Search Images Maps Play YouTube News Gmail Drive More »
Sign in
Screen reader users: click this link for accessible mode. Accessible mode has the same essential features but works better with your reader.

Patents

  1. Advanced Patent Search
Publication numberUS20070233097 A1
Publication typeApplication
Application numberUS 11/760,064
Publication dateOct 4, 2007
Filing dateJun 8, 2007
Priority dateDec 16, 2003
Also published asUS7666188, US8523916, US8721692, US9216040, US20050131422, US20100137915, US20130317552, US20140222083, US20160045233
Publication number11760064, 760064, US 2007/0233097 A1, US 2007/233097 A1, US 20070233097 A1, US 20070233097A1, US 2007233097 A1, US 2007233097A1, US-A1-20070233097, US-A1-2007233097, US2007/0233097A1, US2007/233097A1, US20070233097 A1, US20070233097A1, US2007233097 A1, US2007233097A1
InventorsDavid Anderson, George Ross
Original AssigneeDepuy Spine, Inc.
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Methods and devices for spinal fixation element placement
US 20070233097 A1
Abstract
Minimally invasive methods and devices are provided for positioning a spinal fixation element in relation to adjacent spinal anchors. In an exemplary embodiment, the device is a percutaneous access device that can be coupled to a spinal anchor, and the method includes the step of positioning a spinal fixation element through at least one sidewall opening of at least two percutaneous access devices such that the spinal fixation element extends in a lengthwise orientation that is substantially transverse to the longitudinal axis of each percutaneous access device. The spinal fixation element can then be advanced in the lengthwise orientation to seat the spinal fixation element in or adjacent to the receiver heads of at least two adjacent spinal anchors. A fastening element or other closure mechanism can then be applied to each spinal anchor to engage the spinal fixation element within the receiver heads of the adjacent anchors.
Images(15)
Previous page
Next page
Claims(17)
1-25. (canceled)
26. A tool set for implanting a spinal rod in a patient; said tool set comprising:
a) a pair of end guide tools;
b) each of said end guide tool being adapted to attach at a lower end thereof to a respective spinal implant bone screw; and
c) each of said end guide tools including a longitudinal guide channel extending upwardly from said lower end thereof; each of said channels being sized and shaped to be adapted to receive opposite ends of the rod for operably guiding the rod ends toward respective bone screws.
27. The tool set according to claim 26 wherein said tool set further includes:
a) at least one intermediate guide tool;
b) each of said intermediate guide tools including attachment structure adapted for attachment to a respective bone screw; and
c) each of said intermediate guide tools including a longitudinal pass through slot extending from a bottom thereof upward and being adapted to receive therethrough and guide the rod to a bone screw attached to a respective intermediate guide tool.
28. The tool set according to claim 26 wherein:
a) said longitudinal guide channel is part of an open pathway that extends from near a bottom of a respective end guide tool to a top thereof; said pathway opening radially outward along the entire length thereof.
29. The tool set according to claim 28 wherein:
a) each said end guide tool has a cutout region between said longitudinal guide channel and said guide tool lower end; said cutout being open in the rear so as to define a pass through slot sized and shaped to be adapted to allow passage therethrough of one end of the rod after the rod has been guided to near a bone screw by said channel.
30. A bone screw and rod seating assembly comprising:
a) a bone screw having a shank for implanting in a bone and a head with a channel adapted to receive a rod;
b) said bone screw head including a first attachment structure thereon;
c) an elongate guide tool having a radially outward facing channel extending parallel to an axis thereof and upwardly from near a bottom of said guide tool; said channel sized and shaped to receive a first end of a rod and operably guide said rod first end to said bone screw head; said guide tool being sized to partially extend above a patient's skin so as to allow percutaneous manipulation of said guide tool by a surgeon; and
d) said guide tool bottom including a second attachment structure thereon; said first and second attachment structures being mateable to releaseably secure said guide tool to said bone screw head.
31. A bone screw and rod seating assembly comprising:
a) a bone screw having a shank for implanting in a bone and a head with channel adapted to receive a rod;
b) said bone screw head including a first attachment structure thereon;
c) an elongate guide tool having a radially pass through slot extending upwardly from near a bottom thereof; said slot being sized and shaped to receive a rod therethrough and operably guide said rod to said bone screw head; said guide tool being sized to partially extend above a patient's skin so as to allow percutaneous manipulation of said guide tool by a surgeon; and
d) said guide tool bottom including a second attachment structure thereon; said first and second attachment structures being mateable to releaseably secure said guide tool to said bone screw head.
32. A tool set for implanting a spinal rod in a patient; said tool set comprising:
a) a pair of end guide tools;
b) each of said end guide tools being adapted to attach at a lower end thereof to a respective spinal implant bone screw; and
c) each of said end guide tools including a longitudinal guide channel extending upwardly from said lower end thereof; each of said channels being sized and shaped to be adapted to receive opposite ends of the rod for operably guiding the rod ends toward respective bone screws.
33. The tool set according to claim 32 wherein said tool set further includes:
a) at least one intermediate guide tool;
b) each of said intermediate guide tools including attachment structure adapted for attachment to a respective bone screw; and
c) each of said intermediate guide tools including a longitudinal pass through slot extending from a bottom thereof upward and being adapted to receive therethrough and guide the rod to a bone screw attached to a respective intermediate guide tool.
34. A bone screw and rod seating assembly comprising:
a) a bone screw having a shank for implanting in a bone and a head with a channel adapted to receive a rod;
b) said bone screw head including a first attachment structure thereon;
c) an elongate guide tool having a radially outward facing channel extending parallel to an axis thereof and upwardly from near a bottom of said guide tool; said channel sized and shaped to receive a first end of a rod and operably guide said rod first end to said bone screw head; said guide tool being sized to partially extend above a patient's skin so as to allow percutaneous manipulation of said guide tool by a surgeon; and
d) said guide tool bottom including a second attachment structure thereon; said first and second attachment structures being mateable to releaseably secure said guide tool to said bone screw head.
35. A bone screw and rod seating assembly comprising:
a) a bone screw having a shank for implanting in a bone and a head with channel adapted to receive a rod;
b) said bone screw head including a first attachment structure thereon;
c) an elongate guide tool having a radially pass through slot extending upwardly from near a bottom thereof; said slot being sized and shaped to receive a rod therethrough and operably guide said rod to said bone screw head; said guide tool being sized to partially extend above a patient's skin so as to allow percutaneous manipulation of said guide tool by a surgeon; and
d) said guide tool bottom including a second attachment structure thereon; said first and second attachment structures being mateable to releaseably secure said guide tool to said bone screw head.
36. A tool for implanting spinal implants in a patient; said tool comprising:
a) said tool being adapted to attach at a lower end thereof to a first spinal implant; and
b) said tool including a radially outwardly opening and longitudinal guide channel extending the entire length thereof; said channel being sized and shaped to be adapted to receive an end of a rod like second implant for operably guiding the second implant toward said first implant.
37. The tool according to claim 36 including:
a) a lower portion that is sized and shaped to be located beneath a patient's skin during use and an upper portion located outside of the patient during use; and b) said lower portion having attachment structure thereon adapted to removably attach said tool to said first implant.
38. The tool according to claim 38 in combination with said first implant.
39. The tool and implant combination according to claim 38 wherein:
a) said first implant is a bone screw.
40. The tool and implant according to claim 38 wherein:
a) said first implant is a hook.
41. The tool and implant combination according to claim 38 wherein:
a) said bone screw has an upper head with a rod receiving channel therein;
b) said attachment structure being configured to attach said tool to said head such that said tool longitudinal channel aligns with said head rod receiving channel, such that a rod received in said tool channel is guided downwardly by said tool to be received in said head tool receiving channel.
Description
    CROSS-REFERENCE TO RELATED APPLICATIONS
  • [0001]
    This application is a continuation of U.S. patent application Ser. No. 10/737,537 filed on Dec. 16, 2003 and entitled “Methods and Devices for Spinal Fixation Element Placement,” which is hereby incorporated by reference in its entirety.
  • FIELD OF THE INVENTION
  • [0002]
    This application relates to tools for use in spinal surgery, and in particular to minimally invasive methods and devices for introducing a spinal fixation element to one or more spinal anchor sites within a patient's spine.
  • BACKGROUND OF THE INVENTION
  • [0003]
    For a number of known reasons, spinal fixation devices are used in orthopedic surgery to align and/or fix a desired relationship between adjacent vertebral bodies. Such devices typically include a spinal fixation element, such as a relatively rigid fixation rod, that is coupled to adjacent vertebrae by attaching the element to various anchoring devices, such as hooks, bolts, wires, or screws. The fixation elements can have a predetermined contour that has been designed according to the properties of the target implantation site, and once installed, the instrument holds the vertebrae in a desired spatial relationship, either until desired healing or spinal fusion has taken place, or for some longer period of time.
  • [0004]
    Spinal fixation elements can be anchored to specific portions of the vertebrae. Since each vertebra varies in shape and size, a variety of anchoring devices have been developed to facilitate engagement of a particular portion of the bone. Pedicle screw assemblies, for example, have a shape and size that is configured to engage pedicle bone. Such screws typically include a threaded shank that is adapted to be threaded into a vertebra, and a head portion having a rod-receiving element, usually in the form of a U-shaped slot formed in the head. A set-screw, plug, or similar type of fastening mechanism is used to lock the fixation element, e.g., a spinal rod, into the rod-receiving head of the pedicle screw. In use, the shank portion of each screw is threaded into a vertebra, and once properly positioned, a rod is seated through the rod-receiving member of each screw and the rod is locked in place by tightening a cap or other fastener mechanism to securely interconnect each screw and the fixation rod.
  • [0005]
    Recently, the trend in spinal surgery has been moving toward providing minimally invasive devices and methods for implanting spinal fixation devices. One such method, for example, is disclosed in U.S. Pat. No. 6,530,929 of Justis et al. and it utilizes two percutaneous access devices for implanting an anchoring device, such as a spinal screw, into adjacent vertebrae. A spinal rod is then introduced through a third incision a distance apart from the percutaneous access sites, and the rod is transversely moved into the rod-engaging portion of each spinal screw. The percutaneous access devices can then be used to apply closure mechanisms to the rod-engaging heads to lock the rod therein. While this procedure offers advantages over prior art invasive techniques, the transverse introduction of the rod can cause significant damage to surrounding tissue and muscle. Moreover, the use of three separate access sites can undesirably lengthen the surgical procedure, and increase patient trauma and recovery time.
  • [0006]
    Accordingly, there remains a need for improved minimally invasive devices and methods for introducing a spinal fixation element into a patient's spine.
  • SUMMARY OF THE INVENTION
  • [0007]
    The present invention generally provides methods for introducing a spinal fixation element into a receiver head of adjacent spinal anchors. In one embodiment, the method utilizes at least two percutaneous access devices, each of which has a proximal end positioned outside a patient's body and a distal end coupled to a spinal anchor. The access device preferably includes at least one sidewall opening extending from the distal end through at least a portion of the percutaneous access device. In use, a spinal fixation element is positioned through the sidewall opening(s) in at least two adjacent percutaneous access devices such that the spinal fixation element extends in an orientation that is substantially transverse to a longitudinal axis of each percutaneous access device. The spinal fixation element is then advanced in the substantially transverse orientation to seat the spinal fixation element in or adjacent to the receiver head of at least two spinal anchors that are preferably implanted within adjacent vertebrae.
  • [0008]
    In an exemplary embodiment, each percutaneous access device includes first and second opposed sidewall openings, and at least one of the first and second sidewall openings extends from the distal end and terminates at a position distal to the proximal end. The percutaneous access devices can also optionally include a cannula, sleeve, or similar device disposed therearound that is effective to prevent removal of each percutaneous device from the spinal anchor coupled thereto. The sleeve preferably includes at least one sidewall opening formed therein that is adapted to align with the at least one sidewall opening in the percutaneous access device.
  • [0009]
    In another embodiment of the present invention, a percutaneous access system for introducing a spinal fixation element into a patient's body is provided. The system includes at least two spinal anchors that are adapted to be disposed in bone, at least one elongate, generally cylindrical hollow tube having at least one sidewall opening extending from the distal end thereof and terminating at a position distal to the proximal end, and a spinal fixation element. The system can also include at least one sleeve which is adapted to be slidably disposed around at least a portion of one of the hollow tubes. The sleeve(s) preferably includes at least one sidewall opening formed therein that is adapted to align with the sidewall opening(s) formed in the hollow tube. The system can also include a driver mechanism having a proximal handle portion, and a distal end that is adapted to couple to a spinal anchor such that rotation of the driver mechanism is effective to thread the spinal anchor into bone. The driver mechanism is preferably adapted to be disposed through the hollow tube(s).
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0010]
    FIG. 1 is a perspective view of a percutaneous access device coupled to a spinal anchor according to one embodiment of the present invention;
  • [0011]
    FIG. 2 is a cross-sectional view taken along the longitudinal axis L of the percutaneous access device shown in FIG. 1;
  • [0012]
    FIG. 3A is a posterior view of a midline incision formed in the thoracolumbar fascia of a patient's back;
  • [0013]
    FIG. 3B is an end view showing a blunt dissection of the muscles surrounding a patient's vertebra;
  • [0014]
    FIG. 4 is an end view of the vertebra shown in FIG. 3B showing a technique for separating the muscles along the muscle plane to gain access to the vertebra;
  • [0015]
    FIG. 5 is an end view of the vertebra shown in FIG. 4 showing placement of a k-wire through the incision and into the patient's vertebra;
  • [0016]
    FIG. 6 is an end view of the vertebra shown in FIG. 5 having an obturator and several dilators disposed over the k-wire to dilate the tissue and muscles;
  • [0017]
    FIG. 7 is perspective view of a spinal anchor having a percutaneous access device coupled thereto and extending through an incision formed in the patient's tissue surface to implant the spinal anchor in a vertebra;
  • [0018]
    FIG. 8 is a perspective view of two percutaneous access devices attached to spinal anchors that are disposed within adjacent vertebrae in a patient's spinal column;
  • [0019]
    FIG. 9 illustrates a method for introducing a spinal fixation element through the percutaneous access devices shown in FIG. 8;
  • [0020]
    FIG. 10 is a perspective view of the spinal fixation element shown in FIG. 9 being advanced toward the spinal anchors using a pusher device;
  • [0021]
    FIG. 11 is a perspective view of the spinal fixation element shown in FIG. 10 after it is fully positioned within receiver heads of the adjacent spinal anchors;
  • [0022]
    FIG. 12 is a perspective view of a compression tool positioned around the percutaneous access devices shown in FIG. 11 and compressing the devices toward one another; and
  • [0023]
    FIG. 13 is a perspective view of a closure mechanism being applied through one of the percutaneous access devices to lock the spinal fixation element in relation to the spinal anchor.
  • DETAILED DESCRIPTION OF THE INVENTION
  • [0024]
    The present invention provides minimally invasive methods and devices for introducing a spinal fixation element into a surgical site in a patient's spinal column. In general, the method involves positioning a spinal fixation element through openings formed in at least two adjacent percutaneous access devices such that the spinal fixation element extends between the at least two adjacent percutaneous access devices in a lengthwise orientation. The spinal fixation element can then be advanced in a distal direction to seat the spinal fixation element in the receiver heads of the adjacent spinal anchors, or to otherwise position the spinal fixation element in relation to the adjacent spinal anchors. A fastening element or other closure mechanism can optionally be applied to each spinal anchor to engage the spinal fixation element within the receiver heads of the adjacent anchors, or to otherwise directly or indirectly connect the spinal fixation element to the anchors.
  • [0025]
    While a variety of devices can be used to perform the methods of the present invention, FIGS. 1 and 2 illustrate an exemplary embodiment of a percutaneous access device 12 that is mated to a spinal anchor 50 to form a spinal implant assembly 10. The device 12 is in the form of a generally elongate, cylindrical tube having an inner lumen 12 c formed therein and defining a longitudinal axis L that extends between proximal and distal ends 12 a, 12 b. The size of the access device 12 can vary depending on the intended use, but it should have a length l that allows the proximal end 12 a of the access device 12 to be positioned outside the patient's body, while the distal end 12 b of the access device 12 is coupled to, or positioned adjacent to, a spinal anchor, e.g., anchor 50, that is disposed in a vertebra in a patient's spine. The inner diameter di of the access device 12 can also vary depending on the intended use, but the inner diameter di is preferably sufficient to accommodate a diameter or width of a spinal fixation element to be introduced therethrough.
  • [0026]
    The percutaneous access device 12 also preferably includes at least one sidewall opening or slot 14, and more preferably two opposed sidewall openings (only one opening 14 is shown), formed therein and extending proximally from the distal end 12 b thereof. The openings 14 allow a spinal fixation element to be positioned lengthwise between two adjacent devices 12 such that the spinal fixation element extends in an orientation that is substantially transverse to the longitudinal axis L of the access devices 12, i.e., that crosses the longitudinal axis L of the access devices 12. The exact position of the spinal fixation element with respect to the longitudinal axis L will of course vary depending on the configuration of the spinal fixation element. The shape and size of the openings 14 can also vary depending on the configuration of the spinal fixation element, but the openings 14 preferably have a generally elongate shape with a width w that is sufficient to accommodate the diameter of the spinal fixation element. The openings 14 preferably extend over about half of the length, or more than half of the length, of the percutaneous access device 12. This allows a proximal portion of each opening 14 to be positioned outside a patient's body while the device 12 is in use, thus allowing a spinal fixation element to be externally positioned through the openings 14 and then moved distally to be implanted. A person skilled in the art will appreciate that the percutaneous access device 12 can include any number of sidewall openings having any shape that is sufficient to allow a spinal fixation element to be positioned therethrough.
  • [0027]
    Continuing to refer to FIG. 1, in use, the percutaneous access device 12 is preferably adapted to attach to a spinal anchor 50, and more preferably to the receiver head 52 of a spinal anchor 50. Accordingly, the distal end 12 c of the percutaneous access device 12 can include one or more mating elements 18 formed thereon or therein for engaging the spinal anchor 50. Suitable mating elements include, for example, threads, a twist-lock engagement, a snap-on engagement, or any other technique known in the art, and in an exemplary embodiment the mating elements are formed on opposed inner surfaces of the distal end 12 b of the access device 12. A sleeve (not shown) or other device, preferably having sidewall openings that correspond with the sidewall openings 14 formed in the percutaneous access device 12, can also be placed over the percutaneous access device 12, and optionally over the anchor 50 as well, to prevent disengagement of the access device 12 from the anchor 50 during use. Exemplary techniques for mating the percutaneous access device 12 to a spinal anchor are disclosed in a patent application entitled “Percutaneous Access Devices and Bone Anchor Assemblies,” filed concurrently herewith. A person skilled in the art will appreciate that a variety of other techniques can be used to removably mate the percutaneous access device to a spinal anchor.
  • [0028]
    Still referring to FIG. 1, an exemplary spinal anchor for use with the methods and devices of the present invention is shown. A person skilled in the art will appreciate that a variety of implants can be used with the devices and methods of the present invention, including, for example, spinal screws, hooks, bolts, and wires. By way of non-limiting example, FIG. 1 illustrates a spinal screw 50 that includes a distal, bone-engaging portion, e.g., a threaded shank 54, and a proximal, U-shaped, receiver head 52 that is adapted to seat a spinal fixation element, such as a spinal rod (not shown). The threaded shank 54 can be fixedly attached to the receiver head 52 to form a monoaxial screw, or alternatively the shank 54 can be configured as a polyaxial screw, as shown, that is rotatably disposed through an opening formed in the distal end of the receiver head 52 to allow rotation of the shank 54 with respect to the receiver head 52. A variety of techniques can be used to allow rotation of the head 52 with respect to the shank 54.
  • [0029]
    FIGS. 3A-13 show a minimally invasive method of implanting a spinal fixation element into the receiver heads of adjacent spinal anchors. While the method is shown and described in connection with the percutaneous access device 12 and spinal screw 50 disclosed herein, a person skilled in the art will appreciate that the method is not limited to use with such devices, and that a variety of other devices known in the art can be used. Moreover, while only two access devices 12, 12′ and two implants 50, 50′ are shown in FIGS. 8-13, the method of the present invention can be performed using any number of access devices and spinal anchors. The method can also be performed using only some of the method steps disclosed herein, and/or using other methods known in the art.
  • [0030]
    The procedure preferably begins by forming an incision through the tissue located adjacent to the desired implant site. While the location, shape, and size of the incision will depend on the type and quantity of spinal anchors being implanted, FIG. 3A illustrates a midline, blunt dissection incision 62 formed in the thoracolumbar fascia in the patient's back along the muscle plane. The length of the incision 62 is about 4-5 cm, however this can vary depending on the procedure. Once the midline incision 62 is formed, blunt finger dissection can be used, as shown in FIG. 4, to separate the longissimus thoracis and multifidus muscles, thereby exposing the facet and the junction of the transverse process and superior articular process.
  • [0031]
    As shown in FIG. 5, a guide wire, e.g., a k-wire 64, can be implanted, either prior to or after formation of the incision, at each spinal anchor implant site. The k-wire 64 preferably extends between the muscles and into the vertebra at the desired entry point of the spinal anchor. Fluoroscopy is typically used to facilitate proper placement of the k-wire 64.
  • [0032]
    The opposed ends of the incision can then be dilated to provide a pathway for delivery of a spinal anchor to each implant site. FIG. 6 illustrates dilation at one end of the incision 62 using an obturator 66 a having several dilators 66 b, 66 c of increasing size placed there over. The dilators 66 b, 66 c are delivered over the obturator 66 a and k-wire 64 to essentially stretch the skin around the incision 62 and to expand the pathway to the anchor site. While not illustrated, a person skilled in the art will appreciate that the incision 62 can optionally be held opening using a retractor or an expandable cannula.
  • [0033]
    Once the incision 62 is dilated to the proper size, an anchor can be delivered to each anchor site, as shown in FIG. 7. This procedure typically involves preparation of the vertebra 60 using one or more bone preparation instruments, such as drills, taps, awls, burrs, probes, etc. While not always necessary, one or more cannulae can be used to provide a pathway from the incision 62 to the anchor site for insertion of the bone preparation instruments and/or the anchor. In an exemplary embodiment, a relatively small cannula is used to introduce bone preparation instruments into the surgical site. The incision 62 can then be further dilated, and the small cannula can be replaced with a larger cannula that is adapted to receive or mate to the anchor.
  • [0034]
    Once the vertebra 60 is prepared, a spinal anchor can be implanted at each implant site. An access device 12, 12′ can be mated to each anchor 50, 50′ after insertion of the anchor 50, 50′ into bone 60, 60′, but more preferably each percutaneous access device 12, 12′ is attached to the anchor 50, 50′ prior to insertion of the anchor 50, 50′ into bone 60, 60′ to provide a passageway for a driver tool for driving the anchor 50 into bone 60, 60′. FIG. 7 illustrates anchor 50 implanted in a first vertebra 60 and having access device 12 attached thereto. While not shown, the anchor 50 is preferably cannulated to allow the k-wire 64 to extend through the anchor 50 and the access device 12 to guide the devices 50, 12 toward the implant site. FIG. 7 further illustrates a second anchor 50′ having an access device 12′ mated thereto. As shown, the screw 50′ is about to be implanted in a second vertebra 60′ that is adjacent to the first vertebra 60. Once the screw 50′ is positioned adjacent to the vertebra 60′, a driver tool 200 can be positioned through the access device 12′ and coupled to the receiver head 52′ of the screw 50′ to drive the screw 50′ into the vertebra 60′.
  • [0035]
    In another embodiment, a sleeve can be placed over each access device 12, 12′, either prior to or after the devices 12, 12′, 50, 50′ are implanted, to prevent the devices 12, 12′ from becoming disengaged from the anchors 50, 50′ to which they are attached. The sleeve 100, which is partially illustrated in FIG. 3B, is preferably in the form of a cannula that has substantially the same configuration as each access device 12, 12′. The use of a sleeve is particularly desirable where the access devices 12, 12′ utilize pin members that engage corresponding detents formed on an outer surface of each screw head 52, 52′, as the sleeve will prevent the pin members from becoming disengaged from the detents. The sleeve can also optionally serve as an access device, allowing access devices 12, 12′ to be detached and removed from the anchors 50, 50′.
  • [0036]
    After the anchors are implanted, as shown in FIG. 8, a spinal fixation element is delivered to the anchor sites. As shown in FIG. 9, the spinal fixation element 70 is positioned through the openings 14, 14′ in the adjacent devices 12, 12′ such that the spinal fixation element 70 extends in a lengthwise orientation which is substantially transverse to the longitudinal axis L of the access devices 12, 12′. The exact angle of the fixation element 70 with respect to the percutaneous access devices 12, 12′ will vary depending on the orientation of the access device 12, 12′ with respect to the patient's spinal column, and it is understood that the orientation can vary during use since the percutaneous access devices 12, 12′ can be oriented at various angles throughout the surgical procedure.
  • [0037]
    The spinal fixation element 70 is then moved distally toward the distal end 12 b, 12 b′ of the percutaneous access devices 12, 12′. As the spinal fixation element 70 moves distally, it will advantageously pass between the muscles, thus eliminating the need to cut or tear tissue. The method is also particularly advantageous in that the percutaneous access devices 12, 12′ direct the spinal fixation element 70 into the receiver heads 52, 52′ of the adjacent spinal anchors 50, 50′, thus allowing the spinal fixation element to be properly positioned without the necessity for direct visual access to the surgical site.
  • [0038]
    Movement of the spinal fixation element 70 in the distal direction can be achieved using pusher shaft 80, as shown in FIGS. 10 and 11. The pusher shaft 80 can have a variety of configurations, but it should be effective to allow controlled movement of the spinal fixation element 70. A person skilled in the art will appreciate that a variety of other techniques can be used to advance the spinal fixation element 70 distally between the percutaneous access devices 12, 12′ to seat the spinal fixation element 70 into the receiver heads 52, 52′ of adjacent spinal anchors 50, 50′. In the illustrated embodiment, the pusher shaft 80 includes a seating member 82 formed on a distal end thereof that is adapted to seat the spinal fixation element 70. The seating member 82, which is similar to a receiver head of a spinal anchor, is generally cylindrical and includes an open distal end with opposed U-shaped cut-out portions formed therein for receiving the spinal fixation element 70. In use, the seating member 82 is positioned around the spinal fixation element 70 and a force is applied to the pusher shaft 80 to move the spinal fixation element 70 distally.
  • [0039]
    Once the spinal fixation element 70 is fully seated in the receiver heads 52, 52′ of the adjacent spinal anchors 50, 50′, as shown in FIG. 11, the pusher shaft 80, if used, can then be removed or detached from the spinal fixation element 70, and a closure mechanism can be applied to one or both receiver heads 52, 52′ to retain the spinal fixation element 70 therein. In an exemplary embodiment, however, a compression tool 100 is used to compress the access devices 12, 12′ toward one another prior to applying a closure mechanism to each anchor 50, 50′. The closure mechanism(s) can, however, be partially applied before compression.
  • [0040]
    An exemplary compression tool 100 is shown in FIG. 12, and in general it includes opposed arms 102, 104 that are pivotally coupled to one another at a substantial mid-point thereof such that each arm 102, 104 includes a distal portion 102 b, 104 b that is adapted to be disposed around a percutaneous access device 12, 12′, and a proximal, handle portion 102 a, 104 a. The device 100 can also include a fulcrum (not shown) that is disposed between the arms 102, 104 to facilitate controlled movement of the arms 102, 104 with respect to one another. In use, the distal portion 102 b, 104 b of each arm 102, 104 is placed around an access device 12, 12′, preferably around the distal end 12 b, 12 b′ of each device 12, 12′ and/or around the head 52, 52′ of each anchor 50, 50′. The proximal, handle portions 102 a, 104 a are then brought toward one another to move the access devices 12, 12′ toward one another, preferably while maintaining relative spacing therebetween, as shown in FIG. 12.
  • [0041]
    Once properly positioned, a closure mechanism can be applied, preferably via the access devices 12, 12′, to each anchor head 50, 50′ to retain the spinal fixation element 70 within the receiver heads 52, 52′. A variety of closure mechanisms and tools for delivering closure mechanisms are known in the art and they can be used with the present invention. By way of non-limiting example, FIG. 13 illustrates a driver tool 90 disposed through access device 12 for applying a closure mechanism, such as a set screw, to the receiver head 52 of the spinal anchor 50 to lock the spinal fixation element 70 with respect to the spinal anchor 50. This step can be repeated for the adjacent spinal anchor(s).
  • [0042]
    A person skilled in the art will appreciate that the spinal fixation element 70 does not need to be directly attached to each anchor 50, 50′, and that it can be indirectly attached to the anchors 50, 50′ using, for example, a band clamp, or slotted or offset connectors.
  • [0043]
    Once the fixation element 70 is secured in relation to the implants 50, 50′, the access devices 12, 12′ can be removed (if attached) from the implants 50, 50′, leaving only a single, relatively small incision in the patient where each access device 12, 12′ and the spinal fixation element 70 was introduced. This is particularly advantageous in that it reduces the amount of trauma caused to the patient, and it minimizes the damage to muscle surrounding the surgical site.
  • [0044]
    As previously stated, a person skilled in the art will appreciate that the method can be performed in any sequence using any of the steps. Moreover, the access devices of the present invention can be used to deliver multiple spinal fixation elements simultaneously or sequentially, and/or to perform a variety of other surgical procedures not illustrated or described herein.
  • [0045]
    One skilled in the art will appreciate further features and advantages of the invention based on the above-described embodiments. Accordingly, the invention is not to be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are expressly incorporated herein by reference in their entirety.
Patent Citations
Cited PatentFiling datePublication dateApplicantTitle
US4545374 *Sep 3, 1982Oct 8, 1985Jacobson Robert EMethod and instruments for performing a percutaneous lumbar diskectomy
US4913134 *Jul 29, 1988Apr 3, 1990Biotechnology, Inc.Spinal fixation system
US5171279 *Mar 17, 1992Dec 15, 1992Danek MedicalMethod for subcutaneous suprafascial pedicular internal fixation
US5242446 *Jan 2, 1992Sep 7, 1993Acromed CorporationConnector for a spinal column corrective device
US5484440 *Aug 18, 1994Jan 16, 1996Zimmer, Inc.Bone screw and screwdriver
US5569248 *May 9, 1995Oct 29, 1996Danek Medical, Inc.Apparatus for subcutaneous suprafascial pedicular internal fixation
US5647873 *Nov 13, 1995Jul 15, 1997Fastenetix, L.L.C.Bicentric polyaxial locking screw and coupling element
US5728097 *Jul 9, 1996Mar 17, 1998Sdgi Holding, Inc.Method for subcutaneous suprafascial internal fixation
US5817094 *Jan 23, 1997Oct 6, 1998Fastenetix, LlcPolyaxial locking screw and coupling element
US5954635 *Aug 29, 1997Sep 21, 1999Sdgi Holdings Inc.Devices and methods for percutaneous surgery
US5984923 *Apr 24, 1997Nov 16, 1999Science Et Medecine (Sem)Anti-shifting system for spinal arthrodesis bar
US6033406 *Mar 17, 1998Mar 7, 2000Sdgi Holdings, Inc.Method for subcutaneous suprafascial pedicular internal fixation
US6183472 *Apr 7, 1999Feb 6, 2001Howmedica GmbhPedicle screw and an assembly aid therefor
US6200322 *Aug 13, 1999Mar 13, 2001Sdgi Holdings, Inc.Minimal exposure posterior spinal interbody instrumentation and technique
US6235028 *Feb 14, 2000May 22, 2001Sdgi Holdings, Inc.Surgical guide rod
US6299616 *Nov 5, 1999Oct 9, 2001Aesculap Ag & Co. KgEndoscopic insertion apparatus
US6331179 *Jan 6, 2000Dec 18, 2001Spinal Concepts, Inc.System and method for stabilizing the human spine with a bone plate
US6485491 *Sep 15, 2000Nov 26, 2002Sdgi Holdings, Inc.Posterior fixation system
US6520907 *Nov 30, 1999Feb 18, 2003Sdgi Holdings, Inc.Methods for accessing the spinal column
US6530926 *Aug 1, 2000Mar 11, 2003Endius IncorporatedMethod of securing vertebrae
US6530929 *Jul 14, 2000Mar 11, 2003Sdgi Holdings, Inc.Instruments for stabilization of bony structures
US6540749 *Feb 6, 2002Apr 1, 2003Bernd SchäferBone screw
US6554831 *Sep 1, 2000Apr 29, 2003Hopital Sainte-JustineMobile dynamic system for treating spinal disorder
US6652527 *Oct 18, 2001Nov 25, 2003St. Francis Medical Technologies, Inc.Supplemental spine fixation device and method
US6793656 *Mar 6, 2000Sep 21, 2004Sdgi Holdings, Inc.Systems and methods for fixation of adjacent vertebrae
US6849064 *Oct 25, 2002Feb 1, 2005James S. HamadaMinimal access lumbar diskectomy instrumentation and method
US6929647 *Feb 21, 2001Aug 16, 2005Howmedica Osteonics Corp.Instrumentation and method for implant insertion
US7179225 *Aug 26, 2004Feb 20, 2007Shluzas Alan EAccess systems and methods for minimally invasive surgery
US7250052 *Oct 30, 2003Jul 31, 2007Abbott Spine Inc.Spinal stabilization systems and methods
US20010001119 *Dec 28, 2000May 10, 2001Alan LombardoSurgical screw system and related methods
US20020049368 *Oct 1, 2001Apr 25, 2002Stephen RitlandMethod and device for retractor for microsurgical intermuscular lumbar arthrodesis
US20020068975 *Oct 10, 2001Jun 6, 2002Teitelbaum George P.Formable orthopedic fixation system with cross linking
US20020082600 *Aug 29, 2001Jun 27, 2002Shaolian Samuel M.Formable orthopedic fixation system
US20020116000 *Oct 18, 2001Aug 22, 2002Zucherman James F.Supplemental spine fixation device and method
US20020116006 *Feb 21, 2001Aug 22, 2002Herb CohenInstrumentation and method for implant insertion
US20020123668 *Jan 29, 2002Sep 5, 2002Stephen RitlandRetractor and method for spinal pedicle screw placement
US20020138077 *Mar 25, 2002Sep 26, 2002Ferree Bret A.Spinal alignment apparatus and methods
US20020169448 *Mar 27, 2002Nov 14, 2002Vanacker Gerard M.Connector for an osteosynthesis system intended to provide a connection between two rods of a spinal osteosynthesis system, osteosynthesis system using such a connector, and method of implanting such an osteosynthesis system
US20020198526 *May 31, 2002Dec 26, 2002Shaolian Samuel M.Formed in place fixation system with thermal acceleration
US20030083657 *Oct 30, 2001May 1, 2003Drewry Troy D.Flexible spinal stabilization system and method
US20030083688 *Oct 30, 2001May 1, 2003Simonson Robert E.Configured and sized cannula
US20030083689 *Oct 30, 2001May 1, 2003Simonson Robert E.Non cannulated dilators
US20030130659 *Jan 10, 2002Jul 10, 2003Haider Thomas T.Orthopedic hook system
US20030195549 *May 16, 2003Oct 16, 2003Davison Thomas W.Cannula for receiving surgical instruments
US20030195550 *May 16, 2003Oct 16, 2003Davison Thomas W.Cannula for receiving surgical instruments
US20030195551 *May 16, 2003Oct 16, 2003Davison Thomas W.Cannula for receiving surgical instruments
US20030199885 *May 16, 2003Oct 23, 2003Davison Thomas W.Cannula for receiving surgical instruments
US20030208203 *Jul 25, 2002Nov 6, 2003Roy LimMinimally invasive instruments and methods for inserting implants
US20040039384 *Dec 17, 2002Feb 26, 2004Boehm Frank H.Device and method for pertcutaneous placement of lumbar pedicle screws and connecting rods
US20040138662 *Oct 30, 2003Jul 15, 2004Landry Michael E.Spinal stabilization systems and methods
US20040143265 *Oct 30, 2003Jul 22, 2004Landry Michael E.Spinal stabilization systems and methods using minimally invasive surgical procedures
US20040260284 *Jun 23, 2003Dec 23, 2004Matthew ParkerAnti-splay pedicle screw
US20040267277 *Jun 30, 2003Dec 30, 2004Zannis Anthony D.Implant delivery instrument
US20050065517 *Jun 15, 2004Mar 24, 2005Chin Kingsley RichardMethods and devices for improving percutaneous access in minimally invasive surgeries
US20050085813 *Oct 21, 2003Apr 21, 2005Innovative Spinal TechnologiesSystem and method for stabilizing of internal structures
US20050192570 *Feb 27, 2004Sep 1, 2005Jackson Roger P.Orthopedic implant rod reduction tool set and method
US20050192579 *Feb 27, 2004Sep 1, 2005Jackson Roger P.Orthopedic implant rod reduction tool set and method
Referenced by
Citing PatentFiling datePublication dateApplicantTitle
US7691132 *Nov 21, 2005Apr 6, 2010Zimmer Spine, Inc.Spinal stabilization systems and methods
US7824411Dec 15, 2004Nov 2, 2010Depuy Spine, Inc.Instruments and methods for bone anchor engagement and spinal rod reduction
US7824413Dec 15, 2004Nov 2, 2010Depuy Spine, Inc.Instruments and methods for bone anchor engagement and spinal rod reduction
US7842044Sep 26, 2005Nov 30, 2010Depuy Spine, Inc.Instruments and methods for bone anchor engagement and spinal rod reduction
US7887539Jan 20, 2004Feb 15, 2011Depuy Spine, Inc.Spinal rod approximators
US7887541Jul 26, 2007Feb 15, 2011Depuy Spine, Inc.Spinal rod reduction instruments and methods for use
US7914558Aug 24, 2007Mar 29, 2011Zimmer Spine, Inc.Spinal stabilization systems and methods using minimally invasive surgical procedures
US7988698Jan 28, 2003Aug 2, 2011Depuy Spine, Inc.Spinal rod approximator
US8075592Jun 18, 2007Dec 13, 2011Zimmer Spine, Inc.Spinal stabilization systems and methods
US8142437Jun 18, 2010Mar 27, 2012Spine Wave, Inc.System for percutaneously fixing a connecting rod to a spine
US8167887Jun 18, 2010May 1, 2012Spine Wave, Inc.Introducer for inserting a connecting rod into a spine
US8172847Mar 29, 2007May 8, 2012Depuy Spine, Inc.In-line rod reduction device and methods
US8202274Jun 18, 2010Jun 19, 2012Spine Wave, Inc.Apparatus and method for detecting a connecting rod during percutaneous surgery
US8206394May 13, 2009Jun 26, 2012Depuy Spine, Inc.Torque limited instrument for manipulating a spinal rod relative to a bone anchor
US8206395Jun 18, 2010Jun 26, 2012Spine Wave, Inc.Surgical instrument and method for the distraction or compression of bones
US8211012Sep 30, 2008Jul 3, 2012Aesculap Implant Systems, LlcTissue retractor system
US8216241May 31, 2007Jul 10, 2012Depuy Spine, Inc.Instruments and methods for manipulating a spinal fixation element
US8216282Sep 27, 2011Jul 10, 2012Sherwin HuaSystem and method for wire-guided pedicle screw stabilization of spinal vertebrae
US8226656Apr 16, 2008Jul 24, 2012Warsaw Orthopedic, Inc.Minimally invasive systems and methods for insertion of a connecting member adjacent the spinal column
US8236032Oct 20, 2009Aug 7, 2012Depuy Spine, Inc.Spinal implant with a flexible extension element
US8333770Sep 26, 2011Dec 18, 2012Sherwin HuaSystems and methods for pedicle screw stabilization of spinal vertebrae
US8357184 *Nov 10, 2010Jan 22, 2013Nuvasive, Inc.Method and apparatus for performing spinal surgery
US8394108May 31, 2011Mar 12, 2013Spine Wave, Inc.Screw driver for a multiaxial bone screw
US8435269 *Aug 5, 2011May 7, 2013Nuvasive, Inc.Method and apparatus for performing spinal fusion surgery
US8454664Jun 8, 2011Jun 4, 2013Spine Wave, Inc.Method for fixing a connecting rod to a thoracic spine
US8496685Nov 4, 2011Jul 30, 2013Zimmer Spine, Inc.Spinal stabilization systems and methods
US8500750Oct 21, 2010Aug 6, 2013DePuy Synthes Products, LLC.Instruments and methods for bone anchor engagement and spinal rod reduction
US8512383Jun 18, 2010Aug 20, 2013Spine Wave, Inc.Method of percutaneously fixing a connecting rod to a spine
US8518082Nov 12, 2010Aug 27, 2013Depuy Spine, SarlPercutaneous access devices and bone anchor assemblies
US8523916Feb 4, 2010Sep 3, 2013DePuy Synthes Products, LLCMethods and devices for spinal fixation element placement
US8535320Aug 5, 2011Sep 17, 2013Nuvasive, Inc.Method and apparatus for performing spinal surgery
US8545541Apr 29, 2011Oct 1, 2013Sherwin HuaSystem and method for wire-guided pedicle screw stabilization of spinal vertebrae
US8551144Apr 22, 2008Oct 8, 2013Collab Comlo, LLCBone plate system configurable as static or dynamic implant
US8556940Sep 30, 2009Oct 15, 2013Sherwin HuaSystem and method for wire-guided pedicle screw stabilization of spinal vertebrae
US8603094Jul 26, 2010Dec 10, 2013Spinal Usa, Inc.Minimally invasive surgical tower access devices and related methods
US8608746Mar 10, 2008Dec 17, 2013DePuy Synthes Products, LLCDerotation instrument with reduction functionality
US8617210Nov 12, 2010Dec 31, 2013Depuy Spine, SarlPercutaneous access devices and bone anchor assemblies
US8636655Jan 19, 2011Jan 28, 2014Ronald ChildsTissue retraction system and related methods
US8636742Oct 20, 2010Jan 28, 2014Depuy Spine, Inc.Spinal rod reduction instruments and methods for use
US8636776Feb 22, 2011Jan 28, 2014Depuy Spine, Inc.Spinal rod approximator
US8641734Apr 29, 2009Feb 4, 2014DePuy Synthes Products, LLCDual spring posterior dynamic stabilization device with elongation limiting elastomers
US8647347Jun 14, 2012Feb 11, 2014DePuy Synthes Products, LLCInstruments and methods for manipulating a spinal fixation element
US8679126Apr 11, 2012Mar 25, 2014DePuy Synthes Products, LLCTorque limited instrument for manipulating a spinal rod relative to a bone anchor
US8709015Mar 10, 2008Apr 29, 2014DePuy Synthes Products, LLCBilateral vertebral body derotation system
US8709044Jul 21, 2011Apr 29, 2014DePuy Synthes Products, LLCInstruments and methods for manipulating vertebra
US8721691Apr 7, 2011May 13, 2014Sherwin HuaSystems and methods for pedicle screw stabilization of spinal vertebrae
US8721692Aug 2, 2013May 13, 2014Depuy Synthes Products LlcMethods and devices for spinal fixation element placement
US8777954Jun 14, 2012Jul 15, 2014Spine Wave, Inc.Pedicle screw extension for use in percutaneous spinal fixation
US8790348Sep 28, 2007Jul 29, 2014Depuy Spine, Inc.Dual pivot instrument for reduction of a fixation element and method of use
US8845640Jun 18, 2010Sep 30, 2014Spine Wave, Inc.Pedicle screw extension for use in percutaneous spinal fixation
US8894662Aug 5, 2013Nov 25, 2014DePuy Synthes Products, LLCInstruments and methods for bone anchor engagement and spinal rod reduction
US8900238Mar 27, 2009Dec 2, 2014Globus Medical, Inc.Devices and methods for inserting a vertebral fixation member
US8956362Jul 17, 2013Feb 17, 2015Zimmer Spine, Inc.Spinal stabilization systems and methods
US9050146Nov 10, 2010Jun 9, 2015Nuvasive, Inc.Method and apparatus for performing spinal surgery
US9095379Apr 15, 2011Aug 4, 2015Medos International SarlConstrained motion bone screw assembly
US9101416Oct 21, 2010Aug 11, 2015DePuy Synthes Products, Inc.Spinal rod approximator
US9216040Apr 7, 2014Dec 22, 2015DePuy Synthes Products, Inc.Methods and devices for spinal fixation element placement
US9220543 *Dec 5, 2013Dec 29, 2015Spinal Usa, Inc.Minimally invasive surgical tower access devices and related methods
US9232968Sep 19, 2008Jan 12, 2016DePuy Synthes Products, Inc.Polymeric pedicle rods and methods of manufacturing
US9265538Jun 17, 2014Feb 23, 2016DePuy Synthes Products, Inc.Dual pivot instrument for reduction of a fixation element and method of use
US9295500Jun 12, 2013Mar 29, 2016Spine Wave, Inc.Screw driver with release for a multiaxial bone screw
US9320543Oct 27, 2009Apr 26, 2016DePuy Synthes Products, Inc.Posterior dynamic stabilization device having a mobile anchor
US9326798Dec 11, 2013May 3, 2016DePuy Synthes Products, Inc.Derotation instrument with reduction functionality
US9364265Jul 3, 2012Jun 14, 2016DePuy Synthes Products, Inc.Spinal implant with a flexible extension element
US9433446Sep 23, 2014Sep 6, 2016Spine Wave, Inc.Pedicle screw extension for use in percutaneous spinal fixation
US9439692 *Oct 9, 2015Sep 13, 2016Spine Wave, Inc.Minimally invasive spinal fixation system and method therefor
US9439699Jul 9, 2013Sep 13, 2016Medos International SarlPercutaneous access devices and bone anchor assemblies
US9445844Mar 24, 2010Sep 20, 2016DePuy Synthes Products, Inc.Composite material posterior dynamic stabilization spring rod
US20050149036 *Dec 15, 2004Jul 7, 2005Varieur Michael S.Instruments and methods for bone anchor engagement and spinal rod reduction
US20050149053 *Dec 15, 2004Jul 7, 2005Varieur Michael S.Instruments and methods for bone anchor engagement and spinal rod reduction
US20060084993 *Nov 21, 2005Apr 20, 2006Landry Michael ESpinal stabilization systems and methods
US20080039838 *Jun 18, 2007Feb 14, 2008Landry Michael ESpinal stabilization systems and methods
US20080045957 *Aug 24, 2007Feb 21, 2008Landry Michael ESpinal stabilization systems and methods using minimally invasive surgical procedures
US20080234765 *Mar 13, 2007Sep 25, 2008Depuy Spine, Inc.Rod reduction methods and devices
US20090228051 *Mar 10, 2008Sep 10, 2009Eric KolbBilateral vertebral body derotation system
US20090264930 *Apr 16, 2008Oct 22, 2009Warsaw Orthopedic, Inc.Minimally invasive Systems and Methods for Insertion of a Connecting Member Adjacent the Spinal Column
US20090264934 *Apr 22, 2008Oct 22, 2009Youssef Jim ABone plate system configurable as static or dynamic implant
US20100081885 *Sep 30, 2008Apr 1, 2010Aesculap Implant Systems, Inc.Tissue retractor system
US20100249856 *Mar 27, 2009Sep 30, 2010Andrew IottDevices and Methods for Inserting a Vertebral Fixation Member
US20110093015 *Oct 20, 2009Apr 21, 2011Ramsay Christopher LSpinal implant with a flexible extension element
US20110130793 *Nov 10, 2010Jun 2, 2011Nuvasive Inc.Method and apparatus for performing spinal surgery
US20110196429 *Sep 30, 2009Aug 11, 2011Sherwin HuaSystem and method for wire-guided pedicle screw stabilization of spinal vertebrae
US20110288594 *Aug 5, 2011Nov 24, 2011Troy WoolleyMethod and Apparatus for Performing Spinal Fusion Surgery
US20140249583 *Dec 5, 2013Sep 4, 2014Spinal Usa, Inc.Minimally invasive surgical tower access devices and related methods
WO2013191980A1Jun 12, 2013Dec 27, 2013DePuy Synthes Products, LLCImage guided intra-operative contouring aid
Classifications
U.S. Classification606/86.00A
International ClassificationA61B17/58, A61B17/88, A61F2/44
Cooperative ClassificationA61B17/7079, A61B17/7002, A61B17/7091, A61B17/7085, A61B17/7082
European ClassificationA61B17/70T2B2, A61B17/70T2D, A61B17/70T10, A61B17/70T4C