WO2005004733A1 - Procede et dispositif de stabilisation pour facette vertebrale lombaire - Google Patents

Procede et dispositif de stabilisation pour facette vertebrale lombaire Download PDF

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Publication number
WO2005004733A1
WO2005004733A1 PCT/US2003/018672 US0318672W WO2005004733A1 WO 2005004733 A1 WO2005004733 A1 WO 2005004733A1 US 0318672 W US0318672 W US 0318672W WO 2005004733 A1 WO2005004733 A1 WO 2005004733A1
Authority
WO
WIPO (PCT)
Prior art keywords
screw
facet
handle
head
screwdriver
Prior art date
Application number
PCT/US2003/018672
Other languages
English (en)
Inventor
Laurence M. Mckinley
Theodore G. Obenchain
Original Assignee
Mckinley Laurence M
Obenchain Theodore G
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Mckinley Laurence M, Obenchain Theodore G filed Critical Mckinley Laurence M
Priority to AU2003243548A priority Critical patent/AU2003243548A1/en
Priority to PCT/US2003/018672 priority patent/WO2005004733A1/fr
Publication of WO2005004733A1 publication Critical patent/WO2005004733A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • A61B17/863—Shanks, i.e. parts contacting bone tissue with thread interrupted or changing its form along shank, other than constant taper
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8605—Heads, i.e. proximal ends projecting from bone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8863—Apparatus for shaping or cutting osteosynthesis equipment by medical personnel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/8875—Screwdrivers, spanners or wrenches
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • A61B17/8635—Tips of screws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/037—Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter

Definitions

  • the instantaneous center of rotation in the lumbar spine is 7mm or 8mm anterior to the posterior edge of the vertebral body, and it is approximately 2cm anterior to the posterior elements and the facet joints.
  • These joints are arranged in a cross-sectional "J" shape, and are designed to stabilize the spine and transmit the biomechanical forces from one vertebra to another.
  • These joints are an integral part of the stability of the motion segment.
  • the facet joints transmit torsional force, facilitating normal gait. So, when spinal fusions are considered, it is important to re-establish the normal biomechanical arrangement, and to restore the sagittal profile of the spine to obtain optimal results. Arthritic changes in the facet joints following disc degeneration can cause mechanical back paint.
  • the screw passed through the inferior facet of the vertebra above, and as it crossed the joint, it penetrated the superior facet of the vertebra below.
  • this original technique is flawed in that the surgeon is unable to visualize where the tip of the screw comes to rest.
  • the greatest complication of this technique is that the tip of the screw can end up in the vicinity of the exiting segmental nerve root. Nerve root encroachment can, in turn, produce serious radicular pain, which is the major complication of this original method.
  • One embodiment of a method according to the current invention includes angling a screw from a substantially lateral side of the spine toward a dorsal and medial side of the spine and screwing the screw through a superior facet of an inferior vertebra and into an inferior facet of a superior vertebra.
  • the screw continues to travel through the inferior facet of the superior vertebra and into a spinous process of the same superior vertebra.
  • the inserting also includes providing a screwdriver coupled to the screw by an attachment end, and the screwing also includes uncoupling the screwdriver to the screw.
  • One embodiment of a system according to the present invention includes a screwdriver insertable into a surgical opening, a screw coupled to the screwdriver and a torque transmitter.
  • the screwdriver in this embodiment may include a head, which is coupled to a handle and the torque transmitter.
  • the head is rotatable about an axis in response to the torque transmitted by the torque transmitter, which is rotatable about another axis.
  • the screw rotates with the head about the same axis.
  • the screw and an attachment end of the head are formed in one piece.
  • the screw is grasped by the head.
  • the screwdriver according to the invention includes a head projecting from the handle at an angle between 75 degrees and 120 degrees.
  • the screwdriver includes a dial located rotatable on the handle and coupled to the torque transmitter to transmit torque from the dial rotation to the head.
  • the screwdriver includes a stationary section between the handle and the head, where the handle is rotatable and coupled to the torque transmitter to transmit torque to the head.
  • the torque transmitter is electrically coupled to a motor to transmit torque to the head.
  • the screw includes a screw head portion, a point portion and a shaft portion.
  • the shaft portion is substantially elliptical in shape and has threads that are spaced from each other at progressively greater distances on the end of the shaft portion closer to the screw head.
  • the screw can be formed wholly or partially of bioactive or bioabsorbable materials.
  • the cutter in one embodiment of a cutter for cutting a facet screw away from a facet screwdriver within a surgical opening according to the invention, includes a first and second handle rotatably connected and a longitudinal shaft extending from the first handle.
  • the longitudinal shaft is sufficiently narrow to allow viewing of the screw while both the screwdriver and cutter are within the surgical opening.
  • the longitudinal shaft includes a first and second cutting edge which project at an angle from the shaft and are connected to the first and second handles such that when the handles are squeezed together, the cutting edges move closer to each other.
  • the first and second handles can be substituted with a ratchet mechanism rotatably coupled to the first and second cutting edges, such that when a activating end of the ratchet mechanism is rotated, the cutting edges move closer to each other.
  • the cutting edges project substantially orthogonal to the shaft and the first handle. Additionally, in yet another embodiment, at least one of the cutting edges includes carbide.
  • Figure 1 is a side perspective view of a prior art facet joint fixation system.
  • Figure 2 is a side perspective view of one embodiment of a system according to the invention.
  • Figure 3 a is side view of one embodiment of a screwdriver and a screw system according to the invention.
  • Figure 3b is a side view of another embodiment of a screwdriver according to the invention.
  • Figure 3c is a side view of yet another embodiment of a screwdriver according to the invention.
  • Figure 3d is a side view of another embodiment of a screwdriver according to the invention.
  • Figure 4a is a side view of an embodiment of a screwdriver and facet screw system according to the invention.
  • Figure 4b is a side view of another embodiment of a screwdriver and facet screw system according to the invention.
  • Figui'e 4c is a side view of another embodiment of a system according to the invention where the facet screw and a screw head of the screwdriver are formed in one piece.
  • Figure 5 is a side view of an embodiment of a facet screw according to the invention.
  • Figure 6 is a side view of an embodiment of a cutter according to the invention.
  • DETAILED DESCRIPTION The present invention is directed to a method, system, and apparatus for stabilizing a facet joint in a spine.
  • Figure 1 shows a prior art facet joint stabilization system. In this system, a screw 10 is inserted from the dorsal and medial sides of a spine 100 into facet joint 12 toward the ventral and lateral sides of the spine 100.
  • the screw 10 passes through the spinous process 30 to the inferior facet 14 of superior vertebra 18 and into the base of the superior facet 22 of the immediately inferior vertebra 24 pointing towards the transverse process 20.
  • Nerve 26 exits from the spine 100 through neural foramen 28.
  • the spinous process 30 largely blocks the view of the exiting nerve 26 from the dorsal side. Because the surgeon's view of both the tip 32 of the screw 10 and the exiting nerve 26 is blocked, if the screw 10 is angled at even a slightly incorrect angle, the tip 32 of the screw 10 can hit the exiting nerve 26.
  • Figure 2 shows one embodiment of the facet joint stabilization system and method of the present invention.
  • an angulated screwdriver 200 and screw 110 are inserted into a posterolateral surgical opening (not shown).
  • the angulated screwdriver 200 then inserts the screw 110 into the base of the superior facet 122 of the inferior vertebra 124.
  • the angle of insertion is from the slightly ventral and substantially lateral ("inferolateral") sides of spine 100 towards the dorsal and medial (“dorsomedial") sides of the spine 100.
  • the screw 110 then passes through the inferior facet 114 of the immediately superior vertebra 118. As the screw is inserted, the exiting nerve 126 is in plain sight, so the surgeon is better able to avoid encroaching on the nerve 126 with the screw 110.
  • FIG. 2 An angulated screwdriver is shown in Figure 2, it should be understood that any device suitable for inserting screws into a patient as described above may be utilized with the method according to the present invention.
  • One embodiment of the angulated screwdriver 200 is shown in more detail in Figures 3 a- 3d.
  • the screwdriver 200 has a handle 202 and a head 204.
  • a "handle” is a graspable shaft
  • a "head” is the projecting end portion of the screwdriver.
  • the head 204 can extend at an angle of between 0 and 100 degrees from the axis of the handle 202.
  • the head is angled at between 70 and 80 degrees from the axis of the handle 202, so that the head and the handle form an obtuse angle.
  • the angle of the head 204 is adjustable.
  • the head 204 in the embodiment shown in Figure 3a includes an attachment end 205 configured to mate with screw head 220 of screw 110.
  • the head 204 is rotatable about its angled axis.
  • the head 304 is coupled to a dial 306 at one end of the handle 302 by a bent axis 308, such that when the dial 306 is turned relative to the handle 302, the head 304 axially rotates with the dial 306.
  • the bent axis 308 can be any material capable of transmitting torque from the dial 306 to the head 304.
  • the bent axis 308 is a braided cable, such as is used with a Bowden speedometer.
  • a dial is used to generate torque in the head of the embodiment shown in Figure 3b, any suitable mechanism may be used.
  • a stationary section 410 is coupled between the head 404 and the handle 402, and the head 404 and handle 402 are coupled along bent axis 408 such that the head 404 rotates about its axis 408 when the handle 402 is rotated about its axis 408.
  • the head 504 is coupled to a motor (not shown), which rotates the head 504 about its angled axis 508 and is activated by a switch 512 on the handle 502.
  • a motor not shown
  • FIG. 4a One exemplary embodiment of the screwdriver 200 where the screw is coupled to the screwdriver, discussed in relation to Figure 3a, is shown in more detail in Figures 4a-4c.
  • the head 604 can be secured to the screw head 220 by a basket 605.
  • the basket 605 includes a circumferential edge 630, which cii'cumferentially surrounds and holds the screw head 220 securely to the screwdriver 601 through factional forces or biasing means for example.
  • the retaining forces can be overcome by wiggling or popping the basket 605 away from the screw head 220 to allow the screwdriver 601 to be removed from the surgical opening (not shown).
  • the attachment end 625 of the screwdriver 603 removably engages an opening (not shown) in the screw head 220, and when the screw 600 is fixed in the facet joint, the attachment end 625 can be snapped away from the screw 600 to allow the screwdriver 603 to be removed from the surgical opening.
  • the attachment end 655 is formed in one piece with the screw head 660. After fixation of the screw 670 in the facet joint, the screw shaft 680 can be cut or snapped off from the screw head 660, or the attachment end 655 can be cut or snapped off from the screw head 660 by a cutter (shown in Figures 6a and 6b).
  • the screw can be snapped off with a torque of around 25-30 Newtons. It is also within the scope of the invention to attach the screw to the attachment end by any other suitable means, such as through an adhesive, magnetic coupling, flange, clamp, etc., that is capable of holding the screw head onto the attachment end until it is secured in the facet joint.
  • any screw can be used with the screwdriver of the present invention, one preferred embodiment is shown in more detail in Figure 5.
  • the screw 700 of this embodiment has a sharp point 710, which can dig into the bone and m-inimize skidding. In one embodiment, the screw is around 10-14 mm in length.
  • the sharp point 710 is preferably self-tapping, so the passage through the facet joint does not have to be drilled.
  • the screw 700 has a substantially ellipsoidal shaft 716, which narrows toward the point 710 and shank 718.
  • the ellipsoidal shape allows the screw head 714 to compress onto the bone.
  • the shaft is around 2mm in diameter.
  • the spacings "s" between the threads 712 of this embodiment become progressively wider toward the screw head 714 of the screw 700 and project at a substantially perpendicular angle outward from the shaft 716.
  • the screw head 714 in this embodiment is substantially round and bulbous, to allow the screw head 714 to project shghtly from the bone. This projection would simplify removal through muscle or cutting of the screw 700.
  • a screwdriver removably fixed to the screw head 714 can be simply pulled away from the screw 700 and removed from the surgical opening, leaving the screw 700 embedded in the bone.
  • the screw is wholly or partially formed of bioactive or bioabsorbable material.
  • a cutter which may optionally be used in conjunction with the screwdriver system shown in Figure 4c, is shown in Figure 6.
  • the cutter 800 includes a first and a second handle 810, 812, and a long, narrow shaft 820 with first and second cutting edges 822 and 824 projecting parallel to each other from its free end.
  • the cutting edges 822 and 824 project substantially orthogonally from the first handle 810 and the shaft 820. Although a substantially orthogonal angle is likely more intuitive for a surgeon, any other angle of projection is also within the scope of this invention.
  • the first and second cutting edges 820 and822 contain carbide, but one skilled in the art will recognize that any material of sufficient strength to cut the attachment end or the narrow shaft of the screw will also be within the scope of this invention.
  • the first handle 810 is hinged to the second handle 812 and is integral with the shaft 820 and the first cutting edge 822.
  • the second handle 312 is coupled to the second cutting edge 824 such that when the second handle 812 is squeezed toward the first handle 810, the second handle 812 pulls the second cutting edge 824 toward the first cutting edge 822.
  • the first and second cutting edges 822 and 824 surround the attachment end of the screwdriver or the narrow shank, the attachment end or shank can be cut, allowing the screwdriver to be removed from the surgical opening.
  • a spring 830 can be added to cause the handles 810 and 812 to spring away from each other when the handles 810 and 812 are not squeezed together. Although the embodiment shown in Figure 6a depicts the spring 830 as two elastic, curved strips, any spring which counters a squeezing force can be used.
  • a grip stabilizer 840 can also be added to the first handle 810 to assist the surgeon in squeezing the handles together.
  • a ratchet closure mechanism (not shown) can replace the first and second handles 810 and 812 and spring 830 to allow a surgeon to tighten the first and second cutting edges 820 and 822.
  • the shaft 820 is narrow enough to insert into an approximately 1.5" diameter posterolateral surgical opening, which already contains the screwdriver, and allow enough light into the opening for the surgeon to see around it to the attachment end of the screwdriver or the narrow shank of the screw.
  • the shaft 820 is also preferably long enough to reach the attachment end or the shank.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Neurology (AREA)
  • Surgical Instruments (AREA)

Abstract

Cette invention concerne une technique, un système et un dispositif permettant de stabiliser une facette vertébrale lombaire. Cette technique consiste à monter de bais une vis depuis le côté ventral et latéral de la colonne vertébrale vers un côté dorsal et médial de cette même colonne, et à visser la vis au travers d'une facette supérieure (122) d'une vertèbre inférieure (124) et dans une facette inférieure (114) d'une vertèbre supérieure (118). Le système comprend un tournevis (200) que l'on insère dans une ouverture chirurgicale, une vis (110) couplée au tournevis (200) et un transmetteur de couple (308) relié à une tête (204) du tournevis avec laquelle il tourne. Le système comprend également un vis pour facette (700) avec extrémité auto-taraudeuse (710), une tige ellipsoïdale (716) avec des filets allant en s'espaçant (712) et une tête à boule (714). Le système comprend en outre un outil de coupe (800) doté d'une tige longitudinale étroite (820) et d'un mécanisme de fermeture à double poignée (810, 812). Dans un autre mode de réalisation de l'outil de coupe, on trouve un mécanisme à cliquet à la place du mécanisme de fermeture à double poignée.
PCT/US2003/018672 2003-06-13 2003-06-13 Procede et dispositif de stabilisation pour facette vertebrale lombaire WO2005004733A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
AU2003243548A AU2003243548A1 (en) 2003-06-13 2003-06-13 Method and apparatus for stabilization of facet joint
PCT/US2003/018672 WO2005004733A1 (fr) 2003-06-13 2003-06-13 Procede et dispositif de stabilisation pour facette vertebrale lombaire

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US2003/018672 WO2005004733A1 (fr) 2003-06-13 2003-06-13 Procede et dispositif de stabilisation pour facette vertebrale lombaire

Publications (1)

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WO2005004733A1 true WO2005004733A1 (fr) 2005-01-20

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PCT/US2003/018672 WO2005004733A1 (fr) 2003-06-13 2003-06-13 Procede et dispositif de stabilisation pour facette vertebrale lombaire

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WO (1) WO2005004733A1 (fr)

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8043334B2 (en) 2007-04-13 2011-10-25 Depuy Spine, Inc. Articulating facet fusion screw
US8084627B2 (en) 2007-01-26 2011-12-27 University Of Pittsburgh-Of The Commonwealth System Of Higher Education Hydroxymethyl fluorescein derivatives for use as biological markers and dyes
US8133261B2 (en) 2007-02-26 2012-03-13 Depuy Spine, Inc. Intra-facet fixation device and method of use
US8197513B2 (en) 2007-04-13 2012-06-12 Depuy Spine, Inc. Facet fixation and fusion wedge and method of use
US8894685B2 (en) 2007-04-13 2014-11-25 DePuy Synthes Products, LLC Facet fixation and fusion screw and washer assembly and method of use
US9044277B2 (en) 2010-07-12 2015-06-02 DePuy Synthes Products, Inc. Pedicular facet fusion screw with plate

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US984756A (en) * 1909-09-08 1911-02-21 Paul Frisch Surgical forceps.
US3696694A (en) * 1971-02-03 1972-10-10 Fairchild Industries Hand tool for reaching remote locations
US5391170A (en) * 1991-12-13 1995-02-21 David A. McGuire Angled surgical screw driver and methods of arthroscopic ligament reconstruction

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US984756A (en) * 1909-09-08 1911-02-21 Paul Frisch Surgical forceps.
US3696694A (en) * 1971-02-03 1972-10-10 Fairchild Industries Hand tool for reaching remote locations
US5391170A (en) * 1991-12-13 1995-02-21 David A. McGuire Angled surgical screw driver and methods of arthroscopic ligament reconstruction

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8084627B2 (en) 2007-01-26 2011-12-27 University Of Pittsburgh-Of The Commonwealth System Of Higher Education Hydroxymethyl fluorescein derivatives for use as biological markers and dyes
US8133261B2 (en) 2007-02-26 2012-03-13 Depuy Spine, Inc. Intra-facet fixation device and method of use
US8043334B2 (en) 2007-04-13 2011-10-25 Depuy Spine, Inc. Articulating facet fusion screw
US8197513B2 (en) 2007-04-13 2012-06-12 Depuy Spine, Inc. Facet fixation and fusion wedge and method of use
US8894685B2 (en) 2007-04-13 2014-11-25 DePuy Synthes Products, LLC Facet fixation and fusion screw and washer assembly and method of use
US9044277B2 (en) 2010-07-12 2015-06-02 DePuy Synthes Products, Inc. Pedicular facet fusion screw with plate
US9089372B2 (en) 2010-07-12 2015-07-28 DePuy Synthes Products, Inc. Pedicular facet fusion screw with plate

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