CA2660920A1 - Instruments and methods for stabilization of bony structures - Google Patents
Instruments and methods for stabilization of bony structures Download PDFInfo
- Publication number
- CA2660920A1 CA2660920A1 CA002660920A CA2660920A CA2660920A1 CA 2660920 A1 CA2660920 A1 CA 2660920A1 CA 002660920 A CA002660920 A CA 002660920A CA 2660920 A CA2660920 A CA 2660920A CA 2660920 A1 CA2660920 A1 CA 2660920A1
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- CA
- Canada
- Prior art keywords
- brace
- anchors
- connecting element
- instrument
- pair
- Prior art date
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
- A61B17/7083—Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements
- A61B17/7086—Rod reducers, i.e. devices providing a mechanical advantage to allow a user to force a rod into or onto an anchor head other than by means of a rod-to-bone anchor locking element; rod removers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1662—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans for particular parts of the body for the spine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
- A61B17/7035—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other
- A61B17/7038—Screws or hooks, wherein a rod-clamping part and a bone-anchoring part can pivot relative to each other to a different extent in different directions, e.g. within one plane only
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7074—Tools specially adapted for spinal fixation operations other than for bone removal or filler handling
- A61B17/7083—Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements
- A61B17/7089—Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements wherein insertion is along an arcuate path
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8872—Instruments for putting said fixation devices against or away from the bone
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/8897—Guide wires or guide pins
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
- A61B17/90—Guides therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B2017/681—Alignment, compression, or distraction mechanisms
Abstract
The present invention relates to a brace installation instrument placement (220) that is mounted to anchors (60) secured in an animal subject. The installation instrument includes anchor extensions (230) coupled to the anchors (60). The instrument (220) is movable with respect to the anchors (60) to position a brace in a position more proximate the anchors (60). The brace (290) can be indexed for insertion at a predetermined orientation with respect to the installation instrument (220). Methods and techniques for using the installation instrument (220) are also provided.
Claims (164)
1. A brace installation instrument, comprising:
first and second anchor extensions, each having at least one proximal end and at least one distal end for mounting with a corresponding anchor secured to a bony structure; and a pivoting brace inserter having a proximal end and a distal end, and including support arms mounted adjacent the proximal end of said anchor extensions and a pivot arm extending to a brace mounting portion at the distal end of said inserter, said pivoting brace inserter pivotable about a pivot axis relative to said anchors.
first and second anchor extensions, each having at least one proximal end and at least one distal end for mounting with a corresponding anchor secured to a bony structure; and a pivoting brace inserter having a proximal end and a distal end, and including support arms mounted adjacent the proximal end of said anchor extensions and a pivot arm extending to a brace mounting portion at the distal end of said inserter, said pivoting brace inserter pivotable about a pivot axis relative to said anchors.
2. The instrument of claim 1, wherein each of said anchor extensions are pivotably mounted with a corresponding one of the anchors and said brace inserter is pivotably secured to said support arms.
3. The instrument of claim 1, wherein each of the support arms is pivotably secured to a corresponding one of the anchor extensions.
4. The instrument of claim 3, wherein said anchor extensions are coupled together adjacent their proximal ends.
5. The instrument of claim 1 and wherein said inserter is located between said support arms.
6. The instrument of claim 1 and wherein:
said brace mounting portion is located at a predetermined radius from said pivot axis; and a brace mounted in said brace mounting portion extends in a curve at a substantially constant radius relative to said pivot axis from said brace mounting portion.
said brace mounting portion is located at a predetermined radius from said pivot axis; and a brace mounted in said brace mounting portion extends in a curve at a substantially constant radius relative to said pivot axis from said brace mounting portion.
7. The instrument of claim 1 and further comprising a brace coupler operable to selectively couple and release a brace from said inserter.
8. The instrument of claim 7, wherein said brace is a circular rod.
9. The instrument of claim 7, wherein said brace has two ends, one end being connectable to said brace coupler and the other end being adapted to puncture soft tissue of an animal body, said brace being curved in one plane and with one radius relative to said pivot axis.
10. The instrument of claim 9 and wherein said brace inserter includes a curved portion that lies in a circle centered on said pivot axis at said radius, and said brace is oriented to lie in said circle when connected with said brace coupler.
11. The instrument of claim 10 and wherein:
said brace has a maximum dimension measured in a direction parallel to said pivot axis; wid said curved portion tapers to a maximum dimension more than twice said maximum dimension of said brace when measured in a direction parallel to said pivot axis, to facilitate passage of said curved portion through soft tissue while moving behind said brace in said arc about said pivot axis during brace placement.
said brace has a maximum dimension measured in a direction parallel to said pivot axis; wid said curved portion tapers to a maximum dimension more than twice said maximum dimension of said brace when measured in a direction parallel to said pivot axis, to facilitate passage of said curved portion through soft tissue while moving behind said brace in said arc about said pivot axis during brace placement.
12. The instrument of claim 9, wherein the distal end of said brace is pointed to facilitate puncture of animal skin and soft tissue.
13. The instrument of claim 1, wherein each anchor includes a multi-axial screw and said anchor extensions are pivotably and rotatably mounted on said multi-axial screw.
14. A device for use in a surgical procedure on an animal subject, comprising:
a pair of anchors secured to the animal subject;
an installation instrument mounted on said pair of anchors, said installation instrument movable in a fixed geometrical relationship with respect to said pair of anchors; and a connecting element coupled to said installation instrument, wherein said installation instrument moves said connecting element into a position more proximate to said pair of anchors.
a pair of anchors secured to the animal subject;
an installation instrument mounted on said pair of anchors, said installation instrument movable in a fixed geometrical relationship with respect to said pair of anchors; and a connecting element coupled to said installation instrument, wherein said installation instrument moves said connecting element into a position more proximate to said pair of anchors.
15. The device of claim 14, wherein said connecting element is moved percutaneously to said position.
16. The device of claim 14, wherein said installation instrument is mounted excutaneously.
17. The device of claim 14, wherein said anchors are each engaged to bony structure in the animal subject.
18. The device of claim 17, wherein the bony structure is a vertebral body.
19. The device of claim 14, wherein said installation instrument includes a pair of anchor extensions each mounted on a corresponding one of said pair of anchors.
20. The device of claim 19, wherein said installation instrument includes a pair of support arms each coupled to a corresponding one of said anchor extensions.
21. The device of claim 20, wherein said support arms are pivotably coupled to said anchor extensions.
22. The device of claim 21, wherein said device includes a clamping bar extending between said support arms releasably clamping said anchor extensions between said support arms.
23. The device of claim 20, wherein said installation instrument includes a pivoting inserter pivotably coupled to said support arms.
24. The device of claim 14, wherein said anchors each include a passage and said connecting element is moved into said passages.
25. The device of claim 24, wherein said anchors each include a set screw for securing said connecting element in said passage to said anchor.
26. The device of claim 25, wherein each of said set screws is releasably secured to said installation instrument.
27. The device of claim 14, wherein said anchors are multi-axial bone screws.
28. The device of claim 14, wherein said installation instruments moves said connecting element along an arc.
29. The device of claim 28, wherein said arc has a center of curvature defined by a pivot axis of said installation instrument.
30. A device for use in a surgical procedure on an animal subject, comprising:
a pair of anchors secured to the animal subject;
an installation instrument mounted on said pair of anchors, said installation instrument having a pivot axis in a fixed spatial relationship with respect to said pair of anchors; and a connecting element coupled to said installation instrument, wherein said installation instrument is rotated about said pivot axis to guide said connecting element into a desired position relative to said pair of anchors.
a pair of anchors secured to the animal subject;
an installation instrument mounted on said pair of anchors, said installation instrument having a pivot axis in a fixed spatial relationship with respect to said pair of anchors; and a connecting element coupled to said installation instrument, wherein said installation instrument is rotated about said pivot axis to guide said connecting element into a desired position relative to said pair of anchors.
31. The device of claim 30, wherein said connecting element extends from said installation instrument in a curve at a substantially constant radius relative to said pivot axis.
32. The device of claim 30, wherein said installation instrument further comprises a coupler operable to selectively couple and release said connecting element from said installation instrument.
33. The device of claim 32, wherein said connecting element is indexed.
34. The device of claim 30, wherein said installation instrument includes a pair of anchor extensions each mounted on a corresponding one of said pair of anchors.
35. The device of claim 34, wherein said installation instrument includes a pair of support arms each coupled to a corresponding one of said anchor extensions.
36. The device of claim 35, wherein said support arms are pivotably coupled to said anchor extensions.
37. The device of claim 35, wherein said installation instrument includes a pivoting inserter pivotably coupled to said support arms.
38. The device of claim 30, wherein said anchors each include a passageway and said connecting element extends through said passageways when in said desired position.
39. The device of claim 38, wherein each of said anchors include a bone screw pivotably mounted in a connector, said passageway being formed through said connector.
40. A device for use in a surgical procedure on an animal subject, comprising:
an installation instrument coupled to a brace, said brace having an indexed portion coupling said brace in a predetermined orientation with respect to said installation instrument.
an installation instrument coupled to a brace, said brace having an indexed portion coupling said brace in a predetermined orientation with respect to said installation instrument.
41. The device of claim 40, wherein said brace that is connectable to at least one anchor secured to the animal subject.
42. The device of claim 40, wherein said brace is immovable with respect to said installation instrument when coupled to said installation instrument.
43. The device of claim 40, wherein said installation instrument includes a brace inserter having a distal end, said brace indexed portion being coupled at said distal end of said brace inserter.
44. The device of claim 43, wherein said installation instrument includes a curved portion extending proximally from said distal end to a proximal end and having a channel formed along said curved portion for receiving a brace coupler, said brace coupler having a proximal end opposite said brace secured to said brace inserter, said brace coupler having a brace gripper at a distal end pivotably mounted in said channel by a pin secured to said curved portion of said brace inserter, said brace coupler operable to selectively couple and release said brace from said brace inserter.
45. The device of claim 44, wherein said brace coupler includes an elongated flexible member extending from said brace gripper proximally through a nut at said proximal end of said curved portion to a set screw.
46. The device of claim 45, wherein said curved portion has a brace receiving opening at said distal end receiving said brace therein.
47. The device of claim 46, wherein said curved portion includes a stop pin extending through said brace receiving opening.
48. The device of claim 47, wherein said brace includes a connecting end having a recess formed therein, said recess having a proximal end wall and a distal end wall, said stop pin contacting said distal end wall limiting the insertion depth of said brace into said brace receiving opening.
49. The device of claim 48, wherein said brace gripper has a tooth positionable in said recess and contacting said proximal end wall of said recess to couple said brace to said pivot arm.
50. The device of claim 40, wherein said indexed portion is at a first end of said brace, said brace including an opposite second end adapted for percutaneous insertion.
51. The device of claim 40, wherein said installation instrument is movable along a predetermined path and said brace is indexed for orientation along said path.
52. The device of claim 51, wherein said path is an arc having a radius determined by a pivot axis of said installation instrument.
53. A brace installation instrument, comprising:
first and second anchor extensions, each having at least one proximal end and at least one distal end for mounting with an anchor securable to a bony structure;
a brace inserter having a proximal end and a distal end, said brace inserter mounted to said first and second anchor extensions at said proximal end of said anchor extensions, said brace inserter movable about a pivot axis; and a brace releasably coupled to said distal end of said brace inserter.
first and second anchor extensions, each having at least one proximal end and at least one distal end for mounting with an anchor securable to a bony structure;
a brace inserter having a proximal end and a distal end, said brace inserter mounted to said first and second anchor extensions at said proximal end of said anchor extensions, said brace inserter movable about a pivot axis; and a brace releasably coupled to said distal end of said brace inserter.
54. The instrument of claim 53, wherein said brace inserter includes an arm having a brace mounting portion at said distal end receiving said brace.
55. The instrument of claim 53, wherein said brace inserter includes a pair of support arms mounted on a corresponding one of said anchor extensions.
56. The instrument of claim 55, wherein said support arms are pivotably mounted to said anchor extensions.
57. The instrument of claim 55, wherein said brace inserter includes a pivot arm pivotably mounted on said support arms.
58. A device for use in a surgical procedure on an animal subject, comprising:
at least one anchor secured to the animal subject, said anchor including a set screw having a break-off portion; and an instrument mounted on said anchor movable to position a brace relative to said anchor, said instrument being released from said anchor when said break-off portion is severed from said set screw.
at least one anchor secured to the animal subject, said anchor including a set screw having a break-off portion; and an instrument mounted on said anchor movable to position a brace relative to said anchor, said instrument being released from said anchor when said break-off portion is severed from said set screw.
59. The device of claim 58, wherein said instrument includes a tool bore providing access to said set screw break-off portion.
60. The device of claim 58, wherein said at least one anchor includes a bone screw engaged to the animal subject pivotably mounted in a connector, said set screw being threadingly received in said connector.
61. The device of claim 60, wherein said anchor includes a passageway through said connector between said bone screw and said set screw, said instrument movable to position said brace in said passageway.
62. The device of claim 61, wherein said set screw is threaded into said connector passageway to secure said brace to said anchor before said break-off portion is severed.
63. The device of claim 61, wherein said instrument is rotated about a pivot axis to position said brace in said passageway.
64. The device of claim 58, further comprising:
a second anchor secured to the animal subject, said second anchor including a second set screw having a break-off portion; and said instrument also mounted on said second anchor and moveable to position said brace relative to said anchor and said second anchor, said instrument being released from said second anchor when said break-off portion is severed from said second set screw.
a second anchor secured to the animal subject, said second anchor including a second set screw having a break-off portion; and said instrument also mounted on said second anchor and moveable to position said brace relative to said anchor and said second anchor, said instrument being released from said second anchor when said break-off portion is severed from said second set screw.
65. The device of claim 64, wherein said anchor and said second anchor each include a bone screw engaged to the animal subject pivotably mounted in a connector, said set screw of said anchor being threadingly received in said connector.
66. The device of claim 65, wherein said anchor and said second anchor each include a passageway through said connector between said bone screw and said set screw, said instrument movable to position said brace in said passageways of said connectors.
67. The device of claim 66, wherein said instrument is rotated about a pivot axis to position said brace in said passageways of said anchor and said second anchor.
68. The device of claim 67, wherein said set screws are threaded into said passageways of said connectors to secure said brace to said anchors before said break-off portions are severed.
69. A method of installation of an orthopedic brace in an animal subject, comprising:
placing first and second anchors mounted on first and second anchor extensions, respectively, in first and second bony parts of the body;
mounting a brace inserter of an installation instrument on the first and second anchor extensions, the installation instrument having a pivot axis relative to the anchors;
swinging the brace inserter relative to the anchors about the pivot axis and thereby moving the brace through an arc centered on the pivot axis of the instrument;
and introducing an end of the brace to the location of the anchors.
placing first and second anchors mounted on first and second anchor extensions, respectively, in first and second bony parts of the body;
mounting a brace inserter of an installation instrument on the first and second anchor extensions, the installation instrument having a pivot axis relative to the anchors;
swinging the brace inserter relative to the anchors about the pivot axis and thereby moving the brace through an arc centered on the pivot axis of the instrument;
and introducing an end of the brace to the location of the anchors.
70. The method of claim 69, wherein placing first and second anchors includes placing the first and second anchors percutaneously.
71. The method of claim 70, wherein introducing the end of the brace includes introducing the end of the brace percutaneously.
72. The method of claim 69, further comprising:
securing the brace to the anchors;
disconnecting the inserter from the brace; and moving the inserter in a reverse direction through the arc and thereby removing the inserter from the body.
securing the brace to the anchors;
disconnecting the inserter from the brace; and moving the inserter in a reverse direction through the arc and thereby removing the inserter from the body.
73. The method of claim 72, further comprising removing the installation instrument from the body.
74. The method of claim 69, wherein the brace is a shaft curved at a single radius about an axis co-linear with the pivot axis of the arc, and the method further comprises:
introducing the shaft through receivers in the anchors after introducing the brace.
introducing the shaft through receivers in the anchors after introducing the brace.
75. The method of claim 69, wherein:
placing the anchors includes using image guided navigation to locate optimum placement and orientation of the anchors in pedicles of vertebral bodies of a single level of the spine of the animal and to locate animal skin locations for percutaneous puncture entry of the anchors.
placing the anchors includes using image guided navigation to locate optimum placement and orientation of the anchors in pedicles of vertebral bodies of a single level of the spine of the animal and to locate animal skin locations for percutaneous puncture entry of the anchors.
76. The method of claim 75, wherein:
the anchors are bone engaging fasteners; and placing the anchors includes introducing the bone engaging fasteners and support arms as pre-assembled units percutaneously through punctures at two of the animal skin locations.
the anchors are bone engaging fasteners; and placing the anchors includes introducing the bone engaging fasteners and support arms as pre-assembled units percutaneously through punctures at two of the animal skin locations.
77. The method of claim 69 for spinal fusion and wherein the bony parts are vertebral bodies of the animal spine, the method further comprising:
removing the intervertebral disc from the space between first and second vertebral bodies through a first percutaneous puncture in the subject;
introducing one or more interbody fusion devices into the space;
engaging first and second anchors to the first and second vertebral bodies, respectively, through second and third percutaneous punctures in the subject;
and installing the brace through a fourth percutaneous puncture in the subject and connecting the brace to the anchors by application of a fastening tool to the anchors through a bore in each of the first and second anchor extensions.
removing the intervertebral disc from the space between first and second vertebral bodies through a first percutaneous puncture in the subject;
introducing one or more interbody fusion devices into the space;
engaging first and second anchors to the first and second vertebral bodies, respectively, through second and third percutaneous punctures in the subject;
and installing the brace through a fourth percutaneous puncture in the subject and connecting the brace to the anchors by application of a fastening tool to the anchors through a bore in each of the first and second anchor extensions.
78. The method of claim 77, wherein introducing one or more interbody fusion devices includes introducing one or more interbody fusion devices via an anterior approach to the disc space.
79. The method of claim 78, wherein the brace installation step includes:
swinging the brace through an arc in a plane containing the brace and perpendicular to the axis of curvature of the brace; and passing portions of said brace into passageways in the anchors.
swinging the brace through an arc in a plane containing the brace and perpendicular to the axis of curvature of the brace; and passing portions of said brace into passageways in the anchors.
80. The method of claim 76, further comprising:
establishing a pivot axis at a fixed distance from the passageways equal to the radius of curvature of the brace.
establishing a pivot axis at a fixed distance from the passageways equal to the radius of curvature of the brace.
81. The method of claim 80, wherein establishing a pivot axis comprises:
mounting support arms on the anchor extensions to connect the brace inserter to the anchor extensions.
mounting support arms on the anchor extensions to connect the brace inserter to the anchor extensions.
82. The method of claim 81, further comprising:
coupling the brace to the brace inserter; and disconnecting the brace inserter from the brace.
coupling the brace to the brace inserter; and disconnecting the brace inserter from the brace.
83. A method of installation of a connecting element in an animal subject, comprising:
placing first and second anchors in first and second bony parts of the body;
mounting an installation instrument on the first and second anchors, the installation instrument having the connecting element secured thereto; and moving the installation instrument to position the connecting element more proximate the first and second anchors.
placing first and second anchors in first and second bony parts of the body;
mounting an installation instrument on the first and second anchors, the installation instrument having the connecting element secured thereto; and moving the installation instrument to position the connecting element more proximate the first and second anchors.
84. The method of claim 83, wherein the connecting element is releasably secured to the installation instrument.
85. The method of claim 83, further comprising:
securing the connecting element to the first and second anchors after moving the installation instrument.
securing the connecting element to the first and second anchors after moving the installation instrument.
86. A method of installation of a brace in an animal subject, comprising:
placing first and second anchors mounted on first and second anchor extensions, respectively, in first and second bony parts of the body;
mounting a brace inserter on the first and second anchor extensions; and guiding the brace into a desired position relative to the anchors with the brace inserter.
placing first and second anchors mounted on first and second anchor extensions, respectively, in first and second bony parts of the body;
mounting a brace inserter on the first and second anchor extensions; and guiding the brace into a desired position relative to the anchors with the brace inserter.
87. The method of claim 86, wherein the brace is curved, the brace inserter has a pivot axis, and guiding the brace includes swinging the brace through an arc in a plane containing the brace and perpendicular to the axis of curvature of the brace.
88. The method of claim 87, wherein guiding the brace includes passing portions of the brace into passageways in the anchors.
89. The method of claim 88, wherein the pivot axis of the brace inserter is at a fixed distance from the passageways equal to the radius of curvature of the brace.
90. The method of claim 86, further comprising:
using image guided navigation to orient the anchors with respect to the bony parts; and placing first and second anchors and anchor extensions includes placing the anchors and anchor extensions percutaneously.
using image guided navigation to orient the anchors with respect to the bony parts; and placing first and second anchors and anchor extensions includes placing the anchors and anchor extensions percutaneously.
91. The method of claim 86, wherein the bony parts are first and second vertebrae of a vertebral level.
92. The method of claim 91, further comprising:
using image guided navigation to orient and place a guidewire in each of the vertebrae;
guiding the anchors and anchor extensions over a corresponding one of the guidewires; and removing the guidewires after placing the anchors in the first and second vertebrae.
using image guided navigation to orient and place a guidewire in each of the vertebrae;
guiding the anchors and anchor extensions over a corresponding one of the guidewires; and removing the guidewires after placing the anchors in the first and second vertebrae.
93. A method for stabilizing at least one vertebral level of an animal subject, comprising:
inserting at least one interbody fusion device in the disc space between the vertebrae;
engaging first and second anchors to corresponding ones of the vertebrae through first and second percutaneous punctures in the subject;
mounting an installation instrument on the first and second anchors; and positioning a brace proximate the first and second anchors through a third percutaneous puncture in the subject using the installation instrument.
inserting at least one interbody fusion device in the disc space between the vertebrae;
engaging first and second anchors to corresponding ones of the vertebrae through first and second percutaneous punctures in the subject;
mounting an installation instrument on the first and second anchors; and positioning a brace proximate the first and second anchors through a third percutaneous puncture in the subject using the installation instrument.
94. The method of claim 93, wherein engaging first and second anchors includes engaging the anchors through first and second percutaneous punctures.
95. The method of claim 94, wherein positioning the brace includes positioning the brace through a third percutaneous puncture.
96. The method of claim 95, wherein the at least one interbody fusion device is inserted through a fourth percutaneous puncture in the subject.
97. The method of claim 96, further comprising removing intervertebral disc material from the disc space between first and second vertebral bodies through the fourth percutaneous puncture in the subject.
98. The method of claim 93, further comprising:
securing the brace to the anchors by application of fastening tool to the anchors through tool bores of the installation instrument.
securing the brace to the anchors by application of fastening tool to the anchors through tool bores of the installation instrument.
99. A minimally invasive surgical device, comprising:
at least a pair of anchors positioned within a body of a patient; and a connecting element positionable within the body; and an instrument associated with the connecting element, the instrument being operable to percutaneously place the connecting element in a predetermined location relative to the pair of anchors.
at least a pair of anchors positioned within a body of a patient; and a connecting element positionable within the body; and an instrument associated with the connecting element, the instrument being operable to percutaneously place the connecting element in a predetermined location relative to the pair of anchors.
100. The minimally invasive surgical device of claim 99, wherein the predetermined subcutaneous position aligns the pair of anchors with the connecting element.
101. The minimally invasive surgical device of claim 99, wherein the instrument comprises a mechanical guide for directing the connecting element along the predetermined path.
102. The minimally invasive surgical device of claim 101, wherein the mechanical guide is positioned substantially external of the body.
103. The minimally invasive surgical device of claim 99, wherein the instrument is fixedly positioned relative to the anchors and the connecting element is moved relative to the instrument to place the connecting element in the predetermined location.
104. The minimally invasive surgical device of claim 99, wherein the predetermined path is curvilinear.
105. The minimally invasive surgical device of claim 99, wherein the predetermined path has a compound geometry.
106. The minimally invasive surgical device of claim 99, wherein the pair of anchors have a predetermined respective orientation within the body, and wherein the connecting element has a desired geometry corresponding to the predetermined respective orientation of the pair of anchors.
107. The minimally invasive surgical device of claim 106, wherein the connecting element has a compound geometry.
108. The minimally invasive surgical device of claim 99, wherein the connecting element comprises a flexible material.
109. The minimally invasive surgical device of claim 99, wherein the connecting element is selected from the group consisting of a rod, a cable, a band, and an artificial ligament.
110. The minimally invasive surgical device of claim 99, wherein the connecting element is flexible in a first state and rigid in a second state.
111. The minimally invasive surgical device of claim 99, wherein the connecting element comprises a material having elastic or super-elastic characteristics.
112. The minimally invasive surgical device of clam 99, wherein a first anchor of the pair of anchors is affixed to a first bone within the body, wherein a second anchor of the pair of anchors is affixed to a second bone within the body, and wherein the first anchor and the second anchor each have a desired anchor position with respect to each other, and wherein the predetermined location of the connecting element maintains the first anchor and second anchor in the desired anchor position:
113. The minimally invasive surgical device of claim 99, wherein the pair of anchors each have a receiver portion connectable with the connecting element, wherein the receiver portions of the pair of anchors have a predetermined respective orientation within the body, and wherein the connecting element has a desired geometry corresponding to the predetermined respective orientation of the receiver portions.
114. The minimally invasive surgical device of claim 99, wherein the instrument is releasably coupled to the connecting element.
115. The minimally invasive surgical device of claim 99, wherein the instrument is positioned substantially external with respect to the body.
116. The minimally invasive surgical device of claim 99, wherein the instrument is positioned substantially internal with respect to the body.
117. The minimally invasive surgical device of claim 99, wherein the instrument is fixedly connected to the anchors.
118. The minimally invasive surgical device of claim 99, wherein the instrument, or the connecting element, and the anchors include position sensing units associated with an image guided system.
119. The minimally invasive surgical device of claim 99, further comprising an image guided system, and position sensing units associated with the connecting element and the anchors, and wherein the position of the connecting element relative to the anchors is dynamically tracked using a system that identifies the location of the position sensing units.
120. The minimally invasive surgical device of claim 99, wherein the instrument comprises a detachment mechanism for releasing the connecting element from the instrument.
121. The minimally invasive surgical device of claim 120, wherein the detachment mechanism is remotely operable.
122. The minimally invasive surgical device of claim 120, wherein the detachment mechanism is externally operable with respect to the body.
123. The minimally invasive surgical device of claim 99, wherein the instrument comprises a coupling mechanism for attaching the connecting element to the instrument in a predetermined orientation.
124. The minimally invasive surgical device of claim 123, wherein the predetermined orientation is fixed.
125. The minimally invasive surgical device of claim 99, wherein the instrument is releasably coupled to the connecting element, and wherein the instrument is further operable to guide the connecting element along a predetermined path to the predetermined location.
126. The minimally invasive surgical device of claim 99, further comprising:
at least a pair of receiver members movably connected to a corresponding one of the pair of anchors, each of the pair of receiver members comprising a body having a passageway therethrough; and an alignment mechanism percutaneously extending within the body and connectable with the pair of receiver members, the alignment mechanism operable for controlling a position of the passageway of each respective receiver member.
at least a pair of receiver members movably connected to a corresponding one of the pair of anchors, each of the pair of receiver members comprising a body having a passageway therethrough; and an alignment mechanism percutaneously extending within the body and connectable with the pair of receiver members, the alignment mechanism operable for controlling a position of the passageway of each respective receiver member.
127. The minimally invasive surgical device of claim 126, wherein the connecting element comprises a predetermined geometry, and wherein an aligned position of the pair passageways matches the predetermined geometry.
128. A minimally invasive surgical system, comprising:
at least a pair of anchors positioned within a body of a patient;
a connecting element having a geometry configured for connection with the pair of anchors, the connecting element having a first position corresponding to a percutancous insertion position of the connecting element with respect to the body, and a second position within the body, the second position having a predetermined relationship with respect to the position of the pair of anchors; and an inserter referenced to the pair of anchors, the inserter being operable to move the connecting element along a predetermined path between the first position and the second position.
at least a pair of anchors positioned within a body of a patient;
a connecting element having a geometry configured for connection with the pair of anchors, the connecting element having a first position corresponding to a percutancous insertion position of the connecting element with respect to the body, and a second position within the body, the second position having a predetermined relationship with respect to the position of the pair of anchors; and an inserter referenced to the pair of anchors, the inserter being operable to move the connecting element along a predetermined path between the first position and the second position.
129. The minimally invasive surgical system of claim 128, wherein the inserter is mechanically referenced to the pair of anchors.
130. The minimally invasive surgical system of claim 128, wherein the inserter is dynamically referenced to the pair of anchors.
131. The minimally invasive surgical system of claim 128, further comprising an image guided navigation system associated with the inserter and the anchors, the image guided navigation system operable for dynamically referencing the inserter with the pair of anchors.
132. A minimally invasive surgical system, comprising:
a connecting element having a predetermined geometry comprising at least a first connector point and a second connector point; and an instrument having a coupling mechanism for holding the connecting element in a predetermined relationship with the instrument, and wherein the instrument is operable to guide the connecting element along a predetermined path, the predetermined path comprising at least a first path point, a second path point and a third path point, the first path point and the second path point respectively positioned in a predetermined orientation within a body of a patient, the third path point positioned external to the body, wherein the predetermined path comprises a percutaneous insertion path.
a connecting element having a predetermined geometry comprising at least a first connector point and a second connector point; and an instrument having a coupling mechanism for holding the connecting element in a predetermined relationship with the instrument, and wherein the instrument is operable to guide the connecting element along a predetermined path, the predetermined path comprising at least a first path point, a second path point and a third path point, the first path point and the second path point respectively positioned in a predetermined orientation within a body of a patient, the third path point positioned external to the body, wherein the predetermined path comprises a percutaneous insertion path.
133. The minimally invasive surgical system of claim 132, further comprising at least a first anchor and a second anchor, the first anchor at a first position corresponding to the first path point and affixed to a first structure within the body, the second anchor at a second position corresponding to the second path point and affixed to a second structure within the body.
134. The minimally invasive surgical system of claim 133, further comprising a securing element affixing the connecting element to the first and second anchors to maintain the first and second structures relative to the predetermined orientation.
135. A minimally invasive surgical system, comprising:
a connecting element having a predetermined geometry, the connecting element having a first position corresponding to a percutaneous insertion position of the connecting element with respect to a patient's body, and a second position within the body, the second position having a predetermined relationship relative to at least a pair of reference points positioned within the body; and an inserter having a known relationship with respect to the pair of reference points, the inserter being releasably coupled to the connecting element and operable to guide the connecting element along a predetermined path between the first percutaneous position and the second subcutaneous position.
a connecting element having a predetermined geometry, the connecting element having a first position corresponding to a percutaneous insertion position of the connecting element with respect to a patient's body, and a second position within the body, the second position having a predetermined relationship relative to at least a pair of reference points positioned within the body; and an inserter having a known relationship with respect to the pair of reference points, the inserter being releasably coupled to the connecting element and operable to guide the connecting element along a predetermined path between the first percutaneous position and the second subcutaneous position.
136. The minimally invasive surgical system of claim 135, wherein the connecting element includes a longitudinal axis, and wherein the inserter is releasably coupled to the connecting element along the longitudinal axis when the connecting element is in the first position.
137. A minimally invasive surgical method, comprising:
positioning at least a pair of anchors within a body of a patient;
contacting a connecting element with an insertion instrument;
referencing a position of the connecting element relative to a position of the pair of anchors; and percutaneously inserting the connecting element into a desired subcutaneous position relative to the pair of anchors.
positioning at least a pair of anchors within a body of a patient;
contacting a connecting element with an insertion instrument;
referencing a position of the connecting element relative to a position of the pair of anchors; and percutaneously inserting the connecting element into a desired subcutaneous position relative to the pair of anchors.
138. The minimally invasive surgical method of claim 137, further comprising affixing the connecting element to the pair of anchors.
139. The minimally invasive surgical method of claim 137, where contacting the connecting element with the insertion instrument further comprises releasably attaching the connecting element to the insertion instrument.
140. The minimally invasive surgical method of claim 137, where contacting the connecting element to the insertion instrument further comprises attaching the connecting element in a predetermined fixed orientation with respect to the insertion instrument.
141. The minimally invasive surgical method of claim 137, where contacting the connecting element to the insertion instrument further comprises attaching the insertion instrument to the connecting element along a longitudinal axis of the connecting element.
142. The minimally invasive surgical method of claim 137, where the anchors and the connecting element both are associated with position sensing units, and the minimally invasive surgical method further comprises:
dynamically referencing the position of the connecting element relative to the anchors based on tracking the position sensing units.
dynamically referencing the position of the connecting element relative to the anchors based on tracking the position sensing units.
143. A minimally invasive surgical system, comprising:
at least a pair of anchors positioned within a body of a patient;
a connecting element, the connecting element being positionable within the body to a predetermined location relative to the pair of anchors; and an instrument coupled to the connecting element, the instrument being operable to percutaneously guide the connecting element along a predetermined path to the predetermined location.
at least a pair of anchors positioned within a body of a patient;
a connecting element, the connecting element being positionable within the body to a predetermined location relative to the pair of anchors; and an instrument coupled to the connecting element, the instrument being operable to percutaneously guide the connecting element along a predetermined path to the predetermined location.
144. The minimally invasive surgical system of claim 143, wherein the instrument has a known relationship with respect to the pair of anchors.
145. The minimally invasive surgical system of claim 143, wherein the known relationship comprises a fixed relationship.
146. The minimally invasive surgical system of claim 143, wherein the known relationship comprises a variable relationship.
147. The minimally invasive surgical system of claim 143, further comprising an image guided navigation system in communication with the pair of anchors and at least one of the instrument and the connecting element, the image guided navigation system operable from referencing the pair of anchors with respect to the connecting element.
148. The minimally invasive surgical system of claim 143, wherein the connecting element comprises a longitudinal axis, and wherein the instrument is coupled to the connecting element along the longitudinal axis.
149. A minimally invasive surgical system, comprising:
at least a pair of anchors positioned within a body of a patient;
a connecting element positionable within the body at a predetermined location relative to the pair of anchors, the connecting element having a longitudinal axis; and an inserter in contact with the connecting element along the longitudinal axis, the inserter operable to percutaneously position the connecting element at the predetermined location.
at least a pair of anchors positioned within a body of a patient;
a connecting element positionable within the body at a predetermined location relative to the pair of anchors, the connecting element having a longitudinal axis; and an inserter in contact with the connecting element along the longitudinal axis, the inserter operable to percutaneously position the connecting element at the predetermined location.
150. The minimally invasive surgical system of claim 149, wherein the inserter further comprises a contact portion in contact with the connecting element, and wherein the contact portion is substantially aligned with the longitudinal axis of the connecting element during at least a portion of the percutaneous positioning of the connecting element.
151. The minimally invasive surgical system of claim 150, wherein the contact portion is affixed to the connecting element.
152. The minimally invasive surgical system of claim 149, wherein the connecting element and the inserter are positioned in a predetermined orientation relative to one another.
153. The minimally invasive surgical system of claim 152, wherein the predetermined orientation is fixed.
154. The minimally invasive surgical system of claim 149, further comprising a releasable attachment mechanism for connecting a portion of the inserter with the connecting element in alignment with the longitudinal axis.
155. The minimally invasive surgical system of claim 149, further comprising a guide mechanism operable to control relative movement of the connecting element along a predetermined path relative to the pair of anchors.
156. The minimally invasive surgical system of claim 149, wherein the connecting element comprises a first contact portion and the inserter comprises a second contact portion, wherein the first contact portion and the second contact portion are aligned with the longitudinal axis, and further comprising:
an attachment mechanism connected to the first contact portion and the second contact portion; and a release mechanism connected to the attachment mechanism, the release mechanism being operable to release the connection between the attachment mechanism and the first contact portion.
an attachment mechanism connected to the first contact portion and the second contact portion; and a release mechanism connected to the attachment mechanism, the release mechanism being operable to release the connection between the attachment mechanism and the first contact portion.
157. The minimally invasive surgical system of claim 149, wherein the connecting element comprises a first contact portion and the inserter comprises a second contact portion, wherein a connection between the first contact portion and the second contact portion defines an external geometry, and further comprising a release mechanism operable to release the connection without expanding the external geometry.
158. A minimally invasive surgical system for spinal stabilization, comprising:
at least a pair of anchors positioned within at least a corresponding pair of vertebral bone portions;
a connecting element, the connecting element being positionable to a predetermined location relative to the pair of anchors; and an instrument associated with the connecting element, the instrument being operable to percutaneously place the connecting element in the predetermined location.
at least a pair of anchors positioned within at least a corresponding pair of vertebral bone portions;
a connecting element, the connecting element being positionable to a predetermined location relative to the pair of anchors; and an instrument associated with the connecting element, the instrument being operable to percutaneously place the connecting element in the predetermined location.
159. A minimally invasive surgical system for spinal stabilization, comprising:
at least a pair of anchors positioned within at least a corresponding pair of vertebral bone portions within a body;
a connecting element having a geometry configured for connection with the pair of anchors, the connecting element having a first position corresponding to a percutaneous insertion position of the connecting element with respect to the body, and a second position within the body, the second position having a predetermined relationship with respect to the position of the pair of anchors; and an inserter referenced to the pair of anchors, the inserter being operable to move the connecting element along a predetermined path between the first position and the second position.
at least a pair of anchors positioned within at least a corresponding pair of vertebral bone portions within a body;
a connecting element having a geometry configured for connection with the pair of anchors, the connecting element having a first position corresponding to a percutaneous insertion position of the connecting element with respect to the body, and a second position within the body, the second position having a predetermined relationship with respect to the position of the pair of anchors; and an inserter referenced to the pair of anchors, the inserter being operable to move the connecting element along a predetermined path between the first position and the second position.
160. A minimally invasive surgical method for spinal stabilization, comprising:
positioning at least a pair of anchors within at least a corresponding pair of vertebral bone portions;
contacting a connecting element with an insertion instrument referenced to the pair of anchors; and percutaneously inserting the connecting element into a desired subcutaneous position relative to the pair of anchors.
positioning at least a pair of anchors within at least a corresponding pair of vertebral bone portions;
contacting a connecting element with an insertion instrument referenced to the pair of anchors; and percutaneously inserting the connecting element into a desired subcutaneous position relative to the pair of anchors.
161. A minimally invasive surgical system, comprising:
at least a pair of anchors positioned within a body of a patient;
at least a pair of receiver members movably connected to a corresponding one of the pair of anchors, each of the pair of receiver members comprising a body having a passageway therethrough; and an alignment mechanism percutaneously extending within the body and connectable with the pair of receiver members, the alignment mechanism operable for controlling a position of the passageway of each respective receiver member.
at least a pair of anchors positioned within a body of a patient;
at least a pair of receiver members movably connected to a corresponding one of the pair of anchors, each of the pair of receiver members comprising a body having a passageway therethrough; and an alignment mechanism percutaneously extending within the body and connectable with the pair of receiver members, the alignment mechanism operable for controlling a position of the passageway of each respective receiver member.
162. The minimally invasive surgical system of claim 161, further comprising:
a connecting element positionable within the body to a predetermined location relative to each of the passageways; and an instrument associated with the connecting element, the instrument being operable to percutaneously place the connecting element in the predetermined location.
a connecting element positionable within the body to a predetermined location relative to each of the passageways; and an instrument associated with the connecting element, the instrument being operable to percutaneously place the connecting element in the predetermined location.
163. A minimally invasive surgical method, comprising:
positioning at least a pair of anchors within a body of a patient, where each of the pair of anchors comprises an anchor portion and a receiver member movably connected to the anchor portion, where each receiver member comprises a body having a passageway therethough; and percutaneously controlling a position of the passageway of each respective receiver member.
positioning at least a pair of anchors within a body of a patient, where each of the pair of anchors comprises an anchor portion and a receiver member movably connected to the anchor portion, where each receiver member comprises a body having a passageway therethough; and percutaneously controlling a position of the passageway of each respective receiver member.
164. The minimally invasive surgical method of claim 163, further comprising:
aligning the respective positions of each of the passageways into a predetermined orientation; and percutaneously inserting a connecting member into the passageways.
aligning the respective positions of each of the passageways into a predetermined orientation; and percutaneously inserting a connecting member into the passageways.
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2002
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2003
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2010
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2012
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