JP6816122B2 - マルチシールド脊椎アクセスシステム - Google Patents
マルチシールド脊椎アクセスシステム Download PDFInfo
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- JP6816122B2 JP6816122B2 JP2018511695A JP2018511695A JP6816122B2 JP 6816122 B2 JP6816122 B2 JP 6816122B2 JP 2018511695 A JP2018511695 A JP 2018511695A JP 2018511695 A JP2018511695 A JP 2018511695A JP 6816122 B2 JP6816122 B2 JP 6816122B2
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- shield
- distal end
- tubular portion
- inner shield
- substantially tubular
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Description
a)患者の皮膚に切開部を形成する工程と、
b)切開部を通じて、ほぼ管状の形状を有する外側シールド(例えばチューブ又は複数のスロットを有するリトラクタ)を経皮的に挿入する工程であって、外側シールドは、切開部から患者の脊椎の感受性組織と非感受性組織(例えば、上関節突起(SAP)又は椎弓板)との間の境界まで延びるように適合された長さを有する、工程と、
c)この外側シールドを椎弓根アンカーに対して安定化する工程と、
d)外側シールドに一体化された光学的可視化器具を挿入する工程と、
e)上関節突起の一部を切除し、かつ/又はマイクロサージェリーによる減圧手技を行う工程と、
f)内側シールドの遠位端部が椎間板まで延びるように、外側シールドに通して、又は外側シールドから内側シールドを挿入又は配備する工程であって、内側シールドが外側表面を有する、工程と、
g)シールドの外側表面を神経根と接触させて神経根を遮蔽する工程と、
h)神経障害の原因となっていると考えられるすべての組織をマイクロサージェリーにより減圧する工程と、
i)椎骨終板からの軟骨状物質の除去を含む、椎間板物質を抜き取る工程と、
j)椎体間装置を挿入する工程と、
k)安定化機構を配備して椎間部分を安定化させる工程と、を含む、方法が提供される。
患者の椎間板にアクセスする方法であって、
a)患者の皮膚に切開部を形成する工程と、
切開部を通じて、ほぼ管状の形状を有する外側シールドを経皮的に挿入する工程と、
c)この外側シールドを椎弓根アンカーに対して安定化する工程と、
d)内側シールドの遠位端部が椎間板まで延びるように、外側シールドに通して内側シールドを挿入する工程であって、内側シールドが外側表面を有する、工程と、
e)シールドの外側表面を神経根と接触させて神経根を遮蔽する工程と、
f)神経障害の原因となっていると考えられるすべての組織をマイクロサージェリーにより減圧する工程と、
g)椎骨終板からの軟骨状物質の除去を含む、椎間板物質を抜き取る工程と、
h)椎体間装置を挿入する工程と、
i)安定化機構を配備して椎間部分を安定化させる工程と、を含む、方法が提供される。
a)ほぼ管状部分と、切開部から感受性組織と非感受性組織(例えば関節突起又は椎弓板)との間の境界まで延びるように適合された長さと、近位端部と、遠位端部と、外側表面と、内側表面を画定する長手方向の貫通孔とを有する外側シールドと、
b)i)近位端部と、遠位端部と、内側表面を画定する長手方向の貫通孔と、直径を画定する外側表面とを有する第1のほぼ管状部分と、ii)ほぼ管状部分の遠位端部から遠位方向に延びる長手方向のフランジとを有する内側シールドと、を備え、
内側シールドの前記外側表面は、
i)フランジが外側シールドの遠位端部を越えて遠位方向に延びるように、記外側シールドの内側表面内にほぼ入れ子状に収まっている、アクセス装置が提供される。
a)ほぼ管状部分と、切開部から感受性組織と非感受性組織(例えば関節突起)との間の境界まで延びるように適合された長さと、近位端部3と、遠位端部5と、外側表面7と、内側表面10を画定する長手方向の貫通孔9とを有する外側シールド1と、
b)i)近位端部15と、遠位端部17と、内側表面21を画定する長手方向の貫通孔19と、直径を画定する外側表面23とを有する第1のほぼ管状部分13と、ii)ほぼ管状部分の遠位端部から遠位方向に延びる長手方向のフランジ25とを有する内側シールド11と、を備え、
内側シールドの外側表面は、フランジが外側シールドの遠位端部を越えて遠位方向に延びるように、外側シールドの内側表面内にほぼ入れ子状に収まり、
内側シールドのほぼ管状部分の遠位端部は、外側シールドの遠位端を越えて遠位方向に延びる、アクセス装置が提供される。
外側シールドの設計には、従来のチューブ又はスプリットチューブ/リトラクタの概念を用いることができる。「可撓性チューブ」のようなより新しい概念も採用することができる。外側シールドは、単純な円筒状のチューブとすることができる。外側シールドは、従来のリトラクタがスプリットチューブとみなされるようにスプリットチューブとすることもできる。外側シールドは可撓性チューブとすることができる。外側シールドは、近位端から遠位端まで延びるスロットを有するチューブとすることができる。様々な形状の実施形態としては、
a)内径Dを有する円筒状チューブ(図3a)、
b)長さbと異なる高さaを有する楕円形チューブ(図3b)、
c)一部が切りとられた(すなわち弦)「a」、直径Dのほぼ円形又は楕円形の断面を有する「半月」状のチューブ(図3c)、及び、
d)高さaと幅bを有する長方形のチューブ(図3d)がありうる。
ここで図3a〜dを参照すると、内側シールド11も様々な設計を有することができる。
e)内径Dを有する円筒状チューブ(図3a)、
f)長さbと異なる高さaを有する楕円形チューブ(図3b)、
g)一部が切りとられた(すなわち弦)「a」、直径Dの円形の断面を有する「半月」状のチューブ(図3c)、及び、
h)高さaと幅bを有する長方形のチューブ(図3d)がある。
上記に述べた外側シールドは、外側シールド又は内側シールドのいずれかに沿った任意の位置における外側シールドと内側シールドとの干渉に基づいた機構によって配置し、その深さを固定することができる。
第1のポートは、外側シールドを、治療部位に対してその位置(深さ及び向き)が定まるようにナビゲートすることを可能とするものである。一実施形態では、外側シールドの外側表面が、ナビゲーション器具の直接的又は間接的な取り付けを可能とする機構を有する。別の実施形態では、外側シールドの内側表面が、ナビゲーション器具の直接的又は間接的な取り付けを可能とする機構を有する。
いくつかの実施形態では、外側シールドは、解剖学的構造に対して固定又は可変(角度が、又は周方向に)の位置に設定することが可能な一体型内視鏡を有する。このような内視鏡による可視化を、骨切除、内側シールドの配備、椎間板切除、及びインプラント挿入などの次の外科的工程で利用することができる。好ましくは、内視鏡は、インサイツで自動レンズクリーニングを行うための一体型クリーニング機構を有することが好ましい。
内視鏡は、5mmよりも小さい外径を有し、かつ外側シールドの長さにほぼ一致した漸増式の長さを有するチップオンチップ型の内視鏡とすることができる。一体型のチップオンチップ型内視鏡/外側シールドの実施形態の利点としては、外側シールドの孔内に比較的自由な空間が存在することにより、可視化が促されることがある。
別々の外側シールドと内側シールドとを有する実施形態では、内側シールドを外側シールドに対して独立して位置決めすることが可能である。また、より小径(外側シールドに対して)の内側シールドの使用により、牽引感受性の組織(retraction-sensitive tissues)が存在しない部位の進入点における可視化を最大とすることができる。このように可視化が最大となることによって内側シールドの正確な配置が可能となる。牽引感受性の組織(retraction-sensitive tissues)が外側シールドの遠位側に存在する場合、比較的小径の内側シールドによって、これらの組織を通じた、又は組織を越えたアクセスを与える一方で、牽引を最小とすることができる。好ましくは内側シールドの内径は、外側シールドの内径の40〜100%以下である。
神経を保護する別の実施形態では、シールドの収縮運動は回転方向ではなく、径方向である。これらの実施形態では、真っ直ぐ又は差込式の内側シールドを使用することができる。内側シールドは、保護される組織が配置される領域を覆って配置することができる。次に、フランジシールドを、例えば尾側椎弓根に向かって外側シールドの遠位端でアクセス窓の中心へと曲げることができる。次に、内側シールドを、Kambinにより述べられる神経根の内側の「セーフゾーン」内へと長手方向にその後、進めることができる。この後、内側シールドを、内側シールドの遠位先端部が外側に曲げられるように曲げると、内側シールドの外側遠位表面が退出根(existing nerve root)を静かに押し退けるか、かつ/又は、椎間板内の作業を行うためにシールドの内側に更に導入される器具から退出根を遮蔽する。この実施形態は、内側シールドが、a)外側シールドの壁の内部(図19(a))、b)外側シールドの内側表面の内側(図20(b))、又はc)外側シールドの外側表面の外側(図12(c))のいずれかにほぼ入れ子状に収まるように構築することができる。いくつかの実施形態では、内側シールドは、外側シールドの壁の中又は更には外側シールドの外側に組み込まれる。
上記に述べた外側シールドは、外側シールド又は内側シールドのいずれかに沿った任意の位置における外側シールドと内側シールドとの干渉に基づいた機構によってその深さにおいて制御することができる。
いくつかの実施形態では、チップオンチップ技術に基づく、ポートの壁に一体化された可視化素子が使用される。この実施形態は、チューブの壁に取り付けられる標準的なロッド/レンズ型内視鏡と比較して多くの利点を有する。すなわち、
・製造コストチップオンチップ技術は、極めてコスト効率の高い製造を可能とすることから、「1回使用」器具として販売することができる。
・遠位先端部のみに剛性部分標準的なロッド/レンズ型内視鏡システムがチューブ全体にわたって固い円筒状の形状を有するのに対して、チップオンチップ(chip-on-top)型内視鏡は、近位の外側チューブ端部において非円筒状の形態を有することができる。好ましくは、この形状はフラットケーブル形状である。いくつかの新規な実施形態では、標準的なロッド/レンズ型内視鏡に対して、チップオンチップ型内視鏡は比較的短い「剛性」部分(約20mm)を有し、その場合、近位部分は可撓性を有しうるケーブルで構成される。他の実施形態では、剛性部分はより短く(より小さいチップアセンブリを形成する)、レンズ角度を変えるために能動的関節動作の概念が用いられる。チューブ壁にケーブルが一体化されているため、ポート窓の形状は手技の全体を通じて維持される。例えば、5mmのチップオンチップ型内視鏡では、15mmの円形のアクセス窓が腎臓形のアクセス窓に変形する。
・カメラユニットのサイズ/重量標準的なロッド/レンズ型内視鏡は、特定のサイズを有する汎用インターフェースである標準的なアイピースを有する。かかるシステムに接続されるカメラは、アイピースと適合性を有するように特定の寸法で構築されなければならない。この要求条件のため、多くの難点を有する比較的嵩張ったカメラアタッチメントとなる(直径約3〜6cm、長さ約5〜10cm)。第1にこのような大きなカメラの構造は、特に作業ポートの軌道が変化しているか又はカメラと干渉するような場合、作業にとって物理的障害となりうる。第2に、この従来の構造の寸法及び重量は、特に折り曲げの際にロッド/レンズ型内視鏡に特定の望ましくない力を発生させるほど大きい。第3に、比較的脆弱な従来のロッド/レンズ型内視鏡は、金属管のような安定化構造内に埋め込む必要があるため、有効な作業窓が更に小さくなる。
チップケーブルが外側チューブの壁に埋め込まれた本明細書に開示されるチップオンチップ式の実施形態によれば、近位の外側チューブ壁から出るケーブルは、作業ポートに同様の力を発生させない。また、チューブ壁にチップオンチップ形内視鏡を取り付けるアタッチメント機構に関し、これによって発生する折り曲げ力がないため、機械的にそれほど安定している必要のない比較的薄いアタッチメントオプションを採用する可能性を高める。
・作業環境従来、脊椎内視鏡の用途では、一定の流体環境(恒久的な生理食塩水の流れ)が用いられている。しかしながら、微小開口(mini-open)及びマイクロサージェリー環境では、解剖学的条件が大きく異なることから流体環境は有用ではない。したがって、本明細書に述べられる好ましい新規な手技では、チップオンチップ型内視鏡は、乾燥した開放空気環境中で動作する。しかしながら、チップオンチップ型内視鏡が使用される開放乾燥空気環境は、内視鏡のレンズ要素上に望ましくない凝結作用をもたらす場合がある。例えば、湿潤な体温環境中の低温のレンズは曇りやすい。更に、ドリル破片、バリ破片、又はモノポーラメス又は止血具からの煙が内視鏡のレンズに同様に影響して視界を悪化させる。したがって、チップオンチップ型内視鏡のレンズは定期的に拭くことが望ましい場合がある。
ポータルを通じて行われる低侵襲性脊椎手術では、ポータルを受容する部位に準備処置を行うために一組の拡張器がしばしば用いられる。かかる技術の1つが米国特許出願公開第2012−0232552号(モルゲンスターン(Morgenstern))に示されている。この従来の技術(偏心拡張器を有する)では、拡張器のいずれか1つの外径が、次に続く(外側の)拡張器の内径と同じとなっている。このような直径の一致は、透視診断法支援型の経皮的筋肉拡張に必要である。
ナビゲーションは、静止X線検査、CT、又はMRIのデータを手術中にリアルタイムで示すことによって向上させるものであり、実際に使用されている器具が患者の解剖学的構造に対して示される。したがって、ナビゲーションは、これらの器具の安全性を、その形状、軌道、及び配置を示すことによって高め、更により重要な点として、行われる操作の間に外科医が器具の向きを保つことを助ける。
いくつかの実施形態では、新規な手技は、骨のみを特異的に切断し、軟組織は切断しない、SAP除去用の超音波骨切断装置を使用する。椎体間融合用の従来の拡張式ケージ装置に基づく実施形態では、少なくとも12mmの大きさのアクセス窓が必要となりうる。このように大きな窓は、上関節突起(SAP)を(部分的に)除去してKambin’s Triangleを拡張することによってのみ実現することができる。超音波骨切断装置は、神経に誤ってぶつかった場合でも神経を切断しないため、この手技の安全性を大幅に高める。切断装置のブレードが椎間板腔のレベルにまで遠位方向にアプローチする内側チューブ/ブレード(すなわち、クッキーカッターの設計)の形状及び直径となるように設計されている場合、SAPの除去を最小限に抑えることができ(外傷が少なく、患者へのストレスが少なく、回復が速やか)、しかも単一の工程で行うことができる(複数工程の手技よりも速やか)。
いくつかの実施形態では、骨除去装置は、クッキーカッターの設計を有するハーモニックスカルペルである。スカルペルは、外側チューブと接する三日月形の切断表面を有する。スカルペルは1回通過式器具として使用され、1回の通過で所定量の骨を切除する。いくつかの実施形態では、スカルペルが洗浄用の水を噴射するチューブも有する一方で、外側チューブは、除去された骨のスラリーを除去するための吸引ラインを有する。
いくつかの実施形態では、チップビューイング素子を角張るように設けてチューブの隅を見ることができるようにすることができる。
いくつかの実施形態では、外側シールドは、神経に作用する応力を測定するための圧力センサを有する。システムは、距離を測定することが可能な超音波技術を利用し、牽引下の神経の伸長率を測定し、最大限界伸長率(例えば20%)を定義し、次いで限界伸長率を上回った場合に外科医に警告することができる。いくつかの実施形態では、システムは超音波をポートに組み込むことにより、ポートをナビゲートする。
現在では、神経モニタリング装置を使用して、潜在的な神経の健康状態、又は手術環境で発生しうる神経損傷の指標を得ることができる。神経の健康状態のこのような指標は、手術部位の近くの神経とその神経の末端との間で電気的インパルスを測定することによって得られる。例えば、インパルスは、脊髄における神経根と脚に見られるいくつかの点との間で測定することができる。
(1) 椎間板にアクセスするためのアクセス装置であって、
a)ほぼ管状部分と、切開部から関節突起まで延びるように適合された長さと、近位端部と、遠位端部と、外側表面と、内側表面を画定する長手方向の貫通孔とを有する外側シールドと、
b)i)近位端部と、遠位端部と、内側表面を画定する長手方向の貫通孔と、直径を画定する外側表面とを有する第1のほぼ管状部分と、ii)前記ほぼ管状部分の前記遠位端部から遠位方向に延びる長手方向のフランジとを有する内側シールドと、を備え、
前記内側シールドの前記外側表面は、前記フランジが前記外側シールドの前記遠位端部を越えて遠位方向に延びるように、前記外側シールドの前記内側表面内にほぼ入れ子状に収まっている、アクセス装置。
(2) 前記内側シールドの前記外側表面は、前記内側シールドの前記ほぼ管状部分の前記遠位端部が前記外側シールドの遠位端を越えて遠位方向に延びるように、前記外側シールドの前記内側表面内にほぼ入れ子状に収まっている、実施態様1に記載の装置。
(3) 前記内側シールドの前記ほぼ管状部分の前記近位端部が、前記外側シールドの前記近位端部に当接するように適合された係止部を含み、前記係止部は、前記内側シールドの過剰な遠位方向への運動を防止するように適合されている、実施態様1に記載の装置。
(4) 前記係止部が、前記内側シールドの前記ほぼ管状部分の前記近位端部の周囲にほぼ径方向に延びている、実施態様3に記載の装置。
(5) 前記係止部が、把持されるように適合された粗面加工が施された径方向表面を更に含む、実施態様4に記載の装置。
(7) 前記フランジの前記円弧状の横断面が、前記外側シールドの前記内側表面の曲率とほぼ同じ曲率を有する前記フランジの外側表面を画定する、実施態様1に記載の装置。
(8) 前記フランジが、前記内側シールドの前記第1のほぼ管状部分の直径よりも小さい直径を有する第2のほぼ管状部分を画定する、実施態様1に記載の装置。
(9) 前記内側シールドの前記第1のほぼ管状部分と前記第2のほぼ管状部分とが同心である、実施態様8に記載の装置。
(10) 前記内側シールドの前記第1のほぼ管状部分と前記第2のほぼ管状部分とが同心ではない、実施態様9に記載の装置。
(12) 前記外側シールドの前記遠位端部が遠位方向に細くなって第1の半径を画定し、前記内側シールドの前記近位端部が遠位方向に細くなって第2の半径を画定し、前記内側シールドの前記近位端部が前記外側シールドの前記遠位端部内に入れ子状に収まることで、前記内側シールドが多軸枢動することが可能となる、実施態様11に記載の装置。
(13) 前記外側シールドの前記外側表面が、ナビゲーション器具に接続されるように適合された第1のポートを更に含む、実施態様1に記載の装置。
(14) 前記ナビゲーション器具を更に備え、前記第1のポートが前記ナビゲーション器具に接続されている、実施態様13に記載の装置。
(15) 前記外側シールドの前記外側表面が、光源に接続されるように適合された第2のポートを更に含む、実施態様1に記載の装置。
(17) 前記内側シールドが、アンカーとして機能する尖った遠位先端部を有する、実施態様1に記載の装置。
(18) c)前記シールドの近位端の間に配置された位置決めリングを更に備え、前記リングは、前記内側シールドを前記外側シールド上に近位側に固定するように適合されている、実施態様1に記載の装置。
(19) 前記内側シールドと前記外側シールドとが共に、深さ調節手段を形成する、実施態様1に記載の装置。
(20) 前記内側シールドが、遠位方向に延びる回転するフランジを更に含む、実施態様1に記載の装置。
(22) 患者の椎間板にアクセスする方法であって、
a)前記患者の皮膚に切開部を形成する工程と、
b)前記切開部を通じて、ほぼ管状の形状を有する外側シールドを経皮的に挿入する工程であって、前記外側シールドは、前記切開部から前記患者の脊椎の上関節突起まで延びるように適合された長さを有する、工程と、
c)前記上関節突起の少なくとも外側部分を切除する工程と、
d)内側シールドの遠位端部が前記椎間板まで延びるように、前記外側シールドに通して前記内側シールドを挿入する工程であって、前記内側シールドが外側表面を有する、工程と、
e)前記シールドの前記外側表面を神経根と接触させて前記神経根を遮蔽する工程と、を含む、方法。
(23) 患者の椎間板にアクセスする方法であって、
a)前記患者の皮膚に切開部を形成する工程と、
b)前記切開部を通じて、ほぼ管状の形状を有する外側シールドを経皮的に挿入する工程と、
c)内側シールドの遠位端部が前記椎間板まで延びるように、前記外側シールドに通して前記内側シールドを挿入する工程であって、前記内側シールドが外側表面を有する、工程と、
d)前記シールドの前記外側表面を神経根と接触させて前記神経根を遮蔽する工程と、を含む、方法。
(24) フランジシールドが、前記外側シールドの遠位端でアクセス窓の中心へと曲げられた後、続いて前記神経根の内側へと長手方向に進められている、実施態様23に記載の方法。
(25) 患者の椎間板にアクセスする方法であって、
a)前記患者の皮膚に切開部を形成する工程と、
b)前記切開部を通じて、ほぼ管状の形状を有する外側シールドを経皮的に挿入する工程であって、前記外側シールドは、前記切開部から前記患者の脊椎の上関節突起(SAP)まで延びるように適合された長さを有する、工程と、
c)前記外側シールドを椎弓根アンカーに対して安定化する工程と、
d)外側シールドに一体化された光学的可視化器具を挿入する工程と、
e)前記上関節突起の一部を切除し、かつ/又はマイクロサージェリーによる減圧手技を行う工程と、
f)内側シールドの遠位端部が前記椎間板まで延びるように、前記外側シールドに通して前記内側シールドを挿入する工程であって、前記内側シールドが外側表面を有する、工程と、
g)前記シールドの前記外側表面を神経根と接触させて前記神経根を遮蔽する工程と、
h)神経障害の原因となっていると考えられるすべての組織をマイクロサージェリーにより減圧する工程と、
i)椎骨終板からの軟骨状物質の除去を含む、椎間板物質を抜き取る工程と、
j)椎体間装置を椎間板腔内に挿入する工程と、
k)安定化機構を配備して椎間部分を安定化させる工程と、を含む、方法。
a)脊椎内に挿入されたリトラクタによって神経を変位させて変位神経とすることと、
b)前記変位神経に対する神経変位値を測定することであって、前記神経変位値は、神経の伸長、変位、弧長、及び直径からなる群から選択される、ことと、
c)前記神経変位値を神経変位値のライブラリと比較して神経の健康状態を定量することと、を含む、方法。
(27) 椎間板にアクセスするためのアクセス装置であって、
a)ほぼ管状部分と、切開部から関節突起まで延びるように適合された長さと、近位端部と、遠位端部と、外側表面と、内側表面を画定する長手方向の貫通孔とを有する外側シールドと、
b)i)近位端部と、遠位端部と、内側表面を画定する長手方向の貫通孔と、直径を画定する外側表面とを有する第1のほぼ管状部分と、ii)前記ほぼ管状部分の前記遠位端部から遠位方向に延びる長手方向のフランジとを有する内側シールドと、を備え、
前記内側シールドは、前記フランジが前記外側シールドの前記遠位端部を越えて遠位方向に延びるように、前記外側シールドの壁の内部にほぼ入れ子状に収まっている、アクセス装置。
Claims (23)
- 椎間板にアクセスするためのアクセス装置であって、
a)ほぼ管状部分と、切開部から関節突起まで延びるように適合された長さと、近位端部と、遠位端部と、外側表面と、内側表面を画定する長手方向の貫通孔とを有する外側シールドと、
b)i)近位端部と、遠位端部と、内側表面を画定する長手方向の貫通孔と、直径を画定する外側表面とを有する第1のほぼ管状部分と、ii)前記ほぼ管状部分の前記遠位端部から遠位方向に延びる長手方向のフランジとを有する内側シールドと、
c)前記外側シールドの前記遠位端部に固定的に配置されているビデオチップと、を備え、
前記内側シールドの前記外側表面は、前記フランジが前記外側シールドの前記遠位端部を越えて遠位方向に延びるように、前記外側シールドの前記内側表面内にほぼ入れ子状に収まっている、アクセス装置。 - 前記内側シールドの前記外側表面は、前記内側シールドの前記ほぼ管状部分の前記遠位端部が前記外側シールドの遠位端を越えて遠位方向に延びるように、前記外側シールドの前記内側表面内にほぼ入れ子状に収まっている、請求項1に記載の装置。
- 前記内側シールドの前記ほぼ管状部分の前記近位端部が、前記外側シールドの前記近位端部に当接するように適合された係止部を含み、前記係止部は、前記内側シールドの過剰な遠位方向への運動を防止するように適合されている、請求項1に記載の装置。
- 前記係止部が、前記内側シールドの前記ほぼ管状部分の前記近位端部からほぼ径方向に延びている、請求項3に記載の装置。
- 前記係止部が、把持されるように適合された粗面加工が施された径方向表面を更に含む、請求項4に記載の装置。
- 前記フランジが、円弧状の横断面を有する、請求項1に記載の装置。
- 前記フランジの前記円弧状の横断面が、前記外側シールドの前記内側表面の曲率とほぼ同じ曲率を有する前記フランジの外側表面を画定する、請求項6に記載の装置。
- 前記フランジが、前記内側シールドの前記第1のほぼ管状部分の直径よりも小さい直径を有する第2のほぼ管状部分を画定する、請求項1に記載の装置。
- 前記内側シールドの前記第1のほぼ管状部分と前記第2のほぼ管状部分とが同心である、請求項8に記載の装置。
- 前記内側シールドの前記第1のほぼ管状部分と前記第2のほぼ管状部分とが同心ではない、請求項8に記載の装置。
- 前記内側シールドの前記外側表面は、前記内側シールドの前記ほぼ管状部分の前記近位端部が前記外側シールド内で終端するように、前記外側シールドの前記内側表面内にほぼ入れ子状に収まっている、請求項1に記載の装置。
- 前記外側シールドの前記遠位端部が遠位方向に細くなって第1の半径を画定し、前記内側シールドの前記近位端部が遠位方向に細くなって第2の半径を画定し、前記内側シールドの前記近位端部が前記外側シールドの前記遠位端部内に入れ子状に収まることで、前記内側シールドが多軸枢動することが可能となる、請求項11に記載の装置。
- 前記外側シールドの前記外側表面が、ナビゲーション器具に接続されるように適合された第1のポートを更に含む、請求項1に記載の装置。
- 前記ナビゲーション器具を更に備え、前記第1のポートが前記ナビゲーション器具に接続されている、請求項13に記載の装置。
- 前記外側シールドの前記外側表面が、光源に接続されるように適合された第2のポートを更に含む、請求項1に記載の装置。
- 前記内側シールドが、係止部として機能する近位ひじ部を有する、請求項1に記載の装置。
- 前記内側シールドが、アンカーとして機能する尖った遠位先端部を有する、請求項1に記載の装置。
- c)前記内側及び外側シールドの近位端の間に配置された位置決めリングを更に備え、前記位置決めリングは、前記内側シールドを前記外側シールド上に近位側に固定するように適合されている、請求項1に記載の装置。
- 前記内側シールドと前記外側シールドとが共に、深さ調節手段を形成する、請求項1に記載の装置。
- 前記内側シールドが、遠位方向に延びる回転するフランジを更に含む、請求項1に記載の装置。
- 前記内側シールドが、遠位方向に延びる、回転する内側及び外側フランジを更に含む、請求項1に記載の装置。
- 椎間板にアクセスするためのアクセス装置であって、
a)ほぼ管状部分と、切開部から関節突起まで延びるように適合された長さと、近位端部と、遠位端部と、外側表面と、内側表面を画定する長手方向の貫通孔とを有する外側シールドと、
b)i)近位端部と、遠位端部と、内側表面を画定する長手方向の貫通孔と、直径を画定する外側表面とを有する第1のほぼ管状部分と、ii)前記ほぼ管状部分の前記遠位端部から遠位方向に延びる長手方向のフランジとを有する内側シールドと、
c)前記外側シールドの前記遠位端部に固定的に配置されているビデオチップと、を備え、
前記内側シールドは、前記フランジが前記外側シールドの前記遠位端部を越えて遠位方向に延びるように、前記外側シールドの内部にほぼ入れ子状に収まっている、アクセス装置。 - 前記ビデオチップは、前記ビデオチップが使用時に前記外側シールドを越えて遠位に突き出ないように、前記外側シールの前記遠位端部に固定的に配置されている、請求項1に記載の装置。
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