008 : Fixation appliances for connecting prostheses to the body
• CPC Class Codes: A61F 2220/0025 : Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
• CPC Class Codes: A61F 2220/0033 : made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
• CPC Class Codes: A61F 2220/005 : using adhesives
• CPC Class Codes: A61F 2230/0004 : Rounded shapes, e.g. with rounded corners
• CPC Class Codes: A61F 2230/0015 : Kidney-shaped, e.g. bean-shaped
• CPC Class Codes: A61F 2230/0023 : triangular
• CPC Class Codes: A61F 2230/0045 : Omega-shaped
• CPC Class Codes: A61F 2230/0071 : spherical
• CPC Class Codes: A61F 2230/0091 : helically-coiled or spirally-coiled, i.e. having a 2-D spiral cross-section
• CPC Class Codes: A61F 2250/0018 : differing in elasticity, stiffness or compressibility
• CPC Class Codes: A61F 2250/0028 : differing in fibre orientations
• CPC Class Codes: A61F 2250/0063 : Nested prosthetic parts
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel

Abstract

An implant for use in spinal surgery comprises a resilient element having an inflatable cavity. It is formed of a biologically compatible material and is arranged for placement between end plates of adjacent vertebra. The implant may also include a wound disc replacement element. A method of performing spinal surgery on a patient comprises securely mounting a patient onto a patient support table; imaging a spinal region of the patient; building up a three-dimensional image file of the spinal region of the patient; storing the image file; and utilizing the image file for planning and carrying out computer controlled spinal surgery on the patient utilizing the implant. A computer-controlled surgical implant system comprises a steerable endosurgical implanting assembly operative to install the implant at a desired location in a patient; and a computerized controlled, which operates the steerable endosurgical implanting assembly.

Claims

1. A method for providing surgical access to a spine, said method comprising:

advancing a first access instrument from a posterior-lateral entry site on a patient to a spinal target site on a lateral exterior surface of the anterior column of the spine, the advancement of the first access instrument following a curvilinear path from the entry site to the target site on the lateral exterior surface of the anterior column, wherein the curvilinear path comprises a continuous curve from the entry site to the target site;

advancing a second access instrument over the first access instrument along the curvilinear path from the posterior-lateral entry site to the target site;

advancing a third access instrument over the second access instrument along the curvilinear path from the posterior-lateral entry site to the target site.

2. The method of claim 1, comprising the additional step of removing the first access instrument and the second access instrument from the third access instrument to create a pathway through the third access instrument to the target site.

3. The method of claim 2, comprising the additional step of advancing one or more instruments along the pathway through the third access instrument to the target site and removing intervertebral disc material from the target site.

4. The method of claim 2, comprising the additional step of inserting an implant into an intervertebral space through the pathway in the third access instrument.

5. The method of claim 1, including the additional step of anchoring the third access instrument to the spine after the third access instrument is advanced along the curvilinear path from the posterior-lateral entry site to the target site.

6. The method of claim 5, wherein the third access instrument is anchored to the target site before the first access instrument and second access instrument are removed.

7. The method of claim 5, wherein the third access instrument is anchored to the spine via at least one elongate anchor advanced along a track in the third access instrument.

8. The method of claim 7, wherein the elongate anchor is a screw.

9. The method of claim 1, wherein the first access instrument is anchored to the target site prior to advancing the second access instrument over the first access instrument.

10. The method of claim 9, wherein the first access instrument is anchored to the target site with a screw.

11. The method of claim 1, wherein each of said first, second, and third, access instruments are cannulae.

12. The method of claim 1, comprising the additional step of monitoring tissue adjacent to the distal end of at least one of the first access instrument, second access instrument, and third access instrument during advancement of the at least one of the first access instrument, second access instrument, and third access instrument to the target site.

13. The method of claim 12, wherein said monitoring comprises performing real-time imaging of the tissue.

14. A method for performing spinal surgery on a patient, said method comprising:

creating an access corridor to a spinal target site in the patient by advancing at least one access instrument along a continuous curvilinear path to said the spinal target site, wherein said continuous curvilinear path originates from a location posterior-lateral to the spine and continues to a lateral exterior surface of the anterior column of the spine adjacent the spinal target site;

removing through said access corridor at least a portion of an intervertebral disc from the intervertebral space between a superior vertebra and an inferior vertebra of the spine; and

inserting an implant into the intervertebral space through said access corridor.

15. The method of claim 14, further comprising the step of removing at least one of a portion of the superior vertebra and a portion of the inferior vertebra prior to inserting said implant.

16. The method of claim 14, wherein the at least one access instrument is curvilinear in shape.

17. The method of claim 14, wherein the step of creating the access corridor includes the additional steps of:

advancing a second access instrument over a first access instrument along the curvilinear path to the lateral exterior surface of the anterior column of the spine adjacent the spinal target site; and

advancing a third access instrument over the second access instrument along the curvilinear path to the lateral exterior surface of the anterior column of the spine adjacent the spinal target site.

18. The method of claim 17, comprising the additional step of removing the first access instrument and the second access instrument from the third access instrument to create a pathway through the third access instrument to the target site.

19. The method of claim 17, including the additional step of anchoring the third access instrument to the spine after the third access instrument is advanced to the target site along the curvilinear path.

20. The method of claim 19, wherein the third access instrument is anchored to the target site before the first access instrument and second access instrument are removed.

21. The method of claim 19, wherein the third access instrument is anchored to the spine via at least one elongate anchor advanced along a track in the third access instrument.

22. The method of claim 21, wherein the elongate anchor is a screw.

23. The method of claim 17, wherein the first access instrument is anchored to the target site prior to advancing the second access instrument over the first access instrument.

24. The method of claim 23, wherein the first access instrument is anchored to the target site with a screw.

25. The method of claim 17, wherein each of said first, second, and third, access instruments are cannulae.

26. The method of claim 14, comprising the additional step of monitoring tissue adjacent to the distal end of the at least one access instrument during advancement of the at least one access instrument along the curvilinear path to said the spinal target site.

27. The method of claim 26, wherein said monitoring comprises performing real-time imaging of the tissue.