US20110166576A1 - Method and apparatus for removing material from an intervertebral disc space, such as in performing a nucleotomy - Google Patents

Method and apparatus for removing material from an intervertebral disc space, such as in performing a nucleotomy Download PDF

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Publication number
US20110166576A1
US20110166576A1 US13050388 US201113050388A US20110166576A1 US 20110166576 A1 US20110166576 A1 US 20110166576A1 US 13050388 US13050388 US 13050388 US 201113050388 A US201113050388 A US 201113050388A US 20110166576 A1 US20110166576 A1 US 20110166576A1
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Prior art keywords
tubular
member
cutting
outer
inner
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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.)
Abandoned
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US13050388
Inventor
Dana A. Oliver
Kenneth M. Adams
Tom J. Francis
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Medtronic Xomed Inc
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Medtronic Xomed Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B17/320016Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A61B17/32002Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238Type of minimally invasive operation
    • A61B2017/00261Discectomy
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2901Details of shaft
    • A61B2017/2904Details of shaft curved, but rigid

Abstract

Instrument and method for removing material from an intervertebral disc. The instrument includes outer and inner tubular members. The outer tubular member defines a passage and a cutting window. The inner tubular member is coaxially disposed within the passage, and defines a central lumen and a cutting tip. The cutting tip forms an open mouth having a plurality of teeth. Upon assembly, the cutting tip is exposed within the cutting window combining to define a shaving head. A powered handpiece is coupled to the inner tubular member, and the shaving head is inserted into an intervertebral disc and positioned such that the cutting tip contacts targeted material (e.g., nucleus, annulus and/or end plate). The handpiece is activated to rotate the cutting tip relative to the cutting window. Contacted material is sheared between an edge of the cutting window and the teeth of the cutting tip.

Description

    CROSS-REFERENCE TO RELATED APPLICATION
  • [0001]
    This application is a continuation of U.S. patent application Ser. No. 11/289,266, filed Nov. 29, 2005, the contents of which are incorporated herein by reference.
  • BACKGROUND OF THE INVENTION
  • [0002]
    The present invention relates to removal of intervertebral disc material. More particularly, it relates to a method and powered device for removing some or all of the material (tissue, cartilaginous bone, etc.) associated with an intervertebral disc, for example in performing a nucleotomy.
  • [0003]
    The vertebral spine includes, amongst other structures, a series of bony vertebrae, adjacent ones of which are supported and separated by an intervertebral disc. In a healthy spine, the discs maintain separation between the vertebrae, promoting fluid circulation throughout the spine, and providing a cushioning effect between the vertebral structures. An intervertebral disc generally includes an annulus fibrosis (or “annulus”), a nucleus pulposus (or “nucleus”), and opposing end plates. The end plates are akin to cartilaginous bone and serve to attach adjacent vertebrae to the disc. The nucleus is disposed between the end plates, circumferentially constrained by the annulus.
  • [0004]
    Intervertebral discs are elastic in nature, and can be damaged or displaced. For example, intervertebral discs can be overtly stressed by excessive movement, excess body weight, injury, disease, and/or gradual deterioration with age. Intervertebral disc injuries or other abnormalities can result in serious back pain and physical disability, and are often chronic and difficult to treat. For example, the annulus may bulge or tear, with the distended nucleus tissue compressing against a spinal nerve (e.g., disc herniation). Similarly, the disc may degenerate over time, leading to a collapse of the disc space.
  • [0005]
    Surgical procedures have been developed to repair damage or displaced intervertebral discs. These procedures include nucleotomies or discectomies in which a portion (e.g., the nucleus), or an entirety of the intervertebral disc is excised. Fusion is another accepted technique and entails the bony portions of the spine being fused together to limit the relative motion between adjacent vertebrae. Insertion/implantation of the fusion-inducing device(s) again requires removal of certain discal tissue. Similarly, disc decompression/fusion procedures require forming a hole in the annulus possibly followed by removal of nucleus tissue prior to backfilling with fusion material. More recently, nucleus replacement implants have been developed; these products also require removal of discal tissue (i.e., the nucleus and/or portions of, or all of, the annulus) prior to implantation.
  • [0006]
    Regardless of the exact procedure, various manual instruments for the removal of intervertebral disc material(s) are conventionally employed. These manual instruments include osteotomes, surgical chisels, guillotine cutting devices, etc. The highly confined nature of the surgical site associated with the intervertebral disc, the delicate surrounding structures (e.g., nerves), and the wide-range of material to be cut (i.e., the nucleus tissue is fairly soft, whereas the annulus tissue is quite tough), have likely given rise to the reliance upon simple, manual devices. While viable, use of manual instrumentation can render the procedure overly time consuming. Often times, several different manual instruments must be passed in and out of the surgical site multiple times in order to remove the desired discal material. This increases the chance of damage to sensitive structures adjacent to the spine (vascular and nervous). The manual instruments also require separate irrigation and suction device(s) to clean the surgical site during and after the procedure. Further, for certain procedures such as nucleotomies, manual surgical instruments require a surgeon to rely upon tactile feel to ensure that the annulus is not violated.
  • [0007]
    Injured and degenerated intervertebral discs pose serious health problems to a large number of patients. Many current and future treatments require the removal of nucleus and/or other discal tissue. Manual intervertebral disc material-removing tools are time-consuming to use, and require multiple other instruments. Available powered instruments for cutting intervertebral disc material do not afford the ability to deftly shave only targeted bodily structures, an attribute essentially required by the anatomy forming and surrounding the intervertebral disc. Further, available powered instruments may not be able to adequately cut the disparate bodily materials (in terms of hardness and toughness) typically presented by an intervertebral disc. Any advancement in the tools and related methods for performing this delicate material removal within or at the disc space will be well-received.
  • SUMMARY OF THE INVENTION
  • [0008]
    Some aspects of the present invention relate to a method of removing material from an intervertebral disc otherwise defined by a nucleus surrounded by an annulus and opposing end plates. The method includes providing a surgical shaving instrument including an elongated outer tubular member and an elongated inner tubular member. The outer tubular member defines a central passage and a cutting window at a distal end thereof. The cutting window is defined by a perimeter edge and is fluidly connected to the central passage. The inner tubular member is coaxially disposed within the central passage, and further defines a central lumen and a cutting tip at a distal end thereof. The cutting tip forms a mouth that is open to the lumen and has a plurality of teeth formed along a perimeter. Upon final assembly, the cutting tip is exposed within the cutting window, with the cutting tip and cutting window combining to define a bodily material shaving head. A powered handpiece is coupled to the inner tubular member such that the powered handpiece can cause the inner tubular member to rotate relative to the outer tubular member. The shaving head is inserted into an intervertebral disc and positioned such that the cutting tip contacts targeted material of the disc. The powered handpiece is activated to rotate the cutting tip relative to the cutting window. Contacted bodily material is, as a result, sheared between the edge of the cutting window and the teeth of the cutting tip. Finally, the sheared material is aspirated through the inner tubular member's lumen via the mouth. In one embodiment, the surgical instrument further includes an irrigation mechanism fluidly connected to the bodily material shaving head, with the method further including irrigating the material shaving head while shearing tissue.
  • [0009]
    Other aspects of the present invention relate to a surgical intervertebral disc material shaving instrument for use with a powered handpiece. The instrument includes outer and inner tubular members. The outer tubular member defines a central passage and a cutting window. The cutting window is fluidly connected to the central passage and is defined by a perimeter edge having opposing, first and second longitudinal sides. At least four teeth are formed on each of the opposing longitudinal sides. The inner tubular member is coaxially disposed within the central passage, and defines a central lumen and a cutting tip. The cutting tip forms a plurality of circumferentially-extending teeth about a mouth that is otherwise fluidly connected to the lumen. Upon final assembly, the cutting tip is exposed within the cutting window, with the cutting window and the cutting tip combining to define a material shaving head adapted to shear intervertebral disc material, as well as to aspirate sheared material through the mouth and lumen.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0010]
    FIG. 1 is a perspective view of an intervertebral disc material shaving instrument in accordance with aspects of the present invention;
  • [0011]
    FIG. 2 is a cross-sectional, partial exploded view of the instrument of FIG. 1;
  • [0012]
    FIG. 3A is an enlarged top plan view of a distal segment of an outer tubular member portion of the instrument of FIG. 1;
  • [0013]
    FIG. 3B is a side view of the segment of FIG. 3A;
  • [0014]
    FIG. 3C is an enlarged, top plan view of a distal segment of an inner tubular member portion of the instrument of FIG. 1;
  • [0015]
    FIG. 3D is a cross-sectional view of the assembled instrument of FIG. 1;
  • [0016]
    FIG. 4 is an enlarged, top plan view of the material shaving head formed by the instrument of FIG. 1
  • [0017]
    FIG. 5 is a simplified, top plan view of an intervertebral disc in combination with the instrument of FIG. 1 upon initial approach;
  • [0018]
    FIG. 6 is the view of FIG. 5 with the instrument fully inserted; and
  • [0019]
    FIG. 7 is a simplified, side cross-sectional view of FIG. 6.
  • DETAILED DESCRIPTION OF THE INVENTION
  • [0020]
    One embodiment of an intervertebral disc shaving instrument 20 in accordance with the principles of the present invention is shown in FIGS. 1 and 2. The instrument 20 includes an outer tubular assembly 22 and an inner tubular assembly 24. The outer tubular assembly 22 includes an outer tubular member 26 and a first hub assembly 28. Similarly, the inner tubular assembly 24 includes an inner tubular member 30 (best seen in FIG. 2) and a second hub assembly 32. Details on the various components are provided below. In general terms, however, the inner tubular member 30 is coaxially disposed within the outer tubular member 26, with the tubular members 26, 30 combining to define a bodily material shaving head 34 (FIG. 1). During use, the instrument 20 is coupled to a powered handpiece (not shown) that rotates the second hub assembly 32, and thus the inner tubular member 30, relative to the outer tubular member 26 in an oscillating fashion, to effectuate shearing of intervertebral disc material (not shown) at the shaving head 34.
  • [0021]
    The outer tubular member 26 is an elongated body defining a proximal segment 40, an intermediate segment 42, and a distal segment 44. Further, the outer tubular member 26 defines a central passage 46 (FIG. 2) extending from the distal segment 44 to the proximal segment 40.
  • [0022]
    With specific reference to FIG. 2, the proximal segment 40 is adapted for connection to the first hub assembly 28, and defines a longitudinal axis A. For example, the proximal segment 40 forms a proximal open end 47 and a radial aperture 48 both of which are open to the central passage 46. As described below, the open end 47 facilitates placement of the inner tubular member 30 within the central passage 46, whereas the aperture 48 establishes fluid connection between the central passage 46 and a corresponding component of the first hub assembly 28. Alternatively, the proximal segment 40 can assume a variety of other forms.
  • [0023]
    The intermediate segment 42 extends from the proximal segment 40 to the distal segment 44 and forms a bend 50. In one embodiment, the distal segment 44 is linear in longitudinal extension. Thus, due to the bend 50, the distal segment 44 extends at or forms a bend angle Θ relative to the longitudinal axis A of the proximal segment 40. The bend angle Θ is selected to facilitate desired positioning of the distal segment 44 (and thus of the tissue shaving head 34) within an intervertebral disc space (not shown) using an expected surgical approach to the disc space as described below. With this in mind, the bend angle Θ is in the range of 0-90°. For example, it has surprisingly been found that for posterior disc approach applications, the bend angle Θ is preferably in the range of 20-45°, more preferably 45°. It has further been surprisingly found that for lateral disc approach procedures, the bend angle Θ is preferably in the range of 0-12.5°, more preferably 12.5°. Notably, however, principles of the present invention are not limited to a particular value or range for the bend angle Θ. Along these same lines, two or more bends can be provided along a length of the outer tubular member 26 (e.g., along one, two, or all of the segments 40-44). Further, the bend 50 can be formed at a longitudinal position varying from that shown in FIGS. 1 and 2 (e.g., along the proximal segment 40). Preferably, however, a length L of the distal segment 44 (i.e., linear distance from a distal termination point of the bend 50 to a distal-most end 52 of the distal segment 44) is in the range of 1.5-3.5 cm, more preferably 2.5 cm. It has surprisingly been found that by forming a “working end” of the instrument 20 to have a length of 2.5 cm is highly conducive to cutting operation within an intervertebral disc via a posterior lumbar approach (e.g., as part of a posterior lumbar intervertebral fusion operation). Notably, the length L can vary in other embodiments.
  • [0024]
    As mentioned above, the distal segment 44 terminates at the distal end 52 that is preferably closed to the central passage 46. Further, the distal segment 44 forms a cutting window 54 proximal the closed distal end 52. As described in greater detail below, the closed distal end 52 serves to distally shield a cutting surface of the inner tubular member 30, whereas the cutting window 54 exposes the surface. Thus, in one embodiment, an exterior surface of the closed distal end 52 is curved.
  • [0025]
    With reference to FIGS. 3A and 3B, the cutting window 54 is open or fluidly connected to the central passage 46, and is defined by a perimeter edge 56. Relative to a longitudinal extension of the outer tubular member 26, the perimeter edge 56 generally defines opposing first and second longitudinal sides 58, 60, and opposing lateral ends 62, 64. With these spatial designations in mind, in one embodiment, the perimeter edge 56 forms a plurality of teeth 66 along each of the longitudinal sides 58, 60. The teeth 66 can assume a variety of forms, but in one embodiment are symmetrically arranged relative to the side 58, 60. In one embodiment, each of the sides 58, 60 includes or forms at least four teeth 66 to promote aggressive removal of intervertebral disc material. The teeth 66 are formed to be highly sharpened (e.g., tip width or thickness on the order of approximately 0.005 inch), and wrap or curve in conformance with a curvature of the remainder of the outer tubular member 26. In one embodiment, a tip-to-tip spacing between adjacent ones of the teeth 66 (along a corresponding side 58 or 60) is in the range of 0.04-0.06 inch, more preferably approximately 0.05 inch (±0.002 inch). Further, in one embodiment, the lateral ends 62, 64 are similarly sharp. While other dimensions and/or configurations can be employed, it has surprisingly been found that the above-described preferences are highly conducive to cutting the disparate material structures associated with an intervertebral disc.
  • [0026]
    Returning to FIG. 2, the outer tubular member 26 is preferably formed of a hardened, surgically safe material, capable of supporting the inner tubular member 30 at high rotational/oscillation speeds (e.g., oscillation speed of 5,000 RPM), while maintaining the bent shape illustrated. Thus, for example, the outer tubular member 26 is formed of 304 stainless steel; although a multitude of other materials are equally acceptable. Regardless, the central passage 46 is sized to coaxially receive the inner tubular member 30 in a manner allowing the inner tubular member 30 to rotate within the passage 46. In one embodiment, and as described below, a diameter of the central passage 46 is slightly greater than an outer diameter of the inner tubular member 30 to establish an irrigation pathway.
  • [0027]
    The first hub assembly 28 is adapted to receive and retain the proximal segment 40 of the outer tubular member 26, and in one embodiment includes an irrigation collar 68, an outer hub 70, and an inner hub 72. The irrigation collar 68 forms an irrigation port 74, and is configured to establish an irrigation fluid flow path to and from the central passage 46 of the outer tubular member 26 upon final assembly, as described below. The outer hub 70 and the inner hub 72 are adopted to secure the irrigation collar 68 to the outer tubular member 26, and thus can assume a variety of forms. In one embodiment, however, the outer hub 70 is sized for securement over the irrigation collar 68 as well as to the outer tubular member 26. Conversely, the inner hub 72 is sized for securement between the irrigation collar 68 and the outer tubular member 26, and in one embodiment forms a longitudinal passageway 76 and a radial opening 77. The longitudinal passageway 76 extends through an entirety of the inner hub 72, whereas the radial opening 77 is sized and positioned for fluid connection to the port 74 (and the radial aperture 48 of the outer tubular member 26) upon final assembly. To further promote a complete, sealed final relationship, the first hub assembly 28 further includes seals (e.g., O-rings) 78 and a seal hub 79 in one embodiment. Regardless, the first hub assembly 28 establishes a mechanism for delivering irrigation liquid from an irrigation source (not shown) to the shaving head 34 via the irrigation port 74 and the passage 46. The irrigation fluid serves to “clean” the surgical site, augment lubrication between the inner and outer tubular members 30, 26, and facilitate evacuation/aspiration of material from the surgical site (described below) by clearing “clogs” at the shaving head 34. Alternatively, the first hub assembly 28 can assume a variety of other forms.
  • [0028]
    The inner tubular member 30 is, similar to the outer tubular member 26, an elongated tube defining a proximal region 80, an intermediate region 82, and a distal region 84. Further, the inner tubular member 30 defines a central lumen 86 extending from the proximal region 80 to the distal region 84. Once again, the inner tubular member 30 is sized to be coaxially received within the outer tubular member 26, with the proximal region 80 adapted for mounting to the second hub 32. In one embodiment, at least the intermediate region 82 has a flexible construction such that the inner tubular member 30 will assume the shape of the outer tubular member 26 (and in particular the bend 50) upon insertion of the inner tubular member 30 within the outer tubular member 26. For example, the intermediate region 82 can be or includes a wound coil(s) or reinforced tube(s) (e.g., inner and outer spiral wraps assembled over a spiral cut formed in the outer tubular member 30), series of laser cut dovetail sections, etc. (it being understood that the intermediate region 82 is illustrated generally in FIG. 2). Regardless, while the regions 80-84 may have differing constructions (e.g., the proximal and distal regions 80, 84 are metal tubes, whereas the intermediate region 82 is a wound coil), the inner tubular member 30 has an overall construction capable of maintaining structural integrity when rotated at high speeds (e.g., oscillation speeds on the order of 5,000 RPM).
  • [0029]
    The distal region 84 forms a cutting tip 90. With additional reference to FIG. 3C, the cutting tip 90 includes a plurality of teeth 92 formed in a circumferentially-extending manner about a mouth 94. The teeth 92 are highly similar to the teeth 66 (FIGS. 3A and 3B) previously described, symmetrically arranged along opposite sides of the mouth 94 (it being understood that only one set of the teeth 92 are visible in FIG. 3C). Thus, in one embodiment, at least four of the teeth 92 are formed along each side of the mouth 94, and are highly sharpened. Further, in one embodiment, the teeth 92 are sized and positioned to be spatially aligned with the teeth 66 upon final assembly. Thus, in one embodiment, adjacent ones of the teeth 92 have a tip-to-tip spacing on the order of 0.04-0.06 inch, more preferably approximately 0.05 inch (±0.002 inch).
  • [0030]
    The mouth 94 is open to, and thus fluidly connected with, the lumen 86. As described in greater detail below, this configuration establishes an aspiration pathway from the mouth 94 and through the lumen 86. In this regard, material aspirated via the lumen 86/mouth 94 can be removed via an appropriate port associated with the second assembly hub 32. In one embodiment, the distal region 84 has a relatively large outer diameter, on the order of 3-8 mm, more preferably 4.5 mm, to reduce clogging of the lumen 86 during use. Alternatively, other dimensions can be employed.
  • [0031]
    Regardless of the exact configuration, at least as a majority of an inner diameter of the outer tubular member 26 is, in one embodiment, slightly larger than an outer diameter of the inner tubular member 30 so as to establish an annular gap 100 between the two components 26, 30 upon final assembly as shown in FIG. 3D. It will be understood that while FIG. 3D illustrates the inner tubular member 30 as being approximately centered relative to the outer tubular member 26, in actual practice, the inner tubular member 30 may contact the outer tubular member 26 at various radial locations. Along these lines, in one embodiment, the cutting tip 90 (FIG. 3C) of the inner tubular member 30 may have a diameter larger than a remainder thereof (such as by separately forming the cutting tip 90 and assembling to a remainder of the inner tubular member 30) that more closely matches an inner diameter of the outer tubular member 26. Regardless, a size of the gap 100 is exaggerated in the view of FIG. 3D for purposes of explanation. With additional reference to FIGS. 1 and 2, the annular gap 100 extends from the irrigation port 74 to the cutting window 54 to establish an interior irrigation pathway or mechanism by which an irrigation fluid can be delivered from the irrigation port 74 to the cutting window 54 (and thus the shaving head 34) via the annular gap 100. Alternatively, a separate irrigation tube (not shown) can be provided along (or formed with) an exterior of the outer tubular member 26.
  • [0032]
    With specific reference to FIG. 2, the second hub assembly 32 is sized for mounting to the inner tubular member 30 and includes, in one embodiment, a rotating hub 102 and a spring 104. The rotating hub 102 is adapted for coupling to a powered handpiece (not shown) as known in the art. The spring 104 facilitates releasable engagement with the powered handpiece, and in alternative embodiments, can be eliminated. To this end, the powered handpiece can assume a variety of forms, and can be electrically, or battery, or pneumatically powered.
  • [0033]
    Assembly of the instrument 20 includes securing the first hub assembly 28 to the outer tubular member 26. In one embodiment, the inner hub 72 is mounted over the proximal segment 40 such that the radial opening 77 is aligned, or otherwise fluidly connected to, the radial aperture 48. To ensure affixment of the inner hub 72 to the outer tubular member 26, an adhesive (e.g., Loctite adhesive) can be employed. The irrigation collar 68 is mounted over the inner hub 72 such that the port 74 is aligned with, or otherwise fluidly connected to, the radial opening 77 (and thus the radial aperture 48). The seals 78 are included at opposite sides of the port 74/radial opening 77 interface to provide a fluid-sealed relationship. The outer hub 70 is assembled or formed over the outer tubular member 26 and the irrigation collar 68. Where desired, an adhesive (e.g., Loctite adhesive) can be employed to bond the outer hub 70 to the irrigation collar 68.
  • [0034]
    The second hub assembly 32 is mounted to the proximal region 80 of the inner tubular member 30. An adhesive can be employed to bond the rotating hub 102 to the inner tubular member 30. The inner tubular member 30 is distally slid or inserted into and through the inner hub 72 and the outer tubular member 26 such that the cutting tip 90 is at or within the cutting window 54. To this end, the seal hub 79 sealingly engages an exterior of the inner tubular member 30 such that irrigation fluid within the outer tubular member 26 (e.g., within the gap 100 (FIG. 3D)) will not flow or leak proximal the seal hub 79.
  • [0035]
    The shaving head 34 upon final assembly is shown in greater detail in FIG. 4. In particular, the cutting tip 90 is exposed at the cutting window 54. During use, as the inner tubular member 30 is rotatably oscillated relative to the outer tubular member 26, a shearing action is created between the teeth 92 of the cutting tip 90 and the teeth 66 of the cutting window 54. By providing a large number of sharp teeth, this shearing motion is able to aggressively remove material, yet provides a user with the ability to perform a controlled shaving or shearing operation, thus ensuring that only desired bodily material is contacted and cut. To this end, the closed distal end 52 of the outer tubular member 26 provides a blunt surface for non-traumatically contacting anatomical structures, thus providing instrument safety during “blind” cutting procedures.
  • [0036]
    One method of removing material from an intervertebral disc 110 using the intervertebral disc material shaving instrument 20 in accordance with principles of the present invention is illustrated in FIGS. 5-7. By way of reference, the intervertebral disc 110 generally includes a nucleus 112 surrounded by an annulus 114 and opposing ends plates 116, 118 (FIG. 7). The end plates 116, 118 in turn, are formed as part of adjacent vertebrae 120, 122 (FIG. 7), respectively, and thus are akin to cartilaginous bone. With these general definitions in mind, the instrument 20 is employed to surgically remove or shave some or all of the material (e.g., tissue, cartilaginous bone, etc.) associated with the intervertebral disc 110. For example, one common procedure associated with treatment of a diseased intervertebral disc 110 is a nucleotomy in which a portion, or all, of the nucleus 112 is removed. With this in mind, the instrument 20 is deployed to the disc 110, for example via an posterior-lateral approach. Alternative approaches to the disc 110 are also acceptable and within the principles of the present invention, such as posterior approach, transforaminal approach, anterior approach, left or right lateral approach, etc. Regardless, as shown in FIG. 5, the shaving head 34 is positioned at an exterior of the annulus 114, aligned with an opening 124 formed therein. The opening 124 can be a naturally-occurring tear or similar passage; alternatively, the opening 124 can be surgically cut or otherwise created in the annulus 114. The closed distal end 52 contacts the annulus 114 in a non-traumatic manner, and protects the annulus 114 from potentially damaging, undesired contact with the teeth 66 (FIG. 3A) and 92 (FIG. 3C).
  • [0037]
    The shaving head 34 is then distally advanced within the annulus 114, with the bend 50 facilitating desired extension of the shaving head 34 “across” the nucleus 112 region as shown in FIG. 6. That is to say, the bend 50 is configured to anatomically “match” the expected insertion site of the tissue shaving head 34 relative to the opening 124 in the annulus 114 (that is otherwise offset from a “center” of the disc 110 so as to avoid contact with other bodily structures such as nerves). Thus, the bend angle Θ (FIG. 2) is a function of the expected disc 110 approach location. With the shaving head 34 properly positioned, the bend 50 generally resides at the annulus 114.
  • [0038]
    Regardless of the exact positioning, the instrument 20 is powered to effectuate removal of contacted material. More particularly, and with additional reference to FIG. 7, the powered handpiece (not shown) is activated, causing the cutting tip 90 (FIG. 3C) to rotationally oscillate relative to the cutting window 54. For example, the cutting tip 90 can be rotationally oscillated at speeds at or in excess of 5,000 RPM. In one embodiment, the powered handpiece is operated to rotate the inner tubular member 26 (FIG. 2) two revolutions in one direction, followed by two revolutions in the opposite direction, etc., although other operational formats are also acceptable. Nucleus tissue 112, otherwise in contact with the cutting tip 90/cutting window 54, is sheared between the two components, and aspirated from the surgical site via the mouth 94/lumen 86 (FIG. 2). Further, irrigation fluid is directly applied to the surgical site via the irrigation mechanism previously described so as to minimize clogging of the tissue shaving head 34, and in particular the mouth 94/lumen 86. The irrigation fluid can also serve to lubricate the surgical site as well as the inner tubular member 30/outer tubular member 26 interface.
  • [0039]
    While the instrument 20 has been described in connection with performing a nucleotomy, other material of the intervertebral disc 110 can also be aggressively shaved or sheared with the instrument 20. For example, the annulus 114 tissue and/or end plate 116, 118 cartilaginous bone can also be shaved/sheared as desired.
  • [0040]
    Although the present invention has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes can be made in form and detail without departing from the spirit and scope of the present invention.

Claims (8)

  1. 1. A surgical intervertebral disc material shaving instrument for use with a powered handpiece, the instrument comprising:
    an elongated outer tubular member defining a central passage and a cutting window at a distal end thereof, the cutting window being fluidly connected to the central passage and defined by a perimeter edge forming at least four teeth on a first longitudinal side and at least four teeth on a second longitudinal side thereof; and
    an inner tubular member coaxially disposed within the central passage, the inner tubular member defining a central lumen and a cutting tip at a distal end thereof, the cutting tip including a plurality of circumferentially-extending teeth formed about at least a portion of a mouth otherwise fluidly connected to the lumen;
    wherein upon final assembly, the cutting tip is exposed within the cutting window, the cutting tip and cutting window combining to define a shaving head configured to shear intervertebral disc material and aspirate sheared material through the mouth and lumen.
  2. 2. The instrument of claim 1, wherein the cutting tip has a diameter in the range of 3-8 mm.
  3. 3. The instrument of claim 2, wherein the cutting tip has an outer diameter of 4.5 mm.
  4. 4. The instrument of claim 1, wherein the outer tubular member includes a proximal segment and a distal segment, the distal segment forming the cutting window and extending at an angle relative to a longitudinal axis of the proximal segment in the range of 0-90°.
  5. 5. The instrument of claim 4, wherein the distal segment extends at an angle in the range of 20-45° relative to the proximal segment.
  6. 6. The instrument of claim 5, wherein the distal segment extends at an angle of 45° relative to the proximal segment.
  7. 7. The instrument of claim 1, wherein the distal segment extends from the distal end to the bend, the distal segment having a length in the range of 1-3.5 cm.
  8. 8. The instrument of claim 7, wherein the distal segment has a length of 2.5 cm.
US13050388 2005-11-29 2011-03-17 Method and apparatus for removing material from an intervertebral disc space, such as in performing a nucleotomy Abandoned US20110166576A1 (en)

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US11289266 US7927361B2 (en) 2005-11-29 2005-11-29 Method and apparatus for removing material from an intervertebral disc space, such as in performing a nucleotomy
US13050388 US20110166576A1 (en) 2005-11-29 2011-03-17 Method and apparatus for removing material from an intervertebral disc space, such as in performing a nucleotomy

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US13050388 US20110166576A1 (en) 2005-11-29 2011-03-17 Method and apparatus for removing material from an intervertebral disc space, such as in performing a nucleotomy

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9603610B2 (en) 2013-03-15 2017-03-28 DePuy Synthes Products, Inc. Tools and methods for tissue removal

Families Citing this family (28)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8123750B2 (en) * 2005-08-17 2012-02-28 Corespine Technologies, Llc Apparatus and methods for removal of intervertebral disc tissues
US8088163B1 (en) 2008-02-06 2012-01-03 Kleiner Jeffrey B Tools and methods for spinal fusion
US9247943B1 (en) 2009-02-06 2016-02-02 Kleiner Intellectual Property, Llc Devices and methods for preparing an intervertebral workspace
USD656610S1 (en) 2009-02-06 2012-03-27 Kleiner Jeffrey B Spinal distraction instrument
US8366748B2 (en) 2008-12-05 2013-02-05 Kleiner Jeffrey Apparatus and method of spinal implant and fusion
US8906028B2 (en) * 2009-09-18 2014-12-09 Spinal Surgical Strategies, Llc Bone graft delivery device and method of using the same
US9186193B2 (en) 2009-09-18 2015-11-17 Spinal Surgical Strategies, Llc Fusion cage with combined biological delivery system
US9629729B2 (en) 2009-09-18 2017-04-25 Spinal Surgical Strategies, Llc Biological delivery system with adaptable fusion cage interface
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US9060877B2 (en) 2009-09-18 2015-06-23 Spinal Surgical Strategies, Llc Fusion cage with combined biological delivery system
US8465490B1 (en) * 2010-01-29 2013-06-18 Greatbatch Ltd. Disposable neucleotomy shaver
US20110251616A1 (en) * 2010-04-12 2011-10-13 K2M, Inc. Expandable reamer and method of use
US8409235B2 (en) * 2010-04-30 2013-04-02 Medtronic Xomed, Inc. Rotary cutting tool with improved cutting and reduced clogging on soft tissue and thin bone
US8414606B2 (en) * 2010-10-22 2013-04-09 Medtronic Xomed, Inc. Method and apparatus for removing material from an intervertebral disc space and preparing end plates
US20120197320A1 (en) * 2011-01-28 2012-08-02 Laser Spine Surgical Center, LLC Foraminoplasty Device
US20130023882A1 (en) * 2011-02-15 2013-01-24 Fabro Myra I L Discectomy devices and related methods
JP5723035B2 (en) * 2011-12-03 2015-05-27 ウロボロス メディカル,インコーポレイテッドOuroboros Medical,Inc. Secure the cutting head and cutting systems for rapid ablation of the target tissue
WO2014100761A3 (en) * 2012-12-20 2014-10-23 Spine View, Inc. Discectomy devices and methods
USD723682S1 (en) 2013-05-03 2015-03-03 Spinal Surgical Strategies, Llc Bone graft delivery tool
KR20160040226A (en) * 2013-07-19 2016-04-12 아우로보로스 메디컬, 아이엔씨 An anti-clogging device for a vacuum-assisted, tissue removal system
US20160066945A1 (en) * 2014-09-08 2016-03-10 Medtronic-Xomed, Inc. Tumor margin device
US9737322B2 (en) * 2014-09-08 2017-08-22 Medtronic Xomed, Inc. Method for resection of tumors and tissues
US9636132B2 (en) 2014-09-08 2017-05-02 Medtronic Xomed, Inc. Tumor debulker
US9924979B2 (en) 2014-09-09 2018-03-27 Medos International Sarl Proximal-end securement of a minimally invasive working channel
USD750249S1 (en) 2014-10-20 2016-02-23 Spinal Surgical Strategies, Llc Expandable fusion cage
US20160287264A1 (en) 2015-03-31 2016-10-06 DePuy Synthes Products, Inc. Percutaneous Disc Clearing Device
USD797290S1 (en) 2015-10-19 2017-09-12 Spinal Surgical Strategies, Llc Bone graft delivery tool

Citations (32)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4573448A (en) * 1983-10-05 1986-03-04 Pilling Co. Method for decompressing herniated intervertebral discs
US5151098A (en) * 1990-07-23 1992-09-29 Hanspeter Loertscher Apparatus for controlled tissue ablation
US5152744A (en) * 1990-02-07 1992-10-06 Smith & Nephew Dyonics Surgical instrument
US5286253A (en) * 1992-10-09 1994-02-15 Linvatec Corporation Angled rotating surgical instrument
US5313962A (en) * 1991-10-18 1994-05-24 Obenchain Theodore G Method of performing laparoscopic lumbar discectomy
US5343623A (en) * 1992-05-11 1994-09-06 Urschel Laboratories, Inc. Knife assembly for cutting a food product
US5383884A (en) * 1992-12-04 1995-01-24 American Biomed, Inc. Spinal disc surgical instrument
US5540708A (en) * 1993-05-06 1996-07-30 Linvatec Corporation Polymeric rotatable shaver blade with interlocking cutting tip
US5620447A (en) * 1993-01-29 1997-04-15 Smith & Nephew Dyonics Inc. Surgical instrument
US5911701A (en) * 1998-01-29 1999-06-15 Sdgi Holidings, Inc. Surgical cutting instrument
US5921956A (en) * 1997-09-24 1999-07-13 Smith & Nephew, Inc. Surgical instrument
US5922003A (en) * 1997-05-09 1999-07-13 Xomed Surgical Products, Inc. Angled rotary tissue cutting instrument and method of fabricating the same
US5925056A (en) * 1996-04-12 1999-07-20 Surgical Dynamics, Inc. Surgical cutting device removably connected to a rotary drive element
US5961532A (en) * 1997-08-29 1999-10-05 Stryker Corporation Surgical tool having flexible tubular inner member movable for tissue working
US5980504A (en) * 1996-08-13 1999-11-09 Oratec Interventions, Inc. Method for manipulating tissue of an intervertebral disc
US6055897A (en) * 1996-06-21 2000-05-02 Kimberly-Clark Worldwide, Inc. Die cutting insert for a rotary die cutter and the die itself
US6312438B1 (en) * 2000-02-01 2001-11-06 Medtronic Xomed, Inc. Rotary bur instruments having bur tips with aspiration passages
US20020038130A1 (en) * 2000-09-24 2002-03-28 Medtronic, Inc. Surgical micro-shaving instrument with elevator tip
US6440138B1 (en) * 1998-04-06 2002-08-27 Kyphon Inc. Structures and methods for creating cavities in interior body regions
US20020138091A1 (en) * 2001-03-23 2002-09-26 Devonrex, Inc. Micro-invasive nucleotomy device and method
US6533749B1 (en) * 1999-09-24 2003-03-18 Medtronic Xomed, Inc. Angled rotary tissue cutting instrument with flexible inner member
US6620180B1 (en) * 1998-09-09 2003-09-16 Medtronic Xomed, Inc. Powered laryngeal cutting blade
US20030191474A1 (en) * 2000-02-16 2003-10-09 Cragg Andrew H. Apparatus for performing a discectomy through a trans-sacral axial bore within the vertebrae of the spine
US6656195B2 (en) * 2000-09-22 2003-12-02 Medtronic Xomed, Inc. Flexible inner tubular members and rotary tissue cutting instruments having flexible inner tubular members
US20040092992A1 (en) * 2002-10-23 2004-05-13 Kenneth Adams Disposable battery powered rotary tissue cutting instruments and methods therefor
US20040127927A1 (en) * 2002-09-16 2004-07-01 Kenneth Adams Apparatus and methods for straightening angled tissue cutting instruments
US20040225308A1 (en) * 2003-05-06 2004-11-11 Adams Kenneth M. Straightening tools having guide templates for angled tissue cutting instruments and methods of using the same
US20050065538A1 (en) * 2003-09-22 2005-03-24 Van Wyk Robert Allen Asymmetric shaver and methods for making same
US20050090848A1 (en) * 2003-10-22 2005-04-28 Adams Kenneth M. Angled tissue cutting instruments and method of fabricating angled tissue cutting instruments having flexible inner tubular members of tube and sleeve construction
US20050159767A1 (en) * 2004-01-21 2005-07-21 Adams Kenneth M. Angled tissue cutting instrument having variably positionable cutting window, indexing tool for use therewith and method of variably positioning a cutting window of an angled tissue cutting instrument
US20050209610A1 (en) * 2004-03-03 2005-09-22 Scimed Life Systems, Inc. Radially adjustable tissue removal device
US20060149268A1 (en) * 2004-11-19 2006-07-06 Csaba Truckai Bone treatment systems and methods

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7179225B2 (en) 2003-08-26 2007-02-20 Shluzas Alan E Access systems and methods for minimally invasive surgery

Patent Citations (34)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4573448A (en) * 1983-10-05 1986-03-04 Pilling Co. Method for decompressing herniated intervertebral discs
US5152744A (en) * 1990-02-07 1992-10-06 Smith & Nephew Dyonics Surgical instrument
US5151098A (en) * 1990-07-23 1992-09-29 Hanspeter Loertscher Apparatus for controlled tissue ablation
US5313962A (en) * 1991-10-18 1994-05-24 Obenchain Theodore G Method of performing laparoscopic lumbar discectomy
US5343623A (en) * 1992-05-11 1994-09-06 Urschel Laboratories, Inc. Knife assembly for cutting a food product
US5286253A (en) * 1992-10-09 1994-02-15 Linvatec Corporation Angled rotating surgical instrument
US5383884A (en) * 1992-12-04 1995-01-24 American Biomed, Inc. Spinal disc surgical instrument
US5620447A (en) * 1993-01-29 1997-04-15 Smith & Nephew Dyonics Inc. Surgical instrument
US5540708A (en) * 1993-05-06 1996-07-30 Linvatec Corporation Polymeric rotatable shaver blade with interlocking cutting tip
US5925056A (en) * 1996-04-12 1999-07-20 Surgical Dynamics, Inc. Surgical cutting device removably connected to a rotary drive element
US6055897A (en) * 1996-06-21 2000-05-02 Kimberly-Clark Worldwide, Inc. Die cutting insert for a rotary die cutter and the die itself
US5980504A (en) * 1996-08-13 1999-11-09 Oratec Interventions, Inc. Method for manipulating tissue of an intervertebral disc
US5922003A (en) * 1997-05-09 1999-07-13 Xomed Surgical Products, Inc. Angled rotary tissue cutting instrument and method of fabricating the same
USRE38018E1 (en) * 1997-05-09 2003-03-04 Medtronic Xomed, Inc. Angled rotary tissue cutting instrument and method of fabricating the same
US5961532A (en) * 1997-08-29 1999-10-05 Stryker Corporation Surgical tool having flexible tubular inner member movable for tissue working
US5921956A (en) * 1997-09-24 1999-07-13 Smith & Nephew, Inc. Surgical instrument
US5911701A (en) * 1998-01-29 1999-06-15 Sdgi Holidings, Inc. Surgical cutting instrument
US6440138B1 (en) * 1998-04-06 2002-08-27 Kyphon Inc. Structures and methods for creating cavities in interior body regions
US6620180B1 (en) * 1998-09-09 2003-09-16 Medtronic Xomed, Inc. Powered laryngeal cutting blade
US6533749B1 (en) * 1999-09-24 2003-03-18 Medtronic Xomed, Inc. Angled rotary tissue cutting instrument with flexible inner member
US6312438B1 (en) * 2000-02-01 2001-11-06 Medtronic Xomed, Inc. Rotary bur instruments having bur tips with aspiration passages
US20030191474A1 (en) * 2000-02-16 2003-10-09 Cragg Andrew H. Apparatus for performing a discectomy through a trans-sacral axial bore within the vertebrae of the spine
US6656195B2 (en) * 2000-09-22 2003-12-02 Medtronic Xomed, Inc. Flexible inner tubular members and rotary tissue cutting instruments having flexible inner tubular members
US20020038130A1 (en) * 2000-09-24 2002-03-28 Medtronic, Inc. Surgical micro-shaving instrument with elevator tip
US20020138091A1 (en) * 2001-03-23 2002-09-26 Devonrex, Inc. Micro-invasive nucleotomy device and method
US20040127927A1 (en) * 2002-09-16 2004-07-01 Kenneth Adams Apparatus and methods for straightening angled tissue cutting instruments
US20040092992A1 (en) * 2002-10-23 2004-05-13 Kenneth Adams Disposable battery powered rotary tissue cutting instruments and methods therefor
US20040225308A1 (en) * 2003-05-06 2004-11-11 Adams Kenneth M. Straightening tools having guide templates for angled tissue cutting instruments and methods of using the same
US20050065538A1 (en) * 2003-09-22 2005-03-24 Van Wyk Robert Allen Asymmetric shaver and methods for making same
US20050090848A1 (en) * 2003-10-22 2005-04-28 Adams Kenneth M. Angled tissue cutting instruments and method of fabricating angled tissue cutting instruments having flexible inner tubular members of tube and sleeve construction
US20050159767A1 (en) * 2004-01-21 2005-07-21 Adams Kenneth M. Angled tissue cutting instrument having variably positionable cutting window, indexing tool for use therewith and method of variably positioning a cutting window of an angled tissue cutting instrument
US7276074B2 (en) * 2004-01-21 2007-10-02 Medtronic Xomed, Inc. Angled tissue cutting instrument having variably positionable cutting window, indexing tool for use therewith and method of variably positioning a cutting window of an angled tissue cutting instrument
US20050209610A1 (en) * 2004-03-03 2005-09-22 Scimed Life Systems, Inc. Radially adjustable tissue removal device
US20060149268A1 (en) * 2004-11-19 2006-07-06 Csaba Truckai Bone treatment systems and methods

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9603610B2 (en) 2013-03-15 2017-03-28 DePuy Synthes Products, Inc. Tools and methods for tissue removal

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US20070149975A1 (en) 2007-06-28 application

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