CN110891501A - 脊椎固定入路和输送系统 - Google Patents

脊椎固定入路和输送系统 Download PDF

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CN110891501A
CN110891501A CN201880047186.2A CN201880047186A CN110891501A CN 110891501 A CN110891501 A CN 110891501A CN 201880047186 A CN201880047186 A CN 201880047186A CN 110891501 A CN110891501 A CN 110891501A
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feature
access device
chamfered
access
spinal fixation
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希格鲁·坦埃克
克里斯托弗·U·法纳
克里斯托弗·兰伯特
尼古拉斯·多梅克
博恩·尚
爱德华·莱奥乌
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Providence Medical Technology Inc
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    • A61B17/7085—Tools for guidance or insertion of tethers, rod-to-anchor connectors, rod-to-rod connectors, or longitudinal elements for insertion of a longitudinal element down one or more hollow screw or hook extensions, i.e. at least a part of the element within an extension has a component of movement parallel to the extension's axis
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Abstract

公开了一种脊椎固定入路和输送系统。在一些方面，所述系统用于经由后入路进入颈小面关节。所述系统可以包括入路装置，所述入路装置包括具有近侧部分和远侧部分的主体以及位于主体的远侧部分处并构造成用于在颈小面关节处插入的倒角或斜切端部特征。所述系统还可以包括具有入路装置接合特征的引导装置和脊椎固定构件。所述入路装置包括与引导装置的接合特征互补或键合的至少一个引导装置接收特征。

Description

脊椎固定入路和输送系统
相关申请的交叉引用
本申请要求2017年5月19日提交的，名称为“脊椎固定入路和输送系统(SPINALFIXATION ACCESS AND DELIVERY SYSTEM)”的美国专利申请号62/508,434的优先权，上述申请的全部内容通过引用并入本文。
技术领域
本申请涉及医疗装置和方法。更具体地，本申请涉及与脊椎固定有关的装置和方法，以为脊椎提供稳定性并促进脊椎融合。
背景技术
在美国和其他发达国家，慢性腰背问题是引起疼痛和残疾的最常见原因之一。根据至少一个估计，在美国最常用的外科程序是使用板，螺钉和其他植入物将两个相邻的椎骨融合在一起的脊椎融合程序。进行脊椎融合的目的是试图增加被手术的两个相邻椎骨之间的空间(称为脊椎牵开)并且因此防止撞击从脊髓分支并穿过脊柱中的开口的脊髓或神经根。不幸的是，用于执行脊椎融合的大多数技术和装置是相对有创的，并且涉及许多风险以及难以恢复和康复。
脊椎后路融合是外科干预的一种方法。然而，为了提供目标区域的直接可视化，需要对肌肉和韧带进行广泛切开。该切开会引起急性和慢性软组织疼痛综合症。急性地，患者通常需要住院三到四天以控制疼痛，这需要静脉麻醉剂。长期地，由于解剖的广泛性，患者经常会出现持续性疼痛。这与不需要任何肌肉或软组织切开的前入路一日住院形成对比。在一些情况下，软组织可能不会恢复到解剖位置，并且可能会永久变形。后路手术后的持续疼痛被称为椎板切除术后综合症。
因此，由于认为对患者的创伤较小，因此与后路融合手术相比，通常优选前路脊椎融合手术。然而，颈椎后入路确实比前入路有一些优势。
与前板，椎体间装置和棘突间配线相比，侧块或椎弓根螺钉固定提供对颈椎的更多刚性固定。它通常用于创伤性不稳定，但也用于退化性疾病。尽管提供了良好的结果，但如上所述，由于软组织切开的发病率，通常避免进行侧块固定。
因此，需要用于在相邻椎骨融合手术后固定脊椎的替代装置和方法。理想地，这些装置、系统和方法将允许许多当前可用技术无法提供的微创或低创入路和固定。例如，具有使用后路进入脊椎的装置、系统和方法可能是有利的。这些目标中的至少一些将通过本文描述的实施例来实现。
发明内容
本文所述的各种实施例提供了用于经由后入路进入颈椎并输送或提供用于固定颈椎的脊椎固定装置的装置、系统和方法。下文描述的实施例通常包括入路和输送系统，一个或多个脊椎固定装置可以通过其进入或沿着其推进。本文所述的入路装置通常包括可插入颈小面中的远端。一旦插入小面中，入路装置就可以用作稳定点。
公开了一种用于经由后入路进入颈小面关节的颈小面关节入路装置。在一些方面，所述装置包括具有近侧部分和远侧部分的主体以及位于所述主体的所述远侧部分处并构造成用于在颈小面关节处插入的倒角或斜切端部特征。在一些方面，所述倒角或斜切端部特征从所述主体偏移。在一些方面，所述主体是细长主体，具有相对的顶面和底面，相对的侧面和相对的端面，并且所述倒角或斜切端部特征从所述主体偏移并位于所述相对侧面中的一个上。在一些方面，所述主体具有矩形的横截面。在一些方面，所述近侧部分具有第一高度并且所述远侧部分具有第二高度，并且所述第一高度大于所述第二高度。在一些方面，所述主体是细长管状主体。在一些方面，所述倒角或斜切端部特征位于所述远侧部分的端部处。在一些方面，所述端部还包括适于邻接小面关节的后边缘的止动件。所述止动件可以包括适于接合小面关节的凸起或突出特征。在一些方面，所述端部特征包括可扩张锚固件，所述可扩张锚固件经由棘爪特征保持在闭合位置并且通过致动内部杆以将所述端部特征的臂枢转到打开位置而打开。在一些方面，所述端部特征包括可扩张构件，所述可扩张构件保持在闭合位置以用于输送，并且通过致动内部杆而扩张到打开位置。在一些方面，所述端部特征包括铰接尖端。在一些方面，所述主体是管状主体，所述管状主体适于接收用于脊椎固定的其他外科器械。
公开了一种用于经由后入路进入颈小面关节的脊椎固定入路和输送系统。在一些方面，所述系统包括入路装置，所述入路装置包括具有近侧部分和远侧部分的主体以及位于所述主体的所述远侧部分处并构造成用于在颈小面关节处插入的倒角或斜切端部特征。所述系统还可以包括具有入路装置接合特征的引导装置和脊椎固定构件。所述入路装置包括与所述引导装置的接合特征互补或键合的至少一个引导装置接收特征。
所述入路装置可以是如本文公开的入路装置。在一些方面，所述入路装置的所述倒角或斜切端部特征从所述主体偏移。在一些方面，所述主体是细长主体，具有相对的顶面和底面，相对的侧面和相对的端面，并且所述倒角或斜切端部特征从所述主体偏移并位于所述相对侧面中的一个上。在一些方面，所述主体具有矩形的横截面。在一些方面，所述近侧部分具有第一高度并且所述远侧部分具有第二高度，并且所述第一高度大于所述第二高度。在一些方面，所述主体是细长管状主体。在一些方面，所述倒角或斜切端部特征位于所述远侧部分的端部处。在一些方面，所述端部还包括适于邻接小面关节的后边缘的止动件。所述止动件可以包括适于接合小面关节的凸起或突出特征。在一些方面，所述端部特征包括可扩张锚固件，所述可扩张锚固件经由棘爪特征保持在闭合位置并且通过致动内部杆以将所述端部特征的臂枢转到打开位置而打开。在一些方面，所述端部特征包括可扩张构件，所述可扩张构件保持在闭合位置以用于输送并且通过致动内部杆而扩张到打开位置。在一些方面，所述端部特征包括铰接尖端。在一些方面，所述主体是管状主体，所述管状主体适于接收用于脊椎固定的其他外科器械。
在一些方面，所述装置接合特征选自突起、凹口或凹陷。在一些方面，所述系统还可以包括脱皮工具。所述脱皮工具的一部分可以可选地包括磨刀、锉刀或一个或多个齿。
公开了一种用于经由后入路进入颈小面关节的脊椎固定入路和输送系统。在一些方面，所述系统包括入路装置、脊椎固定构件、以及具有至少一个脊椎固定构件接合特征的引导装置。所述脊椎固定构件包括与所述引导装置的接合特征互补或键合的至少一个引导装置接收特征。在一些方面，所述脊椎固定构件是塔柱(tower)或具有塔柱特征的多轴螺钉。在一些方面，所述至少一个脊椎固定构件接合特征是从所述引导装置的外表面突出并且大致沿所述引导装置的长度延伸的大致圆柱形主体。所述入路装置可以是如本文公开的入路装置。
在一些方面，所述入路装置的所述倒角或斜切端部特征从所述主体偏移。在一些方面，所述主体是细长主体，具有相对的顶面和底面，相对的侧面和相对的端面，并且所述倒角或斜切端部特征从所述主体偏移并位于所述相对侧面中的一个上。在一些方面，所述主体具有矩形的横截面。在一些方面，所述近侧部分具有第一高度并且所述远侧部分具有第二高度，并且所述第一高度大于所述第二高度。在一些方面，所述主体是细长管状主体。在一些方面，所述倒角或斜切端部特征位于所述远侧部分的端部处。在一些方面，所述端部还包括适于邻接小面关节的后边缘的止动件。所述止动件可以包括适于接合小面关节的凸起或突出特征。在一些方面，所述端部特征包括可扩张锚固件，所述可扩张锚固件经由棘爪特征保持在闭合位置并且通过致动内部杆以将所述端部特征的臂枢转到打开位置而打开。在一些方面，所述端部特征包括可扩张构件，所述可扩张构件保持在闭合位置以用于输送并且通过致动内部杆而扩张到打开位置。在一些方面，所述端部特征包括铰接尖端。在一些方面，所述主体是管状主体，所述管状主体适于接收用于脊椎固定的其他外科器械。
公开了一种颈部脊椎固定构件。在一些方面，所述脊椎固定构件包括细长管状主体，所述细长管状主体具有在远端和近端之间延伸的长度；限定在所述管状主体的长度的至少一部分中的杆接收槽；以及多轴螺钉。所述脊椎固定构件还可以包括杆。在一些方面，所述杆接收槽还包括限定在所述细长管状主体的外圆周中的开口。在一些方面，所述杆接收槽仅沿所述细长主体的长度的一部分延伸，并且所述细长主体在剩余的长度上是实心的。
下面将参考附图进一步详细描述这些和其他方面以及实施例。
附图说明
图1是C5和C6(颈)椎骨的外侧视图。
图2A是根据本公开的入路装置的透视图。
图2B-2E是使用中的图2A的入路装置的各种视图。
图3A-3C是根据本公开的另一入路装置的透视图、俯视图和局部后视图。
图3D是使用中的图2A和图3A的入路装置的后视图。
图4A-4C是根据本公开的具有止动特征的入路装置的局部透视图。
图4D-4G是使用中的图4A-4C的入路装置的各种视图。
图5A-5D是根据本公开的具有可扩张端部特征的入路装置的侧视图和等距视图，其中图5A和5C示出了闭合位置，图5B和5D示出了打开位置。
图5E-5F示出了使用中的图5A-5D的入路装置。
图6A-6D是根据本公开的具有可扩张端部特征的入路装置的侧视图和等距视图，其中图6A和6C示出了闭合位置，图6B和6D示出了打开位置。
图6E-6F示出了使用中的图6A-6D的入路装置。
图7A-7B是根据本公开的具有带刚性尖端的端部特征的入路装置的俯视图和外侧视图。
图7C是使用中的图7A-7B的装置。
图8A-8B是根据本公开的具有带铰接尖端的端部特征的入路装置的俯视图和等距视图。
图8C-8F是处于解锁位置(图8C-D)和锁定位置(图8E-F)的图8A-B的尖端的放大图。
图8G-H是图8C-8F的尖端的横截面图。
图9A-9B是根据本公开的具有带铰接尖端的端部特征的入路装置的俯视图和等距视图。
图9C-9E是处于解锁位置(图9C-D)和锁定位置(图9E)的图9A-B的尖端的放大图。
图9F-G是图9C-9E的尖端的横截面图。
图10A-10B是根据本公开的具有带铰接尖端的端部特征的入路装置的俯视图和等距视图。
图10C-10D是处于解锁位置(图10C)和锁定位置(图10D)的图10A-B的尖端的放大图。
图10E-F是图10C-D的尖端的横截面图。
图11A-11B是根据本公开的具有带铰接尖端的端部特征的入路装置的俯视图和等距视图。
图11C-11H是处于解锁位置(图11C、11E-F)和锁定位置(图11D、11G-H)的图11A-B的尖端的放大图或透明图。
图12A-12B是根据本公开的具有带铰接尖端的端部特征的入路装置的俯视图和等距视图。
图12C-12H是处于解锁位置(图12C、12E-F)和锁定位置(图12D、12G-H)的图12A-B的尖端的放大图或透明图。
图13A-13F是根据本公开的方面的组合入路和引导系统。
图14A-14G示出了根据本公开的方面的入路和输送系统。
图14H-14S示出了使用中的图14A-14G的系统。
图15A-15G示出了根据本公开的方面的入路和输送系统。
图15H-15R示出了使用中的图15A-15G的系统。
图16A-16C示出了可以通过与固定装置接合而进一步稳定的根据本公开的方面的入路和输送系统。
图17A-17F示出了可以通过与固定装置接合而进一步稳定的根据本公开的方面的入路和输送系统的一部分。
图18A-H是可以通过与固定装置接合而进一步稳定的根据本公开的方面的入路和输送系统的一部分的各种实施例的横截面。
图19A-19E是可以与图17的系统一起使用的临时锁定螺钉的各种视图。
图19F-19Q示出了使用中的图17和19A-19E的螺钉和系统。
图20A是与本公开的装置和系统一起使用的固定装置。
图20B-20E示出了使用中的图20A的固定装置。
具体实施方式
脊椎狭窄反射了通常在上或下背部中的一个或多个脊椎区域的变窄。该变窄会向脊髓或从压缩区域分支的神经施加压力。脊椎的单独椎骨相对于彼此定位，并且通过分离主椎骨的椎间盘和位于小面关节内的囊来保持它们的分离。椎间盘和囊通过软骨与它们相应关节的骨分离。脊椎狭窄通常指示椎间盘，囊或关节中的软骨的退化，这会导致关节压缩和上述变窄。
为了减轻脊椎狭窄，牵开脊椎的两个相邻椎骨(例如，图1中所示的颈椎骨)的选项多种多样，并且可以包括使用植入物，或笼和螺钉。在许多情况下，可以将小面关节植入物插入小面关节本身中，并且由于植入物的设计，不能做进一步将植入物固定在关节内的操作。换句话说，植入物的形状，尺寸，表面特征和整体构造可以使其牢固地保持在小面关节内，而无需其他附接装置。然而在某些情况下，并且通常为了小面关节牵开程序的整体安全性，使用一个或多个附加装置(例如螺钉)来帮助将小面关节植入物用螺钉固定到形成关节的相邻椎骨中的一者或两者可能是有利的。
此外，通过使用椎弓根螺钉和/或侧块螺钉作为脊椎融合手术的补充为融合部位提供额外的稳定可能是有利的。椎弓根螺钉或侧块螺钉是设计用于分别插入椎骨的椎弓根或侧块中的骨螺钉的类型。螺钉插入相邻椎骨(例如，连续的脊椎节段，例如C5和C6)中并且然后经由杆连接以防止正在融合的那些节段处的运动。以该方式，螺钉用作杆的锚固点并且为融合部位提供额外的稳定性以促进更好的融合。融合后，可以去除杆和螺钉。
本文中描述了用于经由后入路进入颈部脊椎并在脊椎中引入、植入和/或固定诸如螺钉和杆的脊椎固定装置的装置、系统和方法。经由后入路进入颈部脊椎利用微创或低创技术。下面描述的方面大体上包括入路工具和引导工具，可以通过其或沿其推进一个或多个脊椎固定装置。另外，可以通过或借助于引导工具推进独立的脱皮工具。脱皮工具可以包括磨刀或锉刀或齿或其他骨糙化特征，用于在插入脊椎固定装置之前准备骨表面。
在使用中，外科医生通过微创或低创切口将入路工具推进到小面关节中。一旦锚固就位，该入路工具将在脊椎深处提供一个固定点，然后将所述固定点用作标记以将钻头，锥子，板，杆和螺钉以及其他器械从后入路推进到颈部脊椎，而无需直接可视化。用公开的装置进行这样的入路防止器械从脊椎滑落或防止钻头捕获软组织并打滑失控。另外，在大部分(如果不是全部)患者中，颈小面与侧块骨具有固定的解剖关系。器械可以在入路工具上，沿着入路工具或围绕入路工具推进到侧块上或处的可靠界标，而无需直接可视化。例如，为了帮助脊椎固定，可以在引导工具的帮助下插入侧块螺钉或椎弓根螺钉。
现在转向附图，入路工具或入路装置也可以被称为入路凿子或入路锚固件。将入路装置推进到在相邻椎骨(例如颈部脊椎的椎骨)之间限定的小面关节。该装置提供了到小面关节和周围解剖结构(如侧块和椎弓根)的入路。
现在参考图2A-12H，入路装置10包括具有近侧部分20和远侧部分25的主体15。远侧部分25还包括倒角或斜切端部特征30。入路装置可以由钛、不锈钢、聚碳酸酯、或任何其他强度足够的金属、金属合金或聚合物制成。
在一些方面，如图2A-2E中所示，入路装置10的主体15是细长主体，具有相对的顶面和底面15a、15b，相对的侧面15c、15d以及相对的端面15e、15f。主体在朝向远侧部分25延伸的近侧部分20处具有大体矩形的横截面。在远侧部分处，细长主体相对于近侧部分逐渐降低或变窄。也就是说，并且参考图2B，近侧部分的高度HP大于主体15的远侧部分的高度HD。近侧部分构造成接收可去除手柄(未示出)以便易于用户操纵装置10。远侧部分25还包括位于细长主体的侧面15d上的倒角或斜切端部特征30。也就是说，端部特征30相对于主体偏移。
从示出在小面关节处或附近插入的装置10的图2B-2D可以理解，细长主体可以竖直定向以在颅尾方向上提供竖直刚性以帮助抵抗椎弓根或侧块螺钉的滑动(在下面更详细描述插入)。此外，细长主体用于参考侧块的外侧方面(参见图2D-2E)，并且这样的形状可以有利地提供到侧块的无阻碍通路。
如图3A-3C中所示，在一些方面，入路装置10包括主体15，其可以是具有近侧部分20和远侧部分25的细长管状主体。远侧部分25还包括位于细长主体的侧面上的倒角或斜切端部特征30。也就是说，端部特征30相对于主体偏移。管状主体具有低轮廓，并且可以用于沿其主体滑动地接收其他器械。
图3D描绘了图2A-2E的入路装置和图3A-3C的入路装置，并且示出了不对称的倒角或斜切端部特征，其提供了从轴向通路到关节空间偏移的装置。
在一些方面，并且从图4A-4G可以理解，入路装置10包括主体15，所述主体可以是具有近侧部分20和远侧部分25的细长管状主体。远侧部分25还包括位于入路装置的远侧部分的端部处的倒角或斜切端部特征30。端部特征30还包括构造成邻接小面关节的后边缘的止动特征35。止动特征35可以包括凸起或突出特征，例如单个尖钉(图4C)或多个尖钉或齿(图4A)，例如华夫饼型尖钉，或龙骨(图4B)。凸起或突出特征接合小面关节以将装置10锚固到小面关节中。图4D-4G示出了使用中的图4A-4C中描绘的止动特征，其中装置10插入小面关节中，止动特征35邻接小面关节的后边缘，并且凸起或突出的特征接合关节以锚固装置10。
在一些方面，并且从图5A-6F可以理解，入路装置10包括主体15，所述主体可以是具有近侧部分20和远侧部分25的细长管状主体。远侧部分25还包括位于入路装置的远侧部分的端部处的倒角或斜切端部特征30。端部特征30可以是可扩张端部特征，其包括齿或凸起的脊30a以接合小面关节和/或止动特征或图4中描述的凸起/突出特征。
如图5A-5D中所示，在一方面，端部特征30包括两个臂40，所述两个臂由棘爪特征42保持在闭合位置，并且当定位在小面关节中时通过内部杆44的致动而扩张(参见图5E-5F，示出了放置在小面关节中)。内部杆可以在枢转点处打开臂，或者臂可以具有带斜坡特征的内部边缘，当杆向远侧推进时所述斜坡特征由杆接合。
如图6A-6D中所示，在另一方面，端部特征包括可扩张构件45，所述可扩张构件在平坦或闭合位置(参见图6E)被输送并且一旦在小面关节中就位(图6F)就扩张或打开。可扩张构件经由连接至尖端的内杆打开，所述内杆向近侧致动以压缩可扩张构件。替代地，外杆向远侧致动以压缩可扩张构件。可扩张构件由镍钛诺(nitinol)，不锈钢，弹簧钢或可以扩张和收缩而不会永久变形的其他金属或金属合金制成。
在一些方面，并且从图7A-7C可以理解，入路装置10包括主体15，所述主体可以是具有近侧部分20和远侧部分25的细长主体。远侧部分25还包括位于入路装置的远侧部分的端部处的倒角或斜切端部特征30。端部特征30可以是刚性尖端50(7A)。在使用中，并且如图7B-7C中所示，装置10被插入小面空间中并与其他器械(例如图7C中所示的引导管)结合使用，从而以与小面关节相同的角度将螺钉(由图7C中的箭头描绘)引导到侧块。
在一些方面，并且从图8A-12H可以理解，入路装置10包括主体15，所述主体可以是具有近侧部分20和远侧部分25的细长主体。远侧部分25还包括位于入路装置的远侧部分的端部处的倒角或斜切端部特征30。端部特征30可以包括铰接尖端50。
如图8A中所示，铰接尖端50可以包括具有板的锁定球接头。如图8B中所示，用户在箭头A的方向上拉动并顺时针旋转手柄以将铰接尖端锁定就位。图8C-8D示出了处于打开或解锁位置的铰接尖端，在该位置允许尖端自由旋转。图8E-8F示出了处于锁定位置的铰接尖端。板55与球接头60接合，将尖端50锁定就位。图8G-8H示出了截面图，其中图8G示出了处于打开位置的尖端50，在该位置板55未与球接头60接合。图8H示出了板55经由沿着主体15的远侧部分的轴的螺纹锁定就位。球接头60与板55接合。
如图9A中所示，铰接尖端50包括具有壳体的锁定球接头。如图9B中所示，用户在箭头B的方向上下推手柄并顺时针旋转手柄以将铰接尖端锁定就位。图9C-9D示出了处于打开或解锁位置的铰接尖端50，在该位置允许尖端自由旋转。图9E示出了处于锁定位置的尖端50。如图所示，杆65与球接头70接合，由此将尖端50锁定就位。图9F-9G示出了截面图，其中图9F示出了处于解锁位置的尖端50，在该位置杆65与球接头70和尖端50脱离。图9G示出了处于锁定位置的尖端50，在该位置杆65与球接头70和尖端50接合。
如图10A中所示，铰接尖端50包括具有郁金香结构(tulip)85的套筒80。如图10B中所示，用户在箭头C的方向上下推手柄以将铰接尖端50锁定就位。图10C示出了处于打开或解锁位置的铰接尖端50，在该位置允许尖端自由旋转。图10D示出了处于锁定位置的尖端。如图所示，套筒80和郁金香结构85与球接头75接合，由此将尖端50锁定就位。图10E-10F示出了截面图，其中图10E示出了处于解锁或打开构造的尖端50。套筒与锁定郁金香结构脱离，并且尖端50能够自由旋转。图10F示出了处于锁定位置的尖端。套筒80与锁定郁金香结构85接合，由此将球接头75锁定就位，并且因此将尖端50锁定就位。
如图11A中所示，铰接尖端50包括单向枢轴90。如图11B中所示，用户在箭头D的方向上下推手柄，并顺时针旋转手柄以将尖端50锁定就位。图11C示出了处于打开或解锁位置的尖端50。图11D示出了处于闭合或锁定位置的尖端50。图11E-F是透明图和放大图，示出了处于解锁位置的尖端50。杆95不与锁定合销100接合，并且尖端50能够沿着冠状平面旋转。图11G-H是透明图和放大图，示出了处于锁定位置的尖端50。杆95被向前推动以与锁定合销100相互作用，由此将尖端50锁定在冠状平面中的一个位置。
如图12A中所示，在一些方面，铰接尖端50包括锁定轮105。如图12B中所示，用户在箭头E的方向上下推手柄并顺时针旋转手柄以将尖端锁定就位。图12C示出了处于打开或解锁位置的尖端50。图12D示出了处于闭合或锁定位置的尖端50。图12E-F是透明图和分解图，示出了处于解锁位置的尖端。杆110与合销115上的锁定特征112脱离，由此允许尖端50自由旋转。图12G-H是透明图和分解图，示出了处于锁定位置的尖端50。杆110被向前推动以与合销115的平坦锁定特征112相互作用，由此将尖端50锁定就位。取决于平坦锁定特征的哪个部分被接合，尖端50可以锁定在冠状平面中的六个不同位置中的一个中。在其他实施例中，平坦锁定特征可以具有六个以上位置或六个以下位置。
如上所述，入路装置可以与其他工具一起使用以输送脊椎固定装置。可以例如通过引导入口或装置来实现输送。
如图13A-13F中所示，在一些方面，入路装置10或尖端50与引导入口组合作为单个、一体或整体入路和引导系统。如图13A-B中所示，引导入口120包括细长管状主体，所述细长管状主体限定通过其中的至少一个管腔125。在一些方面，可以有一个以上管腔或可以有部分管腔。图13C-D示出了入路和引导系统的另一实施例，引导入口120包括细长管状主体，所述细长管状主体限定通过其中的至少一个管腔125。尖端50和引导入口120的小面接合面为锥形以帮助插入和进入小面空间。在使用中，并且如图13E-F中所示，入路和引导系统插入小面空间中。尖端50嵌入入口120并将其固定到小面的角度。在插入之后，系统中的其他器械(例如脊椎固定装置)以与小面相同的角度穿过入口到达侧块。尽管图13E-F示出了图13A-B中所示的实施例的插入，但是应当理解，可以类似地插入图13C-D的实施例。
如图14A-19Q中所示，在一些实施例中，入路装置10与引导装置130键合或配对作为入路和输送系统的部件。引导装置可以用于将脊椎固定装置引导到脊椎。
如图14A-D的透视图和横截面图中所示，在一个实施例中，引导装置130包括多个槽或开口135，构造成接收和引导脊椎固定装置(参见下文的更多描述)的塔柱或螺钉部件的上部槽或第一槽，以及构造成接合入路装置10的下部槽或第二槽。入路装置10包括与引导装置互补并键合的第一(或上部)和第二(或下部)凹口或凹陷140。图14E-G示出了定位在一起的入路装置10和引导装置130。图14H-J示出了插入小面关节中的入路装置10以及然后插入到引导装置上的引导装置。图14K-14S描绘了使用入路装置10和引导装置130来输送一个或多个脊椎固定装置145。在使用中，将入路装置10插入小面关节中，并且然后将引导装置插入到入路装置上。通过引导件130插入脊椎固定装置145，并且将骨螺钉拧入侧块中(图14K-L)。去除引导件130(图14M)，但是入路装置10保持在原位。然后将引导件放置在入路装置的另一侧以接合另一侧块(图14N-O)。通过引导件130插入脊椎固定装置145，并且将骨螺钉拧入侧块(图14P-Q)。然后去除引导装置和入路装置(图14R-S)，并且可以将杆插入固定装置的塔柱中(未示出，但是参见下文)。
如图15A-D的透视图和横截面图中所示，在一个实施例中，引导装置130包括通过其中限定并构造成接收和引导脊椎固定装置(参见下文的更多描述)的塔柱或螺钉部件的管腔155，以及构造成接合入路装置10的轨道配合特征160。入路装置10包括与引导装置互补并键合的第一(或上部)和第二(或下部)凹口或凹陷140。图15E-G示出了定位在一起的入路装置10和引导装置130。图15H-J示出了插入小面关节中的入路装置10以及然后在引导装置旁边插入的引导装置。图15K-15R描绘了使用入路装置10和引导装置130来输送一个或多个脊椎固定装置145。在使用中，将入路装置10插入小面关节中，并且然后在引导装置旁边插入引导装置。通过引导件130插入脊椎固定装置145，并且将骨螺钉拧入侧块中(图15K-L)。去除引导件130(图15M)，但是入路装置10保持在原位。然后将引导件放置在入路装置的另一侧以接合另一侧块(图15N-O)。通过引导件130插入脊椎固定装置145，并且将骨螺钉拧入侧块(图15P-Q)。然后去除引导装置和入路装置(图15R)，并且可以将杆插入固定装置的塔柱中(未示出，但是参见下文)。
在一些方面，引导装置130可以仅与入路装置10的一部分(例如，尖端50)一起使用，并且可以通过与已经植入的固定装置(例如，塔柱或具有塔柱特征的多轴螺钉)接合而进一步稳定。
例如，并且如图16A-B中所示，引导装置130包括通过其中限定的管腔165和螺钉塔柱接合特征170。接合特征可以是从引导装置的外表面突出并且大致沿引导装置的长度延伸的大致圆柱形主体。管腔165可以具有数字8的形状或其他双重定位形状。图16C示出了使用引导装置130和入路装置尖端50来放置固定装置的塔柱，如下面更详细地所述。
图17A-17F示出了引导装置130的另一实施例，所述引导装置可以通过与已经植入的诸如塔柱的固定装置的接合而进一步稳定。如图17A-B中所示，引导装置130包括通过其中限定的管腔165和塔柱接合特征170。接合特征可以是从引导装置的外表面突出并且大致沿引导装置的长度延伸的大致圆柱形主体。管腔165可以具有数字8的形状或其他双重定位形状(由位置1和2指示)。在使用中(为清晰起见隐藏了脊椎)，如图17C-17F中所示，将引导装置130插入锚固塔柱145中。然后，将第二塔柱145通过管腔165插入到位置1或位置2。
图18A-H示出了引导装置130的其他实施例的横截面，所述引导装置130包括通过其中限定的管腔165和塔柱接合特征170。塔柱接合特征可以构造成由塔柱接收(图18A-D)或者可以构造成接收塔柱(图18E-18H)。
图19A-19B描绘了可以与图17的系统一起使用的临时锁定螺钉。锁紧螺钉190包括六角头195，与内部塔柱螺纹匹配的外螺纹200，固定销孔205，固定销210，可以为3.5mm的旋转头部215，以及允许头部围绕轴旋转的销220。在使用中，并且如图19C-19E中所示，将螺钉190插入塔柱中(19C)，并且螺纹200与内部塔柱螺纹接合(19D)。螺钉头部195抵靠鞍座以锁定塔柱相对于螺钉的旋转(19E)。如果螺钉保持拧紧，则塔柱将不会旋转。
在脊椎中使用时，将塔柱拧入侧块中(19F)。用六角螺丝刀将螺钉190插入塔柱145中(19G)。头部215如图所示定向(19H)。顺时针旋转六角螺丝刀以拧紧螺钉直到头部接触鞍座(19I-J)。将引导装置130插入到塔柱上，邻接临时锁定螺钉190的后表面(图19K-L)。接下来，将第二塔柱通过引导管插入(19M-N)。去除引导件并使用六角螺丝刀拧下临时锁定螺钉(190)。去除锁定螺钉(19P)并且将两个塔柱固定在侧块中(19Q)。
在各种实施例中，固定装置145，例如具有塔柱特征的多轴螺钉，用于在脊椎融合程序之后为脊椎提供额外的稳定性。塔柱是如本文所述用于微创后路固定系统的多轴螺钉(例如椎弓根螺钉或侧块螺钉)的延伸部。塔柱可以是可去除塔柱。上述实施例包括具有全长槽的塔柱，其允许将固定杆降低到适当位置。
在另一方面，并且如图20A-20E中所示，与本文公开的装置和系统一起使用的固定装置145包括细长管状主体或塔柱220，槽225和螺钉240。槽225可以是部分槽或L形槽，其沿塔柱的长度的至少一部分延伸并且具有在塔柱的外圆周中形成的杆接收开口。槽225接收用于将螺钉240固定到椎骨中的杆230。槽沿着塔柱的长度的至少一部分延伸，使得杆仍插入在患者的皮肤水平上方的高度，同时仍然为槽入口上方的塔柱的长度的至少一部分提供实心的圆柱形轮廓。在使用中，图20A的固定装置145植入或部署到连续椎骨的侧块中，并且槽225排成一行以接收杆230(图20B)。固定杆230插入槽中(图20C)并沿槽前进或向下滑动(图20D)，直到它安置在螺钉头部中(图20E)。固定螺钉用于固定杆。一旦固定，就将塔柱的多余长度(“塔柱延伸部”)切除或折断，而固定装置保持在原位。
所有相对和方向参考(包括：上，下，向上，向下，左，右，向左，向右，顶，底，侧，上方，下方，前，中，后，竖直，水平等)通过示例的方式给出以帮助读者理解本文所述的特定实施例。除非在权利要求中明确提出，否则不应将它们理解为要求或限制，特别是关于位置，取向或用途。连接参考(例如，附接，联接，连接，接合等)应被广义地解释，并且可以包括元件的连接之间的中间构件以及元件之间的相对运动。因而，除非在权利要求中明确提出，否则连接参考不一定推断两个元件直接连接并且彼此成固定关系。
尽管已在某些实施例和示例的上下文中公开了本发明，但是本发明超出具体公开的实施例扩展到本发明的其他替代实施例和/或用途及其明显的修改和等同形式。因此，意图是本文公开的本发明的范围不应受到上述特定公开的实施例的限制。

Claims (51)

1.一种用于经由后入路进入颈小面关节的颈小面关节入路装置，所述装置包括：
具有近侧部分和远侧部分的主体；以及
位于所述主体的所述远侧部分处并构造成用于在颈小面关节处插入的倒角或斜切端部特征。
2.根据权利要求1所述的入路装置，其中所述倒角或斜切端部特征从所述主体偏移。
3.根据权利要求1或2所述的入路装置，其中所述主体是细长主体，所述细长主体具有相对的顶面和底面、相对的侧面和相对的端面，并且所述倒角或斜切端部特征从所述主体偏移并位于所述相对侧面中的一个上。
4.根据权利要求3所述的入路装置，其中所述主体具有矩形的横截面。
5.根据权利要求4所述的入路装置，其中所述近侧部分具有第一高度并且所述远侧部分具有第二高度，并且所述第一高度大于所述第二高度。
6.根据权利要求1或2所述的入路装置，其中所述主体是细长管状主体。
7.根据前述权利要求中任一项所述的入路装置，其中所述倒角或斜切端部特征位于所述远侧部分的端部处。
8.根据权利要求7所述的入路装置，其中所述特征还包括适于邻接小面关节的后边缘或后部分的止动件。
9.根据权利要求8所述的入路装置，其中所述止动件包括适于接合小面关节的凸起或突出特征。
10.根据权利要求1所述的入路装置，其中所述端部特征包括可扩张锚固件，所述可扩张锚固件经由棘爪特征保持在闭合位置并且通过致动内部杆以将所述端部特征的臂枢转到打开位置而打开。
11.根据权利要求1所述的入路装置，其中所述端部特征包括可扩张构件，所述可扩张构件保持在闭合位置以用于输送并且通过致动内部杆而扩张到打开位置。
12.根据权利要求1所述的入路装置，其中所述端部特征包括铰接尖端。
13.根据权利要求1所述的入路装置，其中所述主体是管状主体，所述管状主体适于接收用于脊椎固定的其他外科器械。
14.一种用于经由后入路进入颈小面关节的脊椎固定入路和输送系统，所述系统包括：
入路装置，所述入路装置包括：
具有近侧部分和远侧部分的主体；以及
位于所述主体的所述远侧部分处并构造成用于在颈小面关节处插入的倒角或斜切端部特征，
具有入路装置接合特征的引导装置；以及
脊椎固定构件，
其中所述入路装置包括与所述引导装置的接合特征互补或键合的至少一个引导装置接收特征。
15.根据权利要求14所述的系统，其中所述入路装置的所述倒角或斜切端部特征从所述主体偏移。
16.根据权利要求14或15所述的系统，其中所述入路装置的主体是细长主体，所述细长主体具有相对的顶面和底面、相对的侧面和相对的端面，并且所述倒角或斜切端部特征从所述主体偏移并位于所述相对侧面中的一个上。
17.根据权利要求16所述的系统，其中所述入路装置的主体具有矩形的横截面。
18.根据权利要求17所述的系统，其中所述近侧部分具有第一高度并且所述远侧部分具有第二高度，并且所述第一高度大于所述第二高度。
19.根据权利要求14或15所述的系统，其中所述入路装置的主体是细长管状主体。
20.根据权利要求14-19中的任一项所述的系统，其中所述入路装置的所述倒角或斜切端部特征位于所述远侧部分的端部处。
21.根据权利要求20所述的系统，其中所述入路装置的所述倒角或斜切端部特征还包括适于邻接小面关节的后边缘或后部分的止动件。
22.根据权利要求21所述的系统，其中所述止动件包括适于接合小面关节的凸起或突出特征。
23.根据权利要求20所述的系统，其中所述入路装置的所述倒角或斜切端部特征包括可扩张锚固件，所述可扩张锚固件经由棘爪特征保持在闭合位置并且通过致动内部杆以将所述端部特征的臂枢转到打开位置而打开。
24.根据权利要求23所述的系统，其中所述端部特征包括可扩张构件，所述可扩张构件保持在闭合位置以用于输送并且通过致动内部杆而扩张到打开位置。
25.根据权利要求23所述的系统，其中所述端部特征包括铰接尖端。
26.根据权利要求23所述的系统，其中所述主体是管状主体，所述管状主体适于接收用于脊椎固定的其他外科器械。
27.根据权利要求14所述的系统，其中所述装置接合特征选自突起、凹口或凹陷。
28.根据权利要求14所述的系统，所述系统还包括脱皮工具。
29.根据权利要求28所述的系统，其中所述脱皮工具的一部分可选地包括磨刀、锉刀或齿。
30.一种用于经由后入路进入颈小面关节的脊椎固定入路和输送系统，所述系统包括：
入路装置；
脊椎固定构件；以及
具有至少一个脊椎固定构件接合特征的引导装置，其中所述脊椎固定构件包括与所述引导装置的接合特征互补或键合的至少一个引导装置接收特征。
31.根据权利要求30所述的系统，其中所述脊椎固定构件是塔柱或具有塔柱特征的多轴螺钉。
32.根据权利要求30或31所述的系统，其中所述至少一个脊椎固定构件接合特征是从所述引导装置的外表面突出并且大致沿所述引导装置的长度延伸的大致圆柱形主体。
33.根据权利要求30-32所述的系统，其中所述入路装置包括：
具有近侧部分和远侧部分的主体；以及
位于所述主体的所述远侧部分处并构造成用于在颈小面关节处插入的倒角或斜切端部特征。
34.根据权利要求33所述的系统，其中所述倒角或斜切端部特征从所述主体偏移。
35.根据权利要求33或34所述的系统，其中所述主体是细长主体，具有相对的顶面和底面、相对的侧面和相对的端面，并且所述倒角或斜切端部特征从所述主体偏移并位于所述相对侧面中的一个上。
36.根据权利要求35所述的系统，其中所述主体具有矩形的横截面。
37.根据权利要求36所述的系统，其中所述近侧部分具有第一高度并且所述远侧部分具有第二高度，并且所述第一高度大于所述第二高度。
38.根据权利要求33或34所述的系统，其中所述主体是细长管状主体。
39.根据权利要求33-38中的任一项所述的系统，其中所述倒角或斜切端部特征位于所述远侧部分的端部处。
40.根据权利要求39所述的系统，其中所述特征还包括适于邻接小面关节的后边缘或后部分的止动件。
41.根据权利要求40所述的系统，其中所述止动件包括适于接合小面关节的凸起或突出特征。
42.根据权利要求33所述的系统，其中所述端部特征包括可扩张锚固件，所述可扩张锚固件经由棘爪特征保持在闭合位置并且通过致动内部杆以将所述端部特征的臂枢转到打开位置而打开。
43.根据权利要求33所述的系统，其中所述端部特征包括可扩张构件，所述可扩张构件保持在闭合位置以用于输送并且通过致动内部杆而扩张到打开位置。
44.根据权利要求33所述的系统，其中所述端部特征包括铰接尖端。
45.根据权利要求33所述的系统，其中所述主体是管状主体，所述管状主体适于接收用于脊椎固定的其他外科器械。
46.根据权利要求30所述的系统，所述系统还包括脱皮工具。
47.根据权利要求46所述的系统，其中所述脱皮工具的一部分可选地包括磨刀、锉刀或齿。
48.一种颈部脊椎固定构件，所述颈部脊椎固定构件包括：
细长管状主体，所述细长管状主体具有在远端和近端之间延伸的长度；
限定在所述管状主体的长度的至少一部分中的杆接收槽；以及
多轴螺钉。
49.根据权利要求48所述的脊椎固定构件，所述的脊椎固定构件还包括杆。
50.根据权利要求48或49所述的脊椎固定构件，其中所述杆接收槽还包括限定在所述细长管状主体的外圆周中的开口。
51.根据权利要求48-50中任一项所述的脊椎固定构件，其中所述杆接收槽仅沿所述细长主体的长度的一部分延伸，并且所述细长主体在剩余的长度上是实心的。
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