Technical Field
The present disclosure relates to an occipital fixation assembly, system and method for attaching the same. More particularly, the present disclosure relates to an occipital fixation assembly that is configured to support a surgical implant thereon and securely anchor to an inside of a skull of a patient.
Description of Related Art
As is commonly known in the art, an occipitocervical junction includes an occiput, atlas and axis. The occipitocervical junction is a unique interface between the cranium and cervical spine. More than 50% of the rotation and flexion-extension are provided from this region. Ligaments in this region must resist forces about all six degrees of freedom. Moreover, instrumentation constructs not only must resist forces in all of these vectors, but also must resist the significant moment created by the suboccipital bone and the cervical spine, which meet at a 50° angle. Any instrumentation construct designed for use in this region must, therefore, have adequate geometry to interface with the osseous structures of the spinal structures as well as have sufficient rigidity and purchase to resist these forces until bone fusion can occur.
At one time, occipitocervical instability and lesions located at the occipitocervical junction were considered inoperable and terminal. Since the first description of an occipitocervical fusion, multiple methods of fusion in this region have been described. Descriptions of simple bone grafts with halo immobilization; wire, pin, or hook constructs; rigid metallic loops and rectangles fixed to the bone with either screws or wires; and most recently, plate or rod constructs with screws have all been described. In general the evolution of this technology has focused on providing increasingly more rigid constructs to facilitate bone fusion and to minimize the need for and duration of external immobilization.
A common technique for fixing occipitocervical instability is the use of an inverted Y-shaped screw plate. Using this technique, the plate is secured to C1-2 with transarticular screws and to the suboccipital bone with paramedian screws; the suboccipital bone varies in thickness, with a mean thickness of 14 mm. Screws must be carefully selected to provide adequate purchase, yet avoid cerebella injury. Utilizing the maximum screw length possible is critical because shorter screws have decreased resistance to pullout. If stabilization is required below the C1-2 level, then lateral mass screws can be placed through additional holes in a longer plate to include these levels as well. In certain instances, a bone graft may be added to promote fusion. The Y-shaped plate, in combination with transarticular screws, is an economical alternative. Immediate postoperative stabilization is achieved and very low rates of pseudarthrosis have been reported. Due to the risk of selecting the correct screw size and the potential for cerebellar injury along with the potential for screw pull-out due to the short nature of the screw lengths allowed for use, it may prove advantageous to provide an occipital fixation assembly, and a system and method for attaching the same that can reduce the chance for pull-out and reduce the risk for cerebellar injury.
The present disclosure provides an occipital fixation assembly. The occipital fixation assembly includes a first mounting plate configured for placement within a sinus cavity adjacent a rear portion of a skull of a patient. A threaded post extends from the first mounting plate. A coupling member includes an aperture configured to receive the threaded post therethrough and an offset extension configured to support a surgical rod thereon. A fixation nut, configured to threadably engage the threaded post of the first mounting plate, is rotatable about the threaded post and translatable therealong. The fixation nut is rotatable with respect to the first mounting plate and the coupling member such that rotation of the fixation nut in a predetermined direction brings the first mounting plate and the coupling member toward one another and into secured engagement with the skull of a patient.
The present disclosure provides an occipital fixation system or system for attaching an occipital fixation assembly to a patient for subsequent attachment of a surgical rod thereto. The system includes a first mounting plate configured for placement within a sinus cavity adjacent a rear portion of a skull of a patient. The first mounting plate has a threaded post that extends therefrom. A coupling member includes an aperture configured to receive the threaded post therethrough. An offset extension disposed in parallel orientation with respect to the threaded post is configured to support a surgical rod thereon. A fixation nut configured to threadably engage the threaded post is rotatable about the threaded post and translatable therealong. The fixation nut is rotatable with respect to the first mounting plate and the coupling member such that rotation of the fixation nut in a predetermined direction brings the first mounting plate and the coupling member toward one another and into secured engagement with the skull of a patient. A forceps is configured to grasp a portion of the threaded post when the threaded post has been inserted through an aperture that has been previously drilled in the sinus cavity. A wrench assembly is adapted to engage and, subsequently, rotate the fixation nut about the threaded post.
The present disclosure also provides a method for attaching an occipital fixation assembly to a patient for subsequent attachment of a surgical rod thereto. The method includes creating an aperture within a sinus cavity adjacent a rear portion of a skull of a patient. A threaded post of a first mounting plate of an occipital fixation assembly is, subsequently, positioned through the aperture created within the sinus cavity. Thereafter, a coupling member of the occipital fixation assembly is attached to the threaded post of the first mounting plate. A fixation nut is then positioned about the threaded post and, subsequently, rotated in a predetermined direction about the threaded post such that the first mounting plate and the coupling member move toward one another and into secured engagement with the skull of a patient. A surgical rod is coupled to the coupling member.
Various embodiments of the present disclosure are described herein with reference to the drawings wherein:
In the following description, as is traditional, the term “proximal” refers to a portion of a surgical instrument closer to the operator while the term “distal” refers to a portion of a surgical instrument farther from the operator. In addition, the term “cephalad” is used in this application to indicate a direction toward a patient's head, whereas the term “caudad” indicates a direction toward the patient's feet. Further still, for the purposes of this application, the term “medial” indicates a direction toward the middle of the body of the patient, whilst the term “lateral” indicates a direction toward a side of the body of the patient (i.e., away from the middle of the body of the patient). The term “posterior” indicates a direction toward the patient's back, and the term “anterior” indicates a direction toward the patient's front. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail.
With reference to
Continuing with reference to
One or more barbs (two barbs 20a and 20b are shown in the drawings) are operably disposed on the top surface 10 of the mounting plate 4 (
In one particular embodiment, to facilitate fixation of the mounting plate 4 to an interior surface of a skull, the barbs 20a and 20b may reside in generally circumferential recesses 21a and 21b, respectively, see
With reference again to
A plurality of threads 16a extends along an outer circumferential surface of the elongated post 14a. The plurality of threads 16a extends along a majority of a length of the elongated post such that a portion of the elongated post 14a adjacent the top surface 10 of the mounting plate 4 is devoid of the plurality of threads 16a (
In the embodiment illustrated in
Continuing with reference to
Base 36 includes a generally annular configuration defined by an outer peripheral wall 35 that joins respective bottom and top surfaces 31 and 33 (
Coupling member 6 is also configured to support the surgical rod “R” thereon (
Offset extension 34 is disposed in parallel orientation with respect to the threaded post 14a (or in some embodiments with respect to the threaded post 14b), see
With reference again to
Preferably, a bottom surface 48 of the fixation nut 8 includes a generally elongated extension 50 that is configured to extend into an aperture 52 of a washer 54 and the aperture 32 of the base 36 (
To facilitate fixation of occipital fixation assembly 2a to an interior surface of a skull, a second mounting plate 5 may be operably coupled to the mounting plate 4, see
Mounting plate 5 includes one or more barbs, e.g., barbs 20c and 20d, disposed on a top surface 30 thereof. As described above with respect to barbs 20a and 20b, barbs 20c and 20d may reside in corresponding recesses 21c and 21d, respectively, see
To facilitate positioning the mounting plates 4 and 5 inside the occiput, a bottom surface 28 of the mounting plate 5 includes a pair of indents 25a and 25b that are configured to releasably engage the barbs 20a and 20b (
To facilitate anchoring the mounting plates 4 and 5 into the interior surface of a skull, a bottom surface 28 of the mounting plate 5 includes a notched portion 24 that is configured to receive and/or mate with a portion, e.g., a corresponding notched portion 26 disposed on the top surface 10, of the mounting plate 4 (
In use, an aperture is, initially, created within a sinus cavity adjacent a rear portion of a skull of a patient, i.e., adjacent the occiput. For purposes herein, the aperture may be created utilizing one or more suitable surgical devices, e.g., a surgical drill.
Mounting plate 4 is positioned through the aperture created within the sinus cavity adjacent the occiput. Thereafter, coupling member 6 is positioned about the threaded post 14a (see
The fixation nut 8 including the washer 54 is positioned about the threaded post 14a and over the base 36 of coupling member 6. For illustrative purposes, the fixation nut 8 including washer 54 is shown engaged with the coupling member 6. Subsequently, the fixation nut 8 is rotated in a predetermined direction, e.g., a clockwise direction, about the threaded post 14a. In one particular embodiment, a screwdriver (or other suitable device) is utilized to engage the slot 17 to facilitate rotation the mounting plate 4 and/or fixation nut 8. Rotation of the fixation nut 8 about the threaded post 14b causes the coupling member 6 and the mounting plate 4 to move toward one another and into secured engagement with an interior and exterior surface, respectively, of the skull of a patient. As a result thereof, the occiput is “sandwiched” between the surgical rod coupling member 6 (with barbs 20e-20g) and mounting plate 4 (with barbs 20a-20b) by threading the fixation nut 8 over the threaded post 14a and tightening to the specified torque.
In some surgical scenarios, the occiput is “sandwiched” between the surgical rod coupling member 6 (with barbs 20e-20g) and mounting plates 4 and 5 (with barbs 20a-20d) by threading the fixation nut 8 over the threaded post 14a and tightening to the specified torque.
Thereafter, the surgical rod “R” is coupled to the offset extension 34 of the coupling member 6 and secured to the coupling member 6 via the set screw 42.
As can be appreciated, the combination of the unique mounting plate 4 having the threaded post 14a configured to couple to the coupling member 6 reduces and/or eliminates the likelihood of the occipital fixation assembly 2 inadvertently pulling out from the occiput, which, in turn, reduces the risk for cerebellar injury. Moreover, anchoring the barbs 20a-20b and the barbs 20e-20g into the interior and exterior surfaces, respectively, of the skull diminishes the likelihood of inadvertent rotation of mounting plate 4 and coupling member 6 after the surgical rod “R” has been attached to the occipital fixation assembly and/or the spine.
With reference to
With reference to
Forceps 60 is configured to grasp a portion of the threaded post 14b (as best seen in
Each of the jaw members 63 and 64 includes a respective inner facing surface 69 and 68 (
The distal ends 72 and 73 of the jaw members 63 and 64 include a protrusion 74 and 75 (
A ratchet mechanism 90 may be operably coupled to the shafts 61 and 62 adjacent the handles 65 and 66 and is configured to maintain the jaw members 63 and 64 in one or more positions. More particularly, each shaft 61 and 62 includes a respective ratchet component 90a and 90b each having a plurality of ratchet teeth that are configured to matingly engage with one another.
As can be appreciated, in the instance where the occipital fixation assembly 2 includes a mounting plate 4 with a threaded post 14a, the inner facing surfaces 69 and 68 of the forceps 60 may be provided without the protrusions 74 and 75. For example, the inner facing surfaces 69 and 68 of forceps 60 may include one or more slots or grooves that are configured to matingly engage with the plurality of threads 16a on the threaded post 14a.
Wrench assembly 80 is configured to rotate the fixation nut 8 about the threaded post 14b (
The coupling member 81 includes a generally elongated shaft 83 (
A portion 86 (
The proximal end 85 of the coupling member 81 is complementary shaped to receive an open end of a turn-key 87. In the illustrated embodiment, the proximal end 85 and the open end of the turn-key 87 include a hexagonal shape. The turn-key 87 is configured to facilitate rotation of the threaded distal end 84 into the threaded aperture 19 on the threaded post 14b of the mounting plate 4a.
In the embodiment illustrated in
The wrench head member 82 is configured to releasably engage the fixation nut 8 and rotate the fixation nut 8 about the threaded post 14b of the mounting plate 4a. To this end, the wrench head member 82 is complementary shaped to receive and turn the fixation nut 8. In the embodiment illustrated in
Operation of the system 100 including the occipital fixation assembly 2b including the mounting plate 4a with the threaded post 14b is described in terms of use of a method for attaching the occipital fixation assembly 2b for subsequent attachment of a surgical rod “R” thereto.
An aperture is created within a sinus cavity adjacent a rear portion of a skull of a patient. For purposes herein, the aperture may be created utilizing one or more suitable surgical devices, e.g., a surgical drill.
The forceps 60 may be utilized for grasping the threaded post 14b to insert the mounting plate 4a through the aperture created within the sinus cavity and to temporarily hold the threaded post 14b in place (
The fixation nut 8 including the washer 54 is positioned about the threaded post 14b and over the base 36 of coupling member 6. To facilitate positioning the fixation nut 8 about the threaded post 14b, the coupling member 81 of the wrench assembly 80 may be coupled to the threaded post 14b, see
Subsequently, the fixation nut 8 is rotated in a predetermined direction, e.g., a clockwise direction, about the threaded post 14b. To facilitate rotating the fixation nut 8 about the threaded post 14b, the wrench head member 82 may be positioned coaxially about the coupling member 81 and into engagement with the fixation nut 8 (
The wrench head member 82 is rotated about the fixation nut 8, which, in turn, rotates the fixation nut 8 about the threaded post 14b, this in turn, causes the coupling member 6 and the mounting plate 4a to move toward one another and into secured engagement with an interior and exterior surface, respectively, of the skull of a patient.
In one surgical scenario, after the coupling member 6 and the mounting plate 4a are moved into secured engagement with the interior and exterior surface of the skull, the wrench assembly 80 is removed from the occipital fixation assembly 2 (
From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. For example, in some embodiments the slot 38 of the offset extension 34 includes a taper locking mechanism for capturing the surgical rod “R” such that a set screw 42 is not required.
In yet another embodiment, the slot 38 of the offset extension 34 includes a polyaxial coupling for capturing the surgical rod “R” such that an angle and trajectory of the surgical rod “R” does not limit the position of the occipital fixation assembly 2.
In yet another embodiment, a fixation nut may be integrally formed with a coupling member. More particularly, and with reference to
While several embodiments of the disclosure have been shown in the drawings and/or discussed herein, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
The present application is a division of U.S. patent application Ser. No. 14/288,903, filed on May 28, 2014, which is a division of U.S. patent application Ser. No. 12/904,613 filed on Oct. 14, 2010, which has been abandoned, which claims the benefit of and priority to U.S. Provisional Application No. 61/278,925 to Sandhu et al., filed on Oct. 14, 2009, the entire contents of each of which are incorporated by reference herein.
Number | Name | Date | Kind |
---|---|---|---|
1390485 | Bell | Sep 1921 | A |
3019887 | Lowden | Feb 1962 | A |
3997138 | Crock et al. | Dec 1976 | A |
4648388 | Steffee | Mar 1987 | A |
4743260 | Burton | May 1988 | A |
5024213 | Asher et al. | Jun 1991 | A |
5098433 | Freedland | Mar 1992 | A |
5127912 | Ray et al. | Jul 1992 | A |
5129899 | Small et al. | Jul 1992 | A |
5167665 | McKinney | Dec 1992 | A |
5234432 | Brown | Aug 1993 | A |
5250049 | Michael | Oct 1993 | A |
5257994 | Lin | Nov 1993 | A |
5269784 | Mast | Dec 1993 | A |
5312404 | Asher et al. | May 1994 | A |
5380325 | Lahille et al. | Jan 1995 | A |
5507745 | Logroscino et al. | Apr 1996 | A |
5545164 | Howland | Aug 1996 | A |
5545228 | Kambin | Aug 1996 | A |
5591166 | Bernhardt et al. | Jan 1997 | A |
5649926 | Howland | Jul 1997 | A |
5653708 | Howland | Aug 1997 | A |
5713898 | Stucker et al. | Feb 1998 | A |
5722976 | Brown | Mar 1998 | A |
5947968 | Rogozinski | Sep 1999 | A |
6039738 | Sanders et al. | Mar 2000 | A |
6059786 | Jackson | May 2000 | A |
6083224 | Gertzbein et al. | Jul 2000 | A |
6146384 | Lee et al. | Nov 2000 | A |
6287308 | Betz et al. | Sep 2001 | B1 |
6682532 | Johnson et al. | Jan 2004 | B2 |
6755834 | Amis | Jun 2004 | B2 |
7048737 | Wellisz et al. | May 2006 | B2 |
7303563 | Poyner et al. | Dec 2007 | B2 |
9327069 | Foster et al. | May 2016 | B2 |
9597122 | Sandhu et al. | Mar 2017 | B2 |
20010011173 | Lerch | Aug 2001 | A1 |
20040127908 | Roman et al. | Jul 2004 | A1 |
20050070899 | Doubler et al. | Mar 2005 | A1 |
20050080417 | Alexis et al. | Apr 2005 | A1 |
20050137594 | Doubler et al. | Jun 2005 | A1 |
20050256510 | Moskowitz et al. | Nov 2005 | A1 |
20060247628 | Rawlins et al. | Nov 2006 | A1 |
20060264932 | Bert | Nov 2006 | A1 |
20080103502 | Capote | May 2008 | A1 |
20080281359 | Abdou | Nov 2008 | A1 |
20090030463 | Samudrala et al. | Jan 2009 | A1 |
Number | Date | Country |
---|---|---|
9505782 | Mar 1995 | WO |
Entry |
---|
Vijay K. Goel, PhD. et al. “Effects of Rigidity of an Internal Fixation Device”, vol. 16, No. 3 Supplemental, 1991, pp. S155-S161. |
Rolando M. Puno, MD, et al. “Biochemical Analysis of Transpedicular Rod Systems”, vol. 16, No. 8, 1991, pp. 973-980. |
James Zucherman, MD, et al. “Early Results of Spinal Fusion Using Variable Spine Plating Systems”, vol. 13, No. 5, 1988, pp. 570-579. |
Faheem A. Sandhu, MD, PhD. et al. “Occipitocervical Fusion for Rheumatoid Arthritis Using the Inside-Outside Stabilization Technique”, vol. 28, No. 4, 2003, pp. 414-419. |
Number | Date | Country | |
---|---|---|---|
20170238972 A1 | Aug 2017 | US |
Number | Date | Country | |
---|---|---|---|
61278925 | Oct 2009 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 14288903 | May 2014 | US |
Child | 15453153 | US | |
Parent | 12904613 | Oct 2010 | US |
Child | 14288903 | US |