AU4547999A - Transiliac approach to entering a patient's intervertebral space - Google Patents

Transiliac approach to entering a patient's intervertebral space Download PDF

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Publication number
AU4547999A
AU4547999A AU45479/99A AU4547999A AU4547999A AU 4547999 A AU4547999 A AU 4547999A AU 45479/99 A AU45479/99 A AU 45479/99A AU 4547999 A AU4547999 A AU 4547999A AU 4547999 A AU4547999 A AU 4547999A
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AU
Australia
Prior art keywords
patient
ilium
bone
cannula
intervertebral space
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
AU45479/99A
Inventor
James F. Marino
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Nuvasive Inc
Original Assignee
Nuvasive Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Nuvasive Inc filed Critical Nuvasive Inc
Priority claimed from PCT/US1999/012610 external-priority patent/WO2000048521A1/en
Publication of AU4547999A publication Critical patent/AU4547999A/en
Abandoned legal-status Critical Current

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Description

WO00/48521 PCT/US99/12610 TRANSILIAC APPROACH TO ENTERING A PATIENT'S INTERVERTEBRAL SPACE CROSS-REFERENCES TO RELATED APPLICATIONS 5 The present application is a regular application claiming benefit under 35 USC §119(e) from U.S. Provisional Patent Applications Serial No. 60/120,663 filed February 19, 1999; and U.S. Provisional Patent Application No. 60/129,703, filed April 16, 1999; the complete disclosure of 10 which are hereby incorporated herein by reference in their entirety for all purposes. BACKGROUND OF THE INVENTION A major problem when accessing a patient's 15 intervertebral space during spinal surgery is the problem of avoiding sensitive nerves and ligaments during the operative procedure. When accessing the para-spinal space or a specific intra-discal space to perform a discal or intervertebral procedure, the optimal angle of approach to 20 avoid sensitive nerves and ligaments is a posterolateral angle. However, this angle of approach is not practical when accessing the lower vertebrae, specifically the L5/Sl inter-vertebral space, due to the patient's ilium bone which blocks such an angle of approach. Consequently, when 25 performing surgical procedures at L5/Sl it is necessary to enter the intervertebral space from another angle, thus increasing the danger of interfering with the cauda equina and ligaments at such lower vertebrae. 30 SUMMARY OF THE INVENTION The present invention provides methods for percutaneously accessing the patient's intervertebral space by creating an access portal through the patient's ilium and into the patient's intervertebral space. The access portal 35 created by the present invention is preferably at a posterolateral angle, (preferably in the range of 40 to 90 WO00/48521 2 PCTIUS99/12610 degrees to an anterior-posterior axis through the patient), thereby being at the optimal angle of approach to the intervertebral space for these lower L5/Sl vertebrae. Methods are also provided for advancing surgical instruments 5 through the passage and into the intervertebral space. A system is also provided for conveying and depositing bone wax into bone interstices created by the coring of the ilium, thereby reducing bleeding. As dual cannulae system of accessing a patient's 10 intervertebral space is also provided. BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1 is a schematic view of a cannulated obturator inserted percutaneously into the patient's back. 15 Fig. 2 is a schematic view of the cannulated obturator of Fig. 1 placed in contact with the patient's ilium, with a screw-fastening element inserted therethrough. Fig. 3A is a schematic view of a bone cutting drill adapted with a spiral bonewax depression to deposit 20 bone wax during cutting, with the fastening element screwed through the patient's ilium. Fig. 3B shows the bone cutting drill advanced through the patient's ilium. Fig. 4 is a schematic view of a cut-out section of 25 the patient's ilium being removed by a cannulated fastening element. Fig. 5 is a schematic view of a cannulated access portal through the patient's ilium. Fig. 6 is a schematic view of a surgical 30 instrument passing through the patient's ilium and through a second cannula and into the patient's intervertebral space. Fig. 7 is an illustration of a pair of percutaneously inserted cannulae approaching a patient's ilium in posterolateral angles. 35 Fig. 8 is an illustration of a pair of percutaneously inserted cannulae approaching a patient's WO00/48521 3 PCT/US99/12610 ilium in posterolateral angles with a bone cutter passing through the patient's ilium. Fig. 9 is a view of a racetrack-shaped hole passing through the ilium. 5 DESCRIPTION OF THE SPECIFIC EMBODIMENTS Figs. 1-5 are to be viewed in sequence and show different aspects of the present method of providing a surgical access portal through a patient's ilium. Fig. 6 10 shows a method of inserting a surgical device into the intervertebral space through a second cannula which is received through the first cannula and through the access portal cut in the ilium. Fig. 1 shows a cannulated obturator 10 received in 15 a cannula 12 which is percutaneously introduced through the back 14 of a patient having an ilium 16 and an intervertebral space 18. Obturator 10 has a narrow tapered end 11 enabling it to pass through the patient's tissues such that end 11 can be advanced to a position adjacent 20 ilium 16 as is seen in Fig. 2. After obturator 10 reaches ilium 16, cannula 12 can be slipped down thereover such that a distal end 13 of cannula 12 can be placed in contact with ilium 16. Preferably, as is shown in Figs. 1 and 2, distal end 13 of cannula 12 can have a angled end such that it can 25 be rotated about its longitudinally extending central axis to abut against ilium 16 although ilium 16 is angled to cannula 12. A fastening element is then attached to the ilium. In a preferred aspect, this fastening element comprises a 30 screw-type fastening element 20 which is preferably held within bore 9 of obturator 10. Fastening element 20 can then be rotated to be screwed into ilium 16, as shown. As seen in Fig. 3A, obturator 10 is then removed and a bone cutting device 15, which is preferably hollow as 35 shown, is inserted into cannula 12 over fastening screw 20 such that bone cutting device 15 abuts against ilium 16. Screw-type fastening element 20 is received within a hollow WO00/48521 4 PCT/US99/12610 bore 21 of bone cutter 15 as shown. Back and forth oscillation or continuous rotation of bone cutter 15 will eventually bore through ilium 16 to the position shown in Fig. 3B. 5 Bone cutter 15 is adapted to provide for the conveyance and deposition of bone wax into bone interstices created by the coring of the ilium, thereby reducing intraoperative and postoperative bleeding. Specifically, spiral grooves 23 on the exterior surface of bone cutter 15 10 are adapted to hold bone wax or paraffin therein such that the bone wax or paraffin will be heated and melt with the cutting friction, thereby being deposited into the cored bone region. Accordingly, bone healing is promoted. In a preferred aspect, bone cutter 15 comprises an 15 oscillating "cast" drill (ie: a drill which cuts through rigid objects but not soft objects), which is adapted to cut through the hard bony tissue of the ilium without damaging softer surrounding tissues. As shown in Fig. 4, oscillation or rotation of 20 bone cutter 15 will eventually cut out a circular section 19 of ilium 16 which can be removed as follows. Since fastening element 20 is rotated to be screwed into section 19 of ilium 16, removal of fastening element 20 and bone cutter 15 from within cannula 20 will thus also cause 25 circular cut-out section 19, (which is attached to fastening element 20), to be removed as well. When bone cutter 15 and fastening element 20 are simultaneously removed, section 19 will preferably remain within the cannula of bone cutter 15. Rotational or axial movement of fastening element 20 30 relative to bone cutter 15 will subsequently remove section 19 from the cannula of bone cutter 15. As a result, a cannulated access portal 30 will be provided passing percutaneously through the patient's ilium as is shown in Fig. 5. 35 Subsequently, as is shown in Fig. 6, a surgical tool 25 which may comprise an intervertebral insert, bone decorticator, camera, articulating forceps, intervertebral insert positioning systems, bone-graft introducer, WO00/48521 5 PCT/US99/12610 electrocoagulator, bone wax applicator, shaver or curette, can then be inserted through cannula 20 and through ilium 16 such that surgical tool 25 can reach intervertebral space 18. Specifically, in a preferred aspect, a second cannula 22 5 is dimensioned to be slidably received within first cannula 12 such that cannula 22 can be advanced to intervertebral space 18. Surgical tool 25 can then be inserted therethrough such that surgical tool 25 can be positioned at intervertebral space 18, as shown. In a preferred aspect, 10 the second cannula may have an oval cross section. In another preferred aspect, nerve.surveillance electrodes 31 are positioned at the distal end of cannula 22 or on surgical device 25, (which may comprise a blunt obturator). Electrodes 31 can be adapted to sense the 15 presence of a para-spinal nerve as cannula 22 is advanced through access portal 30. In alternative aspects, expandable trocars may be inserted through cannula 22 to access the patient's intervertebral space. Cut-out section 19 can itself be used as bone 20 graft material for packing around or within intervertebral inserts which are positioned in the intervertebral space using the present system. As is shown in Fig. 9, a racetrack-shaped hole 40 can be drilled through the ilium 16 by sequentially drilling 25 overlapping first and second circular holes 42 and 44 using the present method. As can be appreciated holes of various shapes, (including elongated racetrack shapes), can be drilled through the patient's ilium. An advantage of racetrack-shaped hole 40 is that it permits cannulae having 30 oval or racetrack-shaped cross sections to be passed through ilium 16, and into the patient's intervertebral region. As the present invention is adapted to provide a passage through the patient's ilium as is set forth herein, an optimal posterolaterally angled access portal through to 35 the patient's L5/S1 intervertebral spaces can be provided. Fig. 7 shows a pair of percutaneously inserted cannulae 12 approaching the patient's ilium 16 in posterolateral angles, which are preferably in the range of WO00/48521 6 PCT/US99/12610 400 to 90' to an anterior axis through the patient. Fig. 8 shows the pair of percutaneously inserted cannulae 12 positioned against the patient's ilium 16 in posterolateral angles with the distal end of bone cutter 15 passing through 5 patient's ilium 16. The present invention also provides kits for providing a surgical access portal through a patient's ilium, comprising: a cannula; a bone cutting drill dimensioned to be received within the cannula; a fastening 10 element dimensioned to be received within the bone cutting drill; and instructions for use setting forth any of the methods herein described. The present invention also provides kits for providing access to a patient's intervertebral space through 15 a patient's ilium, comprising: a first cannula; a bone cutting drill dimensioned to be received within the first cannula; a fastening element dimensioned to be received within the bone cutting drill; and instructions for use setting forth any of the methods herein described.

Claims (1)

  1. 27. The system of claim 15, further comprising, 2 an intervertebral implant dimensioned to be received within 3 the first and second cannulae.
AU45479/99A 1999-02-19 1999-06-04 Transiliac approach to entering a patient's intervertebral space Abandoned AU4547999A (en)

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US12066399P 1999-02-19 1999-02-19
US60120663 1999-02-19
US12970399P 1999-04-16 1999-04-16
US60129703 1999-04-16
PCT/US1999/012610 WO2000048521A1 (en) 1998-06-09 1999-06-04 Transiliac approach to entering a patient's intervertebral space

Publications (1)

Publication Number Publication Date
AU4547999A true AU4547999A (en) 2000-09-04

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AU45479/99A Abandoned AU4547999A (en) 1999-02-19 1999-06-04 Transiliac approach to entering a patient's intervertebral space

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EP (1) EP1113756A1 (en)
AU (1) AU4547999A (en)

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8834508B2 (en) 2011-05-27 2014-09-16 Spinefrontier Inc Methods, tools and devices for percutaneous access in minimally invasive spinal surgeries

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EP1113756A1 (en) 2001-07-11

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Legal Events

Date Code Title Description
MK1 Application lapsed section 142(2)(a) - no request for examination in relevant period