EP1113756A1 - Approche transiliaque pour acceder a l'espace intervertebral d'un sujet - Google Patents

Approche transiliaque pour acceder a l'espace intervertebral d'un sujet

Info

Publication number
EP1113756A1
EP1113756A1 EP99928407A EP99928407A EP1113756A1 EP 1113756 A1 EP1113756 A1 EP 1113756A1 EP 99928407 A EP99928407 A EP 99928407A EP 99928407 A EP99928407 A EP 99928407A EP 1113756 A1 EP1113756 A1 EP 1113756A1
Authority
EP
European Patent Office
Prior art keywords
cannula
ilium
patient
bone
fastening element
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.)
Withdrawn
Application number
EP99928407A
Other languages
German (de)
English (en)
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/fr
Publication of EP1113756A1 publication Critical patent/EP1113756A1/fr
Withdrawn legal-status Critical Current

Links

Definitions

  • a major problem when accessing a patient's intervertebral space during spinal surgery is the problem of avoiding sensitive nerves and ligaments during the operative procedure.
  • the optimal angle of approach to avoid sensitive nerves and ligaments is a posterolateral angle.
  • this angle of approach is not practical when accessing the lower vertebrae, specifically the L5/S1 inter-vertebral space, due to the patient's ilium bone which blocks such an angle of approach. Consequently, when performing surgical procedures at L5/S1 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.
  • 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 created by the present invention is preferably at a posterolateral angle, (preferably in the range of 40 to 90 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/S1 vertebrae.
  • Methods are also provided for advancing surgical instruments 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.
  • Fig. 1 is a schematic view of a cannulated obturator inserted percutaneously into the patient's back.
  • 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 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 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 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.
  • Fig. 8 is an illustration of a pair of percutaneously inserted cannulae approaching a patient's 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.
  • 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 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 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 ilium 16 as is seen in Fig. 2.
  • cannula 12 can be slipped down thereover such that a distal end 13 of cannula 12 can be placed in contact with ilium 16.
  • distal end 13 of cannula 12 can have a angled end such that it can 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.
  • this fastening element comprises a 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.
  • obturator 10 is then removed and a bone cutting device 15, which is preferably hollow as 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 bore 21 of bone cutter 15 as shown.
  • 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.
  • spiral grooves 23 on the exterior surface of bone cutter 15 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.
  • bone cutter 15 comprises an 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.
  • oscillating "cast” drill ie: a drill which cuts through rigid objects but not soft objects
  • a cannulated access portal 30 will be provided passing percutaneously through the patient's ilium as is shown in Fig. 5.
  • a surgical tool 25 which may comprise an intervertebral insert, bone decorticator, camera, articulating forceps, intervertebral insert positioning systems, bone-graft introducer, 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.
  • a second cannula 22 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.
  • the second cannula may have an oval cross section.
  • 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 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 graft material for packing around or within intervertebral inserts which are positioned in the intervertebral space using the present system.
  • a racetrack-shaped hole 40 can be drilled through the ilium 16 by sequentially drilling overlapping first and second circular holes 42 and 44 using the present method.
  • 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 oval or racetrack-shaped cross sections to be passed through ilium 16, and into the patient's intervertebral region.
  • 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 40° 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 patient's ilium 16.
  • 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 element dimensioned to be received within the bone cutting drill; and instructions for use setting forth any of the methods herein described.
  • kits for providing access to a patient's intervertebral space through 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.

Landscapes

  • Surgical Instruments (AREA)

Abstract

L'invention concerne des procédés permettant d'accéder par voie percutanée à l'espace intervertébral (18) d'un sujet en créant un orifice d'accès (30) traversant l'ilion (16) et pénétrant dans l'espace intervertébral (18). Cet orifice d'accès (30) se situe de préférence à un angle postéro-latéral, (de préférence dans une fourchette de 40 à 90 degrés par rapport à un axe antérieur-postérieur traversant le sujet), ce qui constitue l'angle d'approche optimal de l'espace intervertébral (18) pour les vertèbres inférieures L5/S1. L'invention concerne également des procédés permettant d'introduire, par le passage créé, des instruments chirurgicaux dans l'espace intervertébral (18).
EP99928407A 1999-02-19 1999-06-04 Approche transiliaque pour acceder a l'espace intervertebral d'un sujet Withdrawn EP1113756A1 (fr)

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US12066399P 1999-02-19 1999-02-19
US120663P 1999-02-19
US12970399P 1999-04-16 1999-04-16
US129703P 1999-04-16
PCT/US1999/012610 WO2000048521A1 (fr) 1998-06-09 1999-06-04 Approche transiliaque pour acceder a l'espace intervertebral d'un sujet

Publications (1)

Publication Number Publication Date
EP1113756A1 true EP1113756A1 (fr) 2001-07-11

Family

ID=56289916

Family Applications (1)

Application Number Title Priority Date Filing Date
EP99928407A Withdrawn EP1113756A1 (fr) 1999-02-19 1999-06-04 Approche transiliaque pour acceder a l'espace intervertebral d'un sujet

Country Status (2)

Country Link
EP (1) EP1113756A1 (fr)
AU (1) AU4547999A (fr)

Cited By (1)

* 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

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO0048521A1 *

Cited By (1)

* 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

Also Published As

Publication number Publication date
AU4547999A (en) 2000-09-04

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