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US20090248092A1 - Posterior Intervertebral Disc Inserter and Expansion Techniques - Google Patents

Posterior Intervertebral Disc Inserter and Expansion Techniques Download PDF

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Publication number
US20090248092A1
US20090248092A1 US12055779 US5577908A US20090248092A1 US 20090248092 A1 US20090248092 A1 US 20090248092A1 US 12055779 US12055779 US 12055779 US 5577908 A US5577908 A US 5577908A US 20090248092 A1 US20090248092 A1 US 20090248092A1
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Prior art keywords
disc
motion
insertion
implant
space
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Abandoned
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US12055779
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Jonathan Bellas
SeungKyu Daniel Kwak
Michael J. O'Neil
John Riley Hawkinsl
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DePuy Synthes Products Inc
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DePuy Spine Inc
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Abstract

Insertion and expansion devices for use in inserting motion discs, and associated methods of use.

Description

    BACKGROUND OF THE INVENTION
  • [0001]
    The leading cause of lower back pain arises from rupture or degeneration of lumbar intervertebral discs. Pain in the lower extremities is caused by the compression of spinal nerve roots by a bulging disc, while lower back pain is caused by collapse of the disc and by the adverse effects of articulation weight through a damaged, unstable vertebral joint. One proposed method of managing these problems is to remove the problematic disc and replace it with a prosthetic disc that allows for the natural motion between the adjacent vertebrae (“a motion disc”).
  • [0002]
    There are many types of motion disc inserters disclosed in the prior art. These devices generally hold the inferior and superior endplates of the motion disc for “line of site” insertion. Positive stops and measurement devices are also employed on these inserters to determine the appropriate depth of implant placement.
  • [0003]
    PCT Published Patent Application WO 2006-058281 (“Glenn”) discloses a spinal implant to be inserted between two vertebra to support and stabilize adjacent vertebra and allow for physiological motion. The invention includes an implantable device to support the vertebrae, and a minimally invasive method for inserting and deploying the device within the intervertebral space.
  • SUMMARY OF THE INVENTION
  • [0004]
    The present invention relates to insertion and expansion devices for use in inserting intervertebral motion discs, and associated methods of use. They are grouped into two separate devices and techniques as follows:
  • [0005]
    In a first embodiment, the inserter has a longitudinal handle having a distal pair of holders for holding a proximal end of a pivoting motion disc, wherein one of the holders is axially deployable within the handle. The pair of holders secure the proximal legs of the implant for insertion into the disc space. This assembly utilizes an implant first methodology, wherein this assembly is inserted into the disc space in an orientation wherein the implant is on the leading end of the assembly. Once the motion disc is placed into the disc space, a secondary deployer associated with the handle is activated to axially move one of the holders, thereby moving one of the legs relative to the other leg and thereby changing the disc device footprint (e.g., pivoting one of the legs). Several expansion mechanisms can be used to expand the legs of the implant.
  • [0006]
    The approach used in conjunction with this first embodiment may include one or more annular locations. For example, in some embodiments, the approach is ipsilateral. In some embodiments, the approach is contralateral, or both. In some embodiments, the first embodiment of the present invention produces an X-shaped artificial intervertebral disc in its expanded condition. However, other expanded motion disc geometries, such as an H-shape artificial intervertebral disc in its expanded condition, are also contemplated.
      • Therefore, in accordance with the present invention, there is provided (claim 1) a method of inserting a curvilinear motion disc having a first and second legs connected by a pivot, each leg having an endportion, the method comprising the steps of:
        • a) providing the motion disc in a collapsed position,
        • b) providing a motion disc inserter comprising a handle having a longitudinal axis and a first end having first holder and a deployer, the deployer being axially moveable along the axis of the handle,
        • c) attaching the first endportion of the motion disc to the first holder,
        • d) contacting the second endportion of the motion disc to the deployer,
        • e) arcuately inserting the motion disc into the disc space in the collapsed condition, and
        • f) axially moving the deployer to move the second leg and to expand the motion disc into an open condition).
  • [0014]
    Therefore, in accordance with the present invention, there is provided (claim 15) an assembly for inserting a curvilinear motion disc into a disc space, the assembly comprising:
      • a) a curvilinear motion disc having first and second pivoting legs, each leg having an endportion, wherein the first and second leg endportions are in a first collapsed position, and wherein the first and second leg endportions are in a second expanded position, and
      • b) an inserter comprising a handle having a longitudinal axis and a first end having a first holder and a deployer, the deployer being axially moveable along the axis of the rod,
        wherein the first endportion of the motion disc is attached to the first holder, and wherein the second endportion of the motion disc is attached to the deployer.
  • [0017]
    In a second embodiment, the insertion instrument possesses an insertion track. The insertion track instrument is inserted into the disc space by itself and creates an annular shield for the motion disc implant (thereby protecting the disc). It also provides a guide or track for the subsequently-placed motion disc implant insertion and placement to follow during insertion. Lastly, the guide/track facilitates expansion of the motion disc footprint by holding the central axis pivot point.
      • Therefore, in accordance with the present invention, there is provided (claim 26) a method of inserting a curvilinear motion disc having first and second endportions, the method comprising the steps of:
        • a) providing the motion disc in a collapsed position wherein the first and second endportions are close together,
        • b) inserting into a disc space a distal portion of a motion disc inserter comprising a tubular proximal portion and a curved distal portion comprising upper and lower rails,
        • c) advancing the motion disc in the collapsed condition through the motion disc inserter to insert the motion disc into the disc space and rotate the motion disc, and
        • d) expanding the motion disc into an open condition in the disc space.
  • [0023]
    The methods of the present invention differ from those of the prior art because the present methods employ non-linear insertion techniques with instruments having deployment features that expand or change the footprint of an artificial intervertebral disc implant.
  • [0024]
    Some embodiments of this invention differs from prior art because it employs an expansion means to change location and footprint of the artificial disc, wherein the expansion means is independent of the insertion method.
  • [0025]
    This invention differs from the prior art because it does not use screw attachment to couple the inserter to the implant.
  • DESCRIPTION OF THE FIGURES
  • [0026]
    FIG. 1 discloses inserting a first motion disc/inserter assembly into the disc space, wherein the motion disc is in a collapsed condition.
  • [0027]
    FIG. 2 discloses advancing the motion disc of FIG. 1 further into the disc space to rotate the motion disc.
  • [0028]
    FIG. 3 discloses the initial actuation of the deployer to expand the motion disc to a partially expanded condition.
  • [0029]
    FIG. 4 discloses the complete actuation of the deployer to expand the motion disc to a final expanded condition.
  • [0030]
    FIG. 5 discloses advancing a motion disc up a linear proximal portion of a second motion inserter, wherein the motion disc is in a collapsed condition.
  • [0031]
    FIG. 6 discloses further advancing the motion disc of FIG. 5 through a curved intermediate portion of the inserter to rotate the motion disc.
  • [0032]
    FIG. 7 discloses further advancing the motion disc of FIG. 6 through a curved distal portion of the inserter to insert the motion disc into the disc space.
  • [0033]
    FIG. 8 discloses the final placement of the motion disc of the FIG. 7 in the disc space.
  • [0034]
    FIG. 9 discloses advancing an H-type motion disc up a linear proximal portion of a second motion inserter, wherein the motion disc is in a collapsed condition.
  • [0035]
    FIG. 10 discloses further advancing the motion disc of FIG. 9 through a curved distal portion of the inserter to rotate the motion disc and insert the motion disc into the disc space.
  • [0036]
    FIG. 11 discloses the initial actuation of the motion disc of FIG. 10 to expand a first leg of the motion disc.
  • [0037]
    FIG. 12 discloses the final actuation of the motion disc of FIG. 11 to expand a second leg of the motion disc.
  • DETAILED DESCRIPTION
  • [0038]
    Now referring to FIGS. 1-4, there is provided a method of inserting a motion disc having a first and second legs connected by a pivot, each leg having an endportion, the method comprising the steps of:
      • a) providing the motion disc 1 in a collapsed position wherein the first 3 and second 5 leg endportions are close together,
      • b) providing a motion disc inserter 7 comprising a handle having a longitudinal axis and a first end 11 having first 13 and second holders, the deployer being axially moveable along the axis of the handle,
      • c) attaching the first endportion of the motion disc to the first holder,
      • d) attaching the second endportion of the motion disc to the deployer,
      • e) inserting the motion disc into the disc space in the collapsed condition, and
      • f) axially moving the deployer to move the second leg and to expand the motion disc into an open condition.
  • [0045]
    In particular, and now referring to FIG. 1, the motion disc inserter secures the proximal portion of the motion disc implant for insertion into the disc space by grasping the top and bottom aspects of the proximal portion of the intradiscal device. Now referring to FIG. 2, the implant is inserted into its desired location in the disc space.
  • [0046]
    Now referring to FIG. 3, with the implant in its desired location, the deployment component of the inserter is activated to expand or adjust the implant shape for improved vertebra body contact and balanced load transfer. In particular, the expansion component of the inserter is activated to move the deployer axially and thereby pivot one of the legs of the implant shape. This produces expansion of the implant, improved vertebra body contact and a more balanced load transfer. Means for the axial movement of the deployer (and thereby the second leg) include: a) a rod that is slideably movable within a tube, b) a threaded rod that is threadably movable within a threaded tube, and c) a notched rod that is capable of ratcheted actuation.
  • [0047]
    FIG. 4 shows the motion disc in its expanded condition after it has been expanded by activation of the inserter.
  • [0048]
    The extent to which the deployer can be axially moved can be monitored via depth markings. In some embodiments, the depth markings are placed on the deployer. In some embodiments, the depth markings are placed on the insertion handle.
  • [0049]
    Although the inserter/deployer is shown in FIGS. 1-4 as being utilized in a posterior approach, it can be also used for other angles of approach, including lateral, anterior, and postero/lateral approaches.
  • [0050]
    The implant used in conjunction with the first embodiment can be of varying shape and configurations. Typically, it has at least one pivoting leg. In some embodiments, it has a pair of pivoting legs. An “X shaped” implant is shown in FIG. 1-4. The X-shape can have multiple layers wherein inferior and superior layers are held or deployed individually or simultaneously. Other disc implant geometries can utilizes the inserter holder/deployer of the first embodiment to insert an implant and change the footprint via disclosed the deployment means. An example of an alternate geometry is a “T”-, “Y”- or “H”-shaped implant.
  • [0051]
    In some embodiments, the handle portion of the present invention comprises a tube within which the deployer is contained. In some embodiments, the first holder is fixedly attached to the distal end portion of the tube. In other embodiments, the handle portion of the present invention comprises a solid rod, and the holders are attached to the outer surface of the rod.
  • [0052]
    The insertion track of the second embodiment of the present invention is curvilinear and has a blade, semi-tubular or tubular construction, thereby allowing negotiation of bony or soft tissues without damaging those tissues. This track provides a fixed route for insertion and rotation of the motion disc. In some embodiments, it has a substantially linear proximal portion and a curved distal portion. In some embodiments, the linear proximal portion is tubular. In some embodiments, the curved distal portion can also be tubular. However, in other embodiments, the curved distal portion can comprise upper and lower rails that mate with the upper and lower aspects of the motion disc. The insertion track also allows insertion of the motion disc via a trajectory more comparable to that of the inner wall of the annulus fibrosus, as compared to “line of site” linear insertion techniques. This compatible trajectory has the advantage of intruding upon less of the annulus fibrosus during device insertion. In use, the track is inserted into the disc space prior to insertion of the motion disc. Doing so creates an annular shield around the implant so that the implant can be safely inserted into the disc space. The curved feature of the insertion track also creates a guide for turning the device during device placement. It may also provide a method of changing the device footprint by virtue of a guiding pusher for expansion of shape.
  • [0053]
    Now referring to FIG. 5, there is provided an insertion track 21 of the present invention following its insertion into the disc space along the annular inner wall.
  • [0054]
    Now referring to FIG. 6, a motion disc implant 23 is shown advancing along this insertion track to enter the disc space. Now referring to FIG. 7, the implant is advanced along the track until its final desired central placement is obtained. The placement depth can be limited by a positive stop(s) along the insertion track (proximal tip stop (not shown). The depth to which the implant is inserted into the disc space can be monitored via depth markings provided on the track and referencing off an adjacent vertebral body.
  • [0055]
    Several methods of advancing the device along the insertion track can be carried out in accordance with the present invention. These methods include using a pusher instrument that holds and pushes the proximal end of the implant to advance it distally along the track. Another possible method may use a puller comprising a cable wrapped around a pulley located at the distal tip of the track, wherein one free end of the cable is connected to the implant and the other free end extends out of the proximal tubular portion of the insertion track. In this case, providing a tensile or pull force on the cable moves the device distally along the track and into the disc space.
  • [0056]
    Various methods of deployment can be used to change the device footprint once the motion disc is placed within the disc space. In one embodiment, the method includes temporarily attaching interconnecting features that connect the insertion track to the implant, and withdrawing the insertion track from the disc space, thereby changing the footprint of the implant via the insertion track extraction forces. In a second embodiment, and now referring to FIG. 8, the method includes placing on the contra-lateral side of the disc space an instrument to create an advancement stop. Instrument 31 has a puller mechanism, activating the puller mechanism and pulling or pushing the motion disc into position In alternate embodiments, the contralateral puller or pusher mechanism may be actuated to change the footprint configuration of the motion disc.
  • [0057]
    In some embodiments, the insertion track can be directly connected to the implant, which provides the advantage of controlled trajectory and final position. In other embodiments, the insertion track can be connected to a holder/spacer that is attached to the implant and the insertion track, which provides the advantage of determining the angle of approach and entry for the puller/pusher mechanism.
  • [0058]
    The implant used in conjunction with the second embodiment can be of varying shape and configurations. Typically, it has at least one pivoting leg. In some embodiments, it has a pair of pivoting legs. An X-shaped implant is shown in FIGS. 5-8. The X-shape can have multiple layers, wherein various inferior and superior layers are held and/or deployed individually or simultaneously. Other disc implant geometries can exploit the insertion track to insert an implant and change the footprint via disclosed deployment means. In some embodiments, the alternate implant geometry comprises a “T”-, “Y”- or “H”-shaped implant.
  • [0059]
    FIGS. 9-12 disclose the insertion and actuation of an H-type motion disc using the insertion track inserter of the present invention. This motion disc has a central body 51 having first 53 and second 55 endportions, wherein a first leg 57 is pivotally attached to the first endportion at a first pivot, and wherein a second leg 61 is pivotally attached to the second endportion at a second pivot. Upon expansion, each of the legs of this device pivots to an orientation perpendicular to the longitudinal axis of the central body, and the device takes on an “H” shape.
  • [0060]
    Now referring to FIG. 9, an H-type motion disc in a collapsed condition is advanced up a linear portion of the insertion track inserter. Now referring to FIG. 10, the H-type motion disc is further advanced through a curved portion of the insertion track inserter to rotate the motion disc and insert the motion disc into the disc space. Now referring to FIG. 11, initial actuation of the motion disc causes the pivoting of first leg of the motion disc and initial expansion of the motion disc. Now referring to FIG. 12, final actuation of the motion disc causes pivoting of the second leg of the motion disc and complete expansion of the motion disc.
  • [0061]
    Irrespective of the embodiment selected, if desired, an optional guide 101 (shown in FIG. 8) can be utilized during insertion and deployment to assist the surgeon in any one of disc space distraction, implant positioning, implant expansion, and/or verifying implant placement. This guide is typically placed on a contralateral side of the disc space. When the guide is used as a distractor, it typically has a transverse cross-section having a height and a width, wherein the width is greater than the height. The distractor is inserted into the disc space contralaterally so that its height dimension bears against the endplates. Prior to insertion of the motion disc, the distractor is rotated 90 degrees so that its width dimension now bears against the endplates, thereby increasing the height of the disc space.
  • [0062]
    Irrespective of the embodiment selected, in some embodiments, the inserter/deployer (as shown in FIGS. 1-4) or the insertion track (as shown in FIGS. 5-8) is used in a freehand manner. However, in other embodiments, the inserter/insertion track further comprises a docking means to dock onto or reference off nearby stable landmarks such as a vertebral body edge or a pedicle screw. Docking off of these locations provides for enhanced surgical stability and control.
  • [0063]
    Irrespective of the embodiment selected, intraoperative imaging techniques (including fluoroscopy) can be used to assist in or verify placement and deployment of the inserter and/or motion disc. Although the primary surgical approach shown is posterior or posterior/lateral, other approaches can be utilized.
  • [0064]
    Although the inserter/deployer and insertion track inserters are shown as being utilized posteriorly, they can be also used for other angles of approach including lateral, anterior, and posterior/lateral approaches.

Claims (30)

  1. 1. A method of inserting a curvilinear motion disc having a first and second legs connected by a pivot, each leg having an endportion, the method comprising the steps of:
    a) providing the motion disc in a collapsed position,
    b) providing a motion disc inserter comprising a handle having a longitudinal axis and a first end having a first holder and a deployer, the deployer being axially moveable along the axis of the handle,
    c) attaching the first endportion of the motion disc to the first holder,
    d) contacting the second endportion of the motion disc to the deployer,
    e) arcuately inserting the motion disc into the disc space in the collapsed condition, and
    f) axially moving the deployer to move the second leg and to expand the motion disc into an open condition.
  2. 2. The method of claim 1 wherein the handle comprises a rod within a tube, wherein the deployer is attached to a distal end of the rod, and wherein the axial movement of the deployer is accomplished by axially moving the rod within the tube.
  3. 3. The method of claim 2 wherein the axial movement of the deployer is accomplished by slidably moving the rod within the tube.
  4. 4. The method of claim 2 wherein the axial movement of the deployer is accomplished by threadably moving the rod within the tube.
  5. 5. The method of claim 2 wherein the axial movement of the deployer is accomplished by ratcheting movement of a notched rod within the tube.
  6. 6. The method of claim 1 further comprising monitoring a depth to which the deployer is axially moved by visualizing depth markings.
  7. 7. The method of claim 6 wherein the depth markings are located on the deployer.
  8. 8. The method of claim 6 wherein the depth markings are placed on the handle of the inserter.
  9. 9. The method of claim 1 further comprising the step of distracting the disc space with a distractor prior to inserting the motion disc.
  10. 10. The method of claim 9 wherein the distractor has a transverse cross-section having a height and a width, wherein the width is greater than the height.
  11. 11. The method of claim 1 wherein the motion disc is inserted into the disc space from a posterior approach.
  12. 12. The method of claim 1 further comprising the step of docking the inserter onto a landmark.
  13. 13. The method of claim 1 wherein the motion disc has a shape selected from the group consisting of a “T” shape, “Y” shape and a “H”-shape.
  14. 14. The method of claim 1 wherein the motion disc has an “H” shape.
  15. 15. An assembly for inserting a motion disc into a disc space, the assembly comprising:
    a) a curvilinear motion disc having first and second pivoting legs, each leg having an endportion, wherein the first and second leg endportions are in a first collapsed position, and wherein the first and second leg endportions are in a second expanded position, and
    b) an inserter comprising a handle having a longitudinal axis and a first end having a first holder and a deployer, the deployer being axially moveable along the axis of the rod,
    wherein the first endportion of the motion disc is attached to the first holder, and wherein the second endportion of the motion disc is attached to the deployer.
  16. 16. The assembly of claim 15 wherein the handle comprises a rod within a tube, and wherein the deployer extends from a distal end of the rod.
  17. 17. The assembly of claim 16 wherein the rod is slidably movable within the tube.
  18. 18. The assembly of claim 16 wherein the rod is threadably movable within the tube.
  19. 19. The assembly of claim 16 wherein the rod is ratchetably movable within the tube.
  20. 20. The assembly of claim 15 wherein the handle further comprises depth markings.
  21. 21. The assembly of claim 20 wherein the handle comprises a rod within a tube, and wherein the depth markings are placed on the rod.
  22. 22. The assembly of claim 20 wherein the depth markings are placed on the inserter handle.
  23. 23. The assembly of claim 15 further comprising docking means on the inserter.
  24. 24. The assembly of claim 15 wherein the motion disc has a shape selected from the group consisting of a “T” shape, “Y” shape and a “H” shape.
  25. 25. The assembly of claim 15 wherein the motion disc has an “H” shape.
  26. 26. A method of inserting a curvilinear motion disc having first and second endportions, the method comprising the steps of:
    a) providing the motion disc in a collapsed position wherein the first and second endportions are close together,
    b) inserting into a disc space a distal portion of a motion disc inserter comprising a proximal portion and a curved distal portion comprising upper and lower rails,
    c) advancing the motion disc in the collapsed condition through the motion disc inserter to insert the motion disc into the disc space and rotate the motion disc,
    f) expanding the motion disc into an open condition in the disc space.
  27. 27. The method of claim 26 wherein advancing the motion disc is performed with a pusher that holds and pushes a proximal end of the motion disc to advance it distally within the inserter.
  28. 28. The method of claim 26 wherein advancing the motion disc is performed with a puller comprising a cable wrapped around a pulley located at a distal tip of the track, wherein a first free end of the cable is connected to the motion disc and a second free end of the cable extends out of the proximal tubular portion of the inserter, whereby providing a tensile force on the cable moves the motion disc distally within the inserter and into the disc space.
  29. 29. The method of claim 26 wherein advancing the motion disc is performed by temporarily attaching interconnecting features that connect the inserter to the implant, and withdrawing the inserter from the disc space, thereby changing a footprint of the motion disc via inserter extraction forces.
  30. 30. The method of claim 26 wherein advancing the motion disc is performed by placing an instrument having a puller mechanism on a contra-lateral side of the disc space, activating the puller mechanism and thereby pulling the motion disc into position.
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