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US20110166654A1 - Spine implant insertion device and method - Google Patents

Spine implant insertion device and method Download PDF

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Publication number
US20110166654A1
US20110166654A1 US13046140 US201113046140A US2011166654A1 US 20110166654 A1 US20110166654 A1 US 20110166654A1 US 13046140 US13046140 US 13046140 US 201113046140 A US201113046140 A US 201113046140A US 2011166654 A1 US2011166654 A1 US 2011166654A1
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Prior art keywords
implant
spinal
insertion
vertebra
shaft
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
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US13046140
Inventor
Nicholas Gately
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G&L Consulting
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G&L Consulting
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS 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
    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
    • A61F2/30Joints
    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • A61F2/4465Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or kidney shaped cross-section substantially perpendicular to the axis of the spine
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    • A61F2/00Filters 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
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    • A61F2/4611Special 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
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    • A61F2/00Filters 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
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    • A61F2002/30535Special structural features of bone or joint prostheses not otherwise provided for
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    • A61F2/30767Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth
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    • A61F2002/30904Special external and/or bone-contacting surfaces, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes, grooves serrated profile, i.e. saw-toothed
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    • A61F2/00Filters 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
    • A61F2/02Prostheses implantable into the body
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    • A61F2/00Filters 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
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    • A61F2/4603Special 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
    • A61F2002/4625Special 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 with relative movement between parts of the instrument during use
    • A61F2002/4627Special 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 with relative movement between parts of the instrument during use with linear motion along or rotating motion about the instrument axis or the implantation direction, e.g. telescopic, along a guiding rod, screwing inside the instrument
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    • A61F2002/4629Special 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 connected to the endoprosthesis or implant via a threaded connection
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Abstract

A spinal implant include a top, wherein at least a portion of the top is configured to contact a first vertebra, a bottom, wherein at least a portion of the bottom is configured to contact a second vertebra, a side having a releasable attachment to receive an insertion device and a cam surface to engage a cam on the insertion device

Description

  • [0001]
    This application is a continuation of U.S. Non-Provisional Utility application Ser. No. 11/278,552, filed Apr. 4, 2006, and claims the benefit of U.S. Provisional Patent Application Ser. No. 60/669,356 filed Apr. 8, 2005, both of which applications are incorporated by reference.
  • BACKGROUND OF THE INVENTION
  • [0002]
    The present invention generally relates to the field of medical devices. Some embodiments of the invention relate to spinal implants inserted in the spine of a patient during surgical procedures and to instruments used to insert the implants. Other embodiments of the invention relate to methods for positioning, rotating and advancing an implant during a surgical procedure.
  • [0003]
    A spinal implant may be used to stabilize a portion of a spine. The implant may promote bone growth between adjacent vertebra that fuses the vertebra together. The implant may include a spherical protrusion, a threaded pin and an angled surface to facilitate remote adjustment of the implant position using an insertion instrument.
  • [0004]
    The insertion instrument may include, but is not limited to, a threaded rod, an actuator and a lock knob. The insertion instrument can be attached and detached to the implant, rotate the implant by transferring torque from the actuator to the implant. The actuator can be used to lock the implant in relation to the instrument. The rod can be used to apply force to the implant and advance it. The implant and instruments may be supplied in an instrument kit.
  • [0005]
    An intervertebral disc may degenerate. Degeneration may be caused by trauma, disease, and/or aging. An intervertebral disc that becomes degenerated may have to be partially or fully removed from a spinal column. Partial or full removal of an intervertebral disc may destabilize the spinal column. Destabilization of a spinal column may result in alteration of a natural separation distance between adjacent vertebra. Maintaining the natural separation between vertebra may prevent pressure from being applied to nerves that pass between vertebral bodies. Excessive pressure applied to the nerves may cause pain and nerve damage.
  • [0006]
    During a spinal fixation procedure, a spinal implant may be inserted in a space created by the removal or partial removal of an intervertebral disc between adjacent vertebra. The spinal implant may maintain the height of the spine and restore stability to the spine. Bone growth may fuse the implant to adjacent vertebra.
  • [0007]
    A spinal implant may be inserted during a spinal fixation procedure using an anterior, lateral, posterior, or transverse spinal approach. A discectomy may be performed to remove or partially remove a defective or damaged intervertebral disc. The discectomy may create a space for a spinal implant. The amount of removed disc material may correspond to the size and type of spinal implant to be inserted.
  • [0008]
    Spinal implants are described in U.S. Pat. No. 5,653,763 to Errico et al.; U.S. Pat. No. 5,713,899 to Marney et al.; U.S. Pat. No. 6,143,033 to Paul et al.; U.S. Pat. No. 6,245,108 to Biscup; and U.S. Pat. No. 5,609,635 to Michelson, United States Patent Application 20050027360 to Webb.
  • BRIEF DESCRIPTION OF THE INVENTION
  • [0009]
    A spinal implant is disclosed comprising: a top, wherein at least a portion of the top is configured to contact a first vertebra; a bottom, wherein at least a portion of the bottom is configured to contact a second vertebra and a side having a releasable attachment to receive an insertion device and a cam surface to engage a cam on the insertion device. The spinal implant may include a hemispherical mount and a pin mounted within the spinal implant, wherein the insertion device attaches to the pin that serves as an axis of rotation and pivots around the pin with respect to the hemispherical housing.
  • [0010]
    A method is disclose comprising: inserting an implant between portions of bone, wherein the implant locked at a first angle relative to a shaft of the instrument; loosening the implant relative to the shaft; turning the shaft to pivot the implant relative to the shaft, and releasing the implant from the instrument so that the implant is in position between the bone. Turning the shaft rotates a cam fixed to the shaft across a cam surface on the implant, wherein the cam surface is slanted and the movement of the cam across the cam surface pivots the implant.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0011]
    FIG. 1 is a top-side perspective view of a spinal implant attached to an insertion instrument.
  • [0012]
    FIG. 2 is an exploded view showing the spinal implant separate from the insertion instrument.
  • [0013]
    FIG. 3 is a perspective view of the FIG. 3 illustrates the interaction between the Actuator 202 of the instrument and the implant 100.
  • [0014]
    FIG. 4 is a perspective view of the implant releasably attached to the insertion instrument and positioned over a vertebra.
  • DETAILED DESCRIPTION OF THE INVENTION
  • [0015]
    FIG. 1 shows the spinal implant 100 releasably attached to an insertion instrument 200. The implant 100 may be made by made of PEEK plastic commonly used in spinal implants. The implant includes a hemispherical mount 105 and slanted cam surface 106 from which the mount protrudes. The tip of rod 201 pivotably attaches to the mount such that the implant may pivot with respect to the axis of the instrument. The pivoting of the implant is controlled by the a knob on the instrument that rotates the cam wings 205 about the hemispherical surface. The rotation of the cam, slides the front edges of the cam wings across the and cam surface 106 and thereby forces the implant to pivot with respect to the axis of the instrument.
  • [0016]
    A knob (e.g. actuator wings) 206 on the on the proximal end of the instrument enables a surgeon to rotate the cam and thereby adjust the angle between the implant and the axis of the instrument. Pivoting of the implant is caused as the actuator pushers 205 (e.g., cam) act on the slanted surface 106 of the implant 100. As the cammed actuator 202 rotate and slide across the slanted surface 106, the implant makes a yaw movement with respect to the axis of the instrument. Actuator 202 is equipped with the actuator wings 206 used to rotate pushers 205 (cam) from outside of the patient's body.
  • [0017]
    Locking knob 207 may be tightened to bind the actuator against the implant effectively locking the implant with respect to the instrument. When locked, axial force and torque can be applied to the handle 204 to advance the implant into the spinal space and position the implant in the space. Turning the locking knob 207 that is threaded inside and engages threads on the proximal end of the rod causes the actuator 202 that is hollow to slide axially forward over the threaded rod 201 and thereby loosen or tighten the actuator against the implant.
  • [0018]
    FIG. 2 shows the details of the attachment of the implant 100 to the instrument 200. Threaded pin 102 is inserted into the channel 107 in the spherical protrusion (mount) 105 and retained there by a snap ring 103. A threaded hollow shaft 108 in the threaded pin 102 is aligned with the slot opening 109 of the implant so that the treaded rod 201 can be threaded into the shaft 108 of the pin 102. Slot opening allows pivoting of the implant by accommodating the pendulum motion of the rod 201. Pin 104 is made of a material that enhances X-ray imaging. Making the pin visible assists the physician in the positioning of the implant while viewing a real-time x-ray image of the implant and vertebra.
  • [0019]
    The actuator 202 may be a hollow tube that is coaxial with the rod 201. The pushers are fixed to the distal end of the actuator. The pushers 205 include cams that engage a cam surface 106 on the implant. The proximal end of the tube has a knob (e.g. actuator wings) 206 to turn the tube and thereby move the cams against the cam surface. The angle of the implant with respect to the implant is adjusted by moving the cam against the cam surface. Adjusting the angle may allow the surgeon to properly place the implant in the spine area.
  • [0020]
    FIG. 3 illustrates the interaction between the Actuator 202 of the instrument and the implant 100. The actuator 202 is rotated around the axis of the threaded rod 201 that is engaged in the threaded pin 102. As the cammed pushers 205 rotate, they push against the surface 106. As a result the implant 100 turns around the axis of the pin 102. It can be envisioned as if the implant is performing a “dog wagging its tail” motion with respect to the insert instrument 200.
  • [0021]
    If the locking knob 207 (FIG. 1) is rotated, the actuator 202 is pushed against the implant 100. Both pushers are advanced towards the surface 106 to bind the actuator against the implant so as to lock the implant with respect to the instrument. When locked, the assembly of the implant and instrument can be advanced while retaining the desired angle of the implant 100 in relation to the insertion instrument 200.
  • [0022]
    FIG. 4 shows the implant 100 with the insertion instrument 200 attached and in position on a patient vertebra 401. Rotation of the actuator 202 in relation to the axis of the threaded rod 201 results in the rotation of the implant 100 around the axis of the pin 102. Rotation of the knob 207 pushes the actuator 202 into the implant locking the assembly. When the assembly is locked hammer tapping can be applied to the handle 204 to advance the assembly forward.
  • [0023]
    A spinal implant may be used to stabilize a portion of a spine. The implant may promote bone growth between adjacent vertebra that fuses the vertebra together. An implant may include an opening through a height of a body of the implant. The body of the implant may include curved sides. A top and/or a bottom of the implant may include protrusions that contact and/or engage vertebral surfaces to prevent backout of the implant from the disc space.
  • [0024]
    A spinal implant may be used to provide stability and promote fusion of adjacent vertebra. The implant may be used in conjunction with a spinal stabilization device such as a bone plate or rod-and-fastener stabilization system. The implant may establish a desired separation distance between vertebra. The implant may promote bone growth between adjacent vertebra that fuses the vertebra together. Instrument at is necessary for insertion of an implant in a patient and alignment of the implant in the space.
  • [0025]
    A discectomy may be performed to establish a disc space between vertebra. The disc space may be prepared for implant insertion by distraction of adjacent vertebra, rasping and filing of the bone to achieve the desired spacing.
  • [0026]
    It is desired to perform insertion of the implant and positioning of the implant using minimum number of inserted instruments and thought the smallest possible insertion channel in the body.
  • [0027]
    Implants may be constructed of biocompatible materials sufficiently strong to maintain spinal distraction. Implants may include, but are not limited to, allograft bone, xenograft bone, autograft bone, metals, ceramics, inorganic compositions, polymers such as PEEK, or combinations thereof. If the implant is not made of bone, surfaces of the implant that contact bone may be treated to promote fusion of the implant to the bone. Treatment may include, but is not limited to, applying a hydroxyapatite coating on contact surfaces, spraying a titanium plasma on contact surfaces, and/or texturing the contact surfaces by scoring, peening, implanting particles in the surfaces, or otherwise roughening the surfaces.
  • [0028]
    In some embodiments, an implant may include an opening that extends through a body of the implant. The opening may have a regular shape or an irregular shape. Bone graft may be placed in the opening. The bone graft may be autogenic bone graft, allogenic bone graft, xenogenic bone graft, and/or synthetic bone graft. Some implant embodiments may be constructed from allogenic bone, such as cortical bone from a femur, tibia, or other large bone. In some embodiments, an implant may be formed from one or more pieces of allograft bone cut to a desired shape.
  • [0029]
    In certain embodiments, sides of an implant may be shaped to increase contact between an implant and adjacent vertebra with notches, ribs and other similar features. Increasing contact of an implant with adjacent vertebra may inhibit movement of the implant after insertion. An increased contact area between an implant and adjacent vertebra may promote bone growth between adjacent vertebra.
  • [0030]
    In some embodiments, one or more sides of an implant may be curved. One or more curved sides of an implant may allow the implant to be maneuvered in a disc space during insertion of the implant. The curvature of a side may approximate a curvature of an anterior side of a vertebra adjacent to which the implant is inserted.
  • [0031]
    Instruments may be used to prepare a space for an implant between adjacent vertebra. An instrument may be used to insert an implant in a prepared space. Instruments may be supplied to a surgeon or surgical team in an instrument set. An instrument set may include one or more implants for use during an insertion procedure. An instrument set may include implants of various sizes and/or lordotic angles to allow selection of an implant to suit a patient during surgery. Instrument is attached to the implant before the insertion into the body. When the desired position of the implant is achieved, instrument is disengaged from the implant and can be extracted from the body.
  • [0032]
    An instrument acts as an implant inserter. The implant inserter may be used to push the implant and to rotate the implant. After insertion of the implant, the implant may be released from the inserter without the application of significant repositioning forces to the implant. It can be imagined that the insertion instrument can be screwed into the implant using threads or use other techniques such as a tightening collet, jamming or grabbing. In the disclosed embodiment the implant turns around the axis of the implant pin as a result of the rotation of cam pushers. It can be imagined that other mechanisms can be used to rotate the implant such as ratchets or threaded push rods. The implant inserter may have a low profile that allows for visualization of the implant and surrounding area during insertion of the implant. Implant is equipped to couple and uncouple from the instrument.
  • [0033]
    While the invention has been described in connection with what is presently considered to be the most practical and preferred embodiment, it is to be understood that the invention is not to be limited to the disclosed embodiment, but on the contrary, is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims.

Claims (25)

  1. 1. A method to surgically insert a spinal implant between vertebra in a mammalian patient using an insertion tool, the method comprising:
    releasebly attaching the spinal implant to a distal portion of the insertion tool;
    inserting the spinal implant between the vertebra while the spinal implant is attached to the distal portion;
    while the spinal implant is between the vertebra, manipulating a proximal region of the insertion tool to force the spinal implant to make a yaw movement with respect to an axis of the distal portion, and
    after making the yaw movement, releasing the distal portion from the spinal implant and removing the insertion tool from the patient while the spinal implant remains between the vertebra.
  2. 2. The method as in claim 1 wherein the manipulation of the proximal region includes turning a tube about a rod coaxial to the tube, wherein the step of releasably attaching includes attaching a distal end of the rod to the spinal implant and the yaw movement is made by turning a distal end of the tube against the implant.
  3. 3. The method of claim 1 further comprising locking the implant at a first angle relative to the shaft of the instrument prior to the insertion of the implant.
  4. 4. The method of claim 3 wherein the implant such that a longitudinal axis of the implant is generally aligned with a longitudinal axis of the insertion tool.
  5. 5. The method of claim 1 wherein turning the shaft rotates a cam fixed to the shaft across a cam surface on the implant.
  6. 6. The method of claim 5 wherein the cam surface is slanted and the movement of the cam across the cam surface pivots the implant.
  7. 7. The method of claim 1 wherein the manipulation of the proximal end of the tool is performed without tilting a shaft between the proximal region and distal region.
  8. 8. The method of claim 7 wherein during the steps of the insertion, the manipulation and the removal, a shaft between the proximal region and the distal portions remains aligned along a single line.
  9. 9. The method of claim 1 wherein the yaw movement is within a plane parallel to a shaft between the proximal region and the distal portion.
  10. 10. A method comprising:
    inserting an implant into a patient;
    loosening the implant relative to the shaft;
    turning the shaft about an axis of the shaft to pivot the implant relative to the shaft, and
    releasing the implant from the instrument so that the implant is in position between the bone.
  11. 11. The method of claim 10 further comprising locking the implant at a first angle relative to the shaft of the instrument prior to the insertion of the implant.
  12. 12. The method of claim 10 wherein turning the shaft rotates a cam fixed to the shaft across a cam surface on the implant.
  13. 13. The method of claim 10 wherein the cam surface is slanted and the movement of the cam across the cam surface pivots the implant.
  14. 14. An assembly of a spinal implant and an insertion tool to insert the spinal implant between vertebras wherein
    the insertion tool comprising:
    a shaft assembly including a hollow tube concentric with a rod;
    a distal portion of the rod including a coupling for releasably attaching to the spinal implant;
    a distal portion of the hollow tube having a cam surface adapted to engage an opposing cam surface on the spinal implant, and
    a proximal region of the shaft assembly including a first grip to rotate the hollow tube about the rod and a second grip to rotate the rod within the hollow tube, and
    the spinal implant comprising:
    a pivoting pin within a housing on the implant, the pivoting pin adapted to couple to the coupling of the distal portion of the rod, wherein the pivoting pin is perpendicular to a longitudinal axis of the shaft assembly, and
    the opposing cam surface is adjacent the housing.
  15. 15. The assembly in claim 14 wherein the opposing cam surface is aligned with a line extending through a longitudinal axis of the pin.
  16. 16. The assembly in claim 14 wherein the housing has a hemispherical outer surface and the opposing cam surface is adjacent the hemispherical outer surface.
  17. 17. The assembly in claim 14 wherein the cam surface is a planer surface.
  18. 18. The assembly in claim 14 wherein the pin includes a threaded aperture to receive a threaded tip at the distal portion of the rod.
  19. 19. The assembly in claim 14 wherein the housing and opposing cam surface are on a side of the spinal implant.
  20. 20. The assembly as in claim 19 where the spinal implant includes an upper surface and a lower surface each adapted to engage one of the vertebras, and wherein the side extends from the upper surface to the lower surface.
  21. 21. The assembly as in claim 14 wherein the implant includes at least one of allograft bone, xenograft bone and autograft bone.
  22. 22. A method to surgically insert a spinal implant between vertebra in a mammalian patient using an insertion tool, the method comprising:
    releasebly attaching the spinal implant to a distal portion of a shaft of the insertion tool;
    inserting the spinal implant between the vertebra while the spinal implant is attached to the distal portion of the shaft;
    while the spinal implant is between the vertebra, manipulating a proximal region of the insertion tool to force the spinal implant to make a yaw movement with respect to an axis of the distal portion while the shaft remains substantially aligned with respect to a stationary straight line extending from between the vertebra, and
    after making the yaw movement, releasing the distal portion from the spinal implant and removing the insertion tool from the patient while the spinal implant remains between the vertebra.
  23. 23. A method to insert a spinal implant between vertebra of a mammalian patient, the method comprising:
    forming a space for the spinal implant between adjacent vertebra;
    attaching the spinal implant to an end of a center shaft of an insertion tool, wherein the insertion tool includes a tubular shaft coaxial to the center shaft;
    aligning the spinal implant with an axis of the shaft before inserting the spinal implant into the patient and while the spinal implant is positioned in or proximate to the space between the adjacent vertebra;
    after positioning the spinal implant in or proximate to the space between the adjacent vertebra, rotating the tubular shaft about the center shaft to pivot the spinal implant relative to the center shaft, and
    releasing the spinal implant from the center shaft so that the implant remains between the vertebra and the insertion tool may be removed from the patient.
  24. 24. The method of claim 23 further comprising locking the spinal implant into the alignment with the axis of the shaft while the implant and center shaft are inserted into the patient and releasing the locking to rotate the tubular shaft and pivot the spinal implant.
  25. 26. The method of claim 24 wherein pivoting the spinal implant includes moving the spinal implant in a yaw direction with respect to the center shaft and holding the center shaft stationary while the spinal implant moves in the yaw direction.
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US7959675B2 (en) 2011-06-14 grant

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