JP5271281B2 - 曲線状脊椎アクセス方法およびデバイス - Google Patents
曲線状脊椎アクセス方法およびデバイス Download PDFInfo
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- JP5271281B2 JP5271281B2 JP2009549145A JP2009549145A JP5271281B2 JP 5271281 B2 JP5271281 B2 JP 5271281B2 JP 2009549145 A JP2009549145 A JP 2009549145A JP 2009549145 A JP2009549145 A JP 2009549145A JP 5271281 B2 JP5271281 B2 JP 5271281B2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/17—Guides or aligning means for drills, mills, pins or wires
- A61B17/1739—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body
- A61B17/1757—Guides or aligning means for drills, mills, pins or wires specially adapted for particular parts of the body for the spine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3468—Trocars; Puncturing needles for implanting or removing devices, e.g. prostheses, implants, seeds, wires
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/025—Joint distractors
- A61B2017/0256—Joint distractors for the spine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
- A61B2017/3488—Fixation to inner organ or inner body tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/46—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
- A61F2/4603—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof
- A61F2/4611—Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30108—Shapes
- A61F2002/30199—Three-dimensional shapes
- A61F2002/302—Three-dimensional shapes toroidal, e.g. rings
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
- A61F2230/0063—Three-dimensional shapes
- A61F2230/0065—Three-dimensional shapes toroidal, e.g. ring-shaped, doughnut-shaped
Description
本願は、2007年2月9日に出願されたGarcia−Bengocheaに対する米国仮出願第60/900,554号(名称「Guided Lumbar Interbody Fusion Method and Systems」)に対する優先権を主張し、この仮出願の全開示は本明細書によって参考として援用される。
(技術分野)
本発明は、概して、脊椎手術の分野に関する。より具体的には、本発明は、脊椎への外科的アクセスの分野に関する。
低侵襲性であるとみなされる外科技術は、部位を調製し、インプラントが患者における1つまたはいくつかの小切開を通じて導入されることを可能にする、器具およびインプラント設計を利用する。例えば、腰椎において、腰椎椎体間固定術(「LIF」)として知られる外科的処置が、過去10年間で一般的になってきた。特定の技術は、典型的には、脊椎に対するアプローチの方向、前方(「ALIF」)、後方(「PLIF」)、経椎間孔(「TLIF」)、および側方(「XLIF」)によって指定される。筋肉の破壊および外傷が最小限に抑えられるという点で、これらの処置は従来の手術に比べて改良されているが、技術の困難さは、医学界における広い採用を制限してきた。
本発明は、他の公知の脊椎アクセス処置に関する現実的な問題または認識された課題のいくつかに対処する、腰椎椎体間固定術(「LIF」)の分野におけるデバイスおよび方法を含む、脊椎へのアクセスのためのデバイスおよび方法に関する。本発明の装置およびインプラント設計は、本発明の処置を可能にし、脊椎への有利なアクセスを可能にする。
必要に応じて、本発明の詳細な実施形態を本明細書に開示するが、開示された実施形態は、本発明の例示に過ぎず、種々の形態で具現化されてもよいことを理解されたい。したがって、本明細書に開示される特定の構造および機能の詳細は、制限すると解釈されるものではなく、単に請求項の基礎として、または事実上任意の適切に詳細な構造において本発明を種々に採用することを当業者に教示するための代表的な基礎として解釈されるものとする。
Claims (26)
- 患者の脊椎に処置を行うためのデバイスであって、
該患者の該脊椎の手術部位に向かって前進させられるように構成される、作業ポータルを備え、
該作業ポータルは、
遠位端および近位端と、
該遠位端と該近位端との間に配置される内部チャネルを有する作業ポータル筐体と、
少なくとも1つの伸延傾斜チャネルを含む複数の伸延傾斜部と
を備え、
該遠位端は、該手術部位に配置されるように構成され、該近位端は、該手術部位から離れて配置され、
該筐体は、該近位端と該遠位端との間に画定される湾曲形状を有し、
該内部チャネルは、該手術部位へ向かう少なくとも1つの手術道具および/または少なくとも1つのインプラントの前進を可能にするように構成される、デバイス。 - 前記作業ポータル筐体の外表面上で、かつ前記遠位端と前記近位端との間に配置される外部チャネルをさらに備える、請求項1に記載のデバイス。
- 前記近位端は、前記遠位端に対してある角度を成して配置される、請求項2に記載のデバイス。
- 前記手術部位に前進させられるように構成されるトロカールガイドをさらに備え、該トロカールガイドは、トロカールガイド内部チャネルを含む、請求項3に記載のデバイス。
- 前記トロカールガイド内部チャネルに挿入されるように構成され、前記手術部位において椎間板または椎体の壁に開口部を生成するようにさらに構成される、切削トロカールをさらに備える、請求項4に記載のデバイス。
- 前記切削トロカールの除去の後に前記トロカールガイド内部チャネルに挿入されるように構成される有鉤トロカールをさらに備え、該有鉤トロカールは、前記手術部位において前記椎間板または椎体の壁に固定されるように構成される、請求項5に記載のデバイス。
- 前記トロカールガイドの除去の後に、前記有鉤トロカールに沿って前記手術部位に前進させられるように構成され、該有鉤トロカールの周囲の組織を除去するように構成される、組織分離器具をさらに備える、請求項6に記載のデバイス。
- 前記組織分離器具は、前記有鉤トロカールの周囲の組織を除去するように構成される、複数の分離器をさらに含む、請求項7に記載のデバイス。
- 前記複数の伸延傾斜部は、前記組織分離器の除去の後に、前記有鉤トロカールに沿って前記手術部位に向かって前進させられるように構成される、請求項6に記載のデバイス。
- 前記複数の伸延傾斜部は、前部伸延傾斜部と背部組織伸延傾斜部とを含む、請求項9に記載のデバイス。
- 神経モニタリングリボンをさらに備える、請求項9に記載のデバイス。
- 前記手術部位に向かう前記複数の伸延傾斜部の前進中に、該複数の伸延傾斜部を固定するように構成される、伸延傾斜部整合ブロックをさらに備える、請求項9に記載のデバイス。
- 前記有鉤トロカールの挿入に適応するように構成される小型拡張器内部チャネルを有する小型拡張器をさらに備え、該小型拡張器は、前記複数の伸延傾斜部の挿入の後に該有鉤トロカールに沿って、かつ該複数の伸延傾斜部の間で、前記手術部位に向かって前進させられるように構成される、請求項9に記載のデバイス。
- 前記小型拡張器の挿入に適応するように構成される大型拡張器内部チャネルを有する大型拡張器をさらに備え、該大型拡張器は、前記小型拡張器の内側に配置される前記有鉤トロカールを有する該小型拡張器に沿って、かつ前記複数の伸延傾斜部の間で、前記手術部位に向かって前進させられるように構成される、請求項13に記載のデバイス。
- 前記大型拡張器は、大型拡張器筐体と、該大型拡張器筐体の外表面上に配置されるレールとを含み、該レールは、前記伸延傾斜チャネルの内側を摺動するように構成される、請求項14に記載のデバイス。
- 前記作業ポータルチャネルに沿って前記手術部位に向かって前進させられるように構成され、該手術部位において該作業ポータルを固着するようにさらに構成される、前部突き錐をさらに備える、請求項15に記載のデバイス。
- 前記小型および大型拡張器ならびに前記有鉤トロカールは、前記前部突き錐の挿入の後に除去されるように構成される、請求項16に記載のデバイス。
- 前記外科的処置中に前記作業ポータルを安定させるように構成される、保持アームをさらに備える、請求項1に記載のデバイス。
- 前記作業ポータルは、前記大型拡張器に沿って、かつ前記複数の伸延傾斜部の間で前進させられ、
前記作業ポータル筐体は、該作業ポータル筐体の外表面上に配置される作業ポータルレールを含み、該作業ポータルレールは、前記手術部位に向かって該作業ポータルを前進させるために該伸延傾斜チャネルと相互作用するように構成される、請求項17に記載のデバイス。 - 前記作業ポータルは、5mmから30mmの範囲の幅、および5mmから30mmの範囲の高さを有する、請求項1に記載のデバイス。
- 前記作業ポータルは、8mmから18mmの範囲の高さ、8mmから30mmの範囲の前後方向の奥行き、および20mmから70mmの範囲の横方向の幅を有するインプラントの挿入に適応するように構成される、請求項1に記載のデバイス。
- 前記作業ポータルは、正方形、長方形、楕円形、多角形から成る群より選択される横断面を有する、請求項1に記載のデバイス。
- 前記作業ポータルは、手術領域を視認するための内視鏡をさらに備える、請求項1に記載のデバイス。
- 前記外科的処置は、核置換術、人工椎間板置換術、椎体間固定術、椎間板切除術、神経減圧術、インプラント送達、および任意の他の脊椎処置から成る群より選択される、請求項1に記載のデバイス。
- 前記作業ポータルは、インプラントを送達するために使用され、該インプラントは、骨ネジ、プレート、椎体間デバイス、人工椎間板、および任意の他の脊椎デバイスから成る群より選択される、請求項1に記載のデバイス。
- 患者の脊椎に処置を行うためのデバイスであって、
該患者の該脊椎の手術部位に向かって前進させられるように構成される、作業ポータルを備え、
該作業ポータルは、
遠位端および近位端と、
該遠位端と該近位端との間に配置される内部チャネルを有する作業ポータル筐体と、
該作業ポータル筐体の外表面上、かつ該遠位端と該近位端との間に配置される、外部レール/スロットを有する少なくとも1つの伸延傾斜チャネルを含む複数の伸延傾斜部と
を備え、
該遠位端は、該手術部位に配置されるように構成され、該近位端は、該手術部位から離れて配置され、
該筐体は、該近位端と該遠位端との間に画定される湾曲形状を有し、
該近位端は、該遠位端に対してある角度を成して配置され、
該内部チャネルは、該手術部位に向かって前進させられるように構成され、該内部チャネルおよび/または該外部レール/スロットを使用して、該手術部位に向かって少なくとも1つの手術道具および/または少なくとも1つのインプラントの前進を可能にするようにさらに構成される、デバイス。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US90055407P | 2007-02-09 | 2007-02-09 | |
US60/900,554 | 2007-02-09 | ||
PCT/US2008/001856 WO2008097665A1 (en) | 2007-02-09 | 2008-02-11 | Curvilinear spinal access method and device |
Publications (3)
Publication Number | Publication Date |
---|---|
JP2010517684A JP2010517684A (ja) | 2010-05-27 |
JP2010517684A5 JP2010517684A5 (ja) | 2011-03-03 |
JP5271281B2 true JP5271281B2 (ja) | 2013-08-21 |
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JP2009549145A Expired - Fee Related JP5271281B2 (ja) | 2007-02-09 | 2008-02-11 | 曲線状脊椎アクセス方法およびデバイス |
Country Status (4)
Country | Link |
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US (2) | US8152714B2 (ja) |
EP (1) | EP2114257B1 (ja) |
JP (1) | JP5271281B2 (ja) |
WO (1) | WO2008097665A1 (ja) |
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WO2008097665A1 (en) | 2008-08-14 |
EP2114257B1 (en) | 2013-05-22 |
JP2010517684A (ja) | 2010-05-27 |
US8152714B2 (en) | 2012-04-10 |
US20080221586A1 (en) | 2008-09-11 |
US20120215229A1 (en) | 2012-08-23 |
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