Patent Application
20070038034
The present system and method relate to devices and methods for performing percutaneous surgeries, and more particularly, to percutaneous surgical tooling and methods for minimizing tissue damage within and near a surgical site.
Traditionally, the surgical exposure employed to perform spinal surgery inflicts significant and long lasting damage to the surrounding soft tissues. Surgical exposure, commonly referred to as an ‘open’ procedure, relies on retraction of muscles to open a channel to the underlying bony structures. Surgical retractors are often used to provide the operating channel. Common surgical retractors as used in the art today include rakes, forks, and different sized and shaped hooks. Normally, the hooks are constructed of a stainless steel or latex-free silicon so that they may be used in the sterile environment of the surgery. While such retractors as rakes or hooks are useful for certain types of injury, extreme care must be used to ensure that the retractor does not cause additional damage to the wound. In addition, use of the surgical retractor may require two, three, or more additional assistants to the physician, with appropriate training, in order to hold the retractor in the correct position so that the site of the surgery is more easily accessible to the physician. Other types of surgical retractors are inserted into the surgical site and then one or more arms are spread in order to open the insertion site for further access by the physician. These retractors are generally bulky, require substantial training and skill to operate, and user error may increase the difficulty and the time for the surgery. Traditional retraction using the above-mentioned retractors is recognized to cut-off circulation to the muscles and often results in post-operative pain and long-term degradation of muscle function.
Recently, minimally invasive techniques have been developed to reduce the intra-operative damage and reduce the post-operative recovery time. In minimally invasive surgery (MIS), a desired site is accessed through portals rather than through a significant incision. Various types of access portals have been developed for use in MIS. Many of the existing MIS access portals, such as those described in U.S. Pat. Nos. 4,573,488 and 5,395,317 issued to Kambin, can only be used for a specific procedure. Other prior art portals, such as that described in U.S. Pat. No. 5,439,464 issued to Shapiro, require multiple portals into the patient, adding complexity to the portal placement as well as obstructing the operating space.
According to one exemplary embodiment, the tools and methods described herein provide a variety of ways to minimize the trauma and damage that may occur to the tissue in the vicinity of a surgical site. In one example, reducing the trauma and damage to the paraspinous tissue during a spinal surgery allows the patient to strengthen their back muscles quicker and also recover faster.
In one exemplary embodiment, a tool includes an elongated driver having an expander and a plurality of blades each having a proximal portion and a distal portion. According to this exemplary embodiment, the distal portions of the plurality of blades are positioned around and proximate to the expander. The plurality of blades is moveable from a retracted position to an expanded position. When in the retracted position, the distal portions of the plurality of blades are located a first distance from the driver. However, when in the expanded position, the distal portions of the plurality of blades are located further from the driver than when in the retracted position.
In another exemplary embodiment, a method for percutaneously preparing a vertebrae to receive a screw includes first inserting a wire through at least several layers of human tissue including paraspinous tissue, guiding the wire through interstices present in the paraspinous tissue, contacting at least a portion of the vertebrae with the wire, guiding a tool over the wire and through the interstices, forming a passage in the vertebrae, and forming internal screw threads in the passage.
In yet another exemplary embodiment, a percutaneous method for inserting a screw into a bone includes inserting a driver coupled to the screw through tissue present around the bone, turning the screw into the bone with the driver, and inserting a cannula through the tissue.
The foregoing is a summary and thus contains, by necessity, simplifications, generalizations and omissions of detail; consequently, those skilled in the art will appreciate that the summary is illustrative only and is not intended to be in any way limiting. Other aspects, inventive features, and advantages of the devices and/or processes described herein, as defined solely by the claims, will become apparent in the non-limiting detailed description set forth herein.
The accompanying drawings illustrate various embodiments of the present system and method and are a part of the specification. The illustrated embodiments are merely examples of the present system and method and do not limit the scope thereof.
Throughout the drawings, identical reference numbers designate similar but not necessarily identical elements. The sizes and relative positions of elements in the drawings are not necessarily drawn to scale. For example, the shapes of various elements and angles are not drawn to scale, and some of these elements are arbitrarily enlarged and positioned to improve drawing legibility. Further, the particular shapes of the elements as drawn, are not intended to convey any information regarding the actual shape of the particular elements, and have been solely selected for ease of recognition in the drawings.
In the following description, various details are set forth in order to provide a thorough understanding of a variety of embodiments of the present tools, assemblies, systems, and methods. However, one skilled in the relevant art will recognize that the tools, assemblies, systems, and methods described herein may be practiced without one or more of these specific details, or with other methods, components, materials, etc. In other instances, well-known structures associated with surgical tooling have not been shown or described in detail to avoid unnecessarily obscuring descriptions of the embodiments of the present assemblies, devices and systems.
Reference in the specification to “one embodiment” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. The appearance of the phrase “in one embodiment” in various places in the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.
Unless the context requires otherwise, throughout the specification and claims which follow, the word “comprise” and variations thereof, such as, “comprises” and “comprising” are to be construed in an open, inclusive sense; that is as “including, but not limited to.”
Additionally, the headings provided herein are for convenience only and do not interpret the scope or meaning of the claimed invention.
While the present system and method may be practiced by or incorporated into any number of systems, the present system and method will be described herein, for ease of explanation only, in the context of percutaneous tooling and methods for use in orthopedic spinal surgery; providing a channel to the underlying bony structures of the spine while minimizing trauma to the overlying tissues. According to aspects of the present exemplary system and method, the driver and expander assembly is able to minimize the need for muscle retraction. The features and advantages of the exemplary systems and methods will be set forth in the description which follows, and in part will be apparent from the description.
Percutaneous Surgical Tooling
Additionally, a number of blade members (32) are positioned approximately around the driver (26). According to the present exemplary embodiment, each blade member (32) includes one or more flexible membranes (33;
According to one exemplary embodiment illustrated in
Referring back to
In addition to the above structures, the driver (26), according to one exemplary embodiment, includes the expander (30) having a campana shaped profile and a coupling member (44) protruding there from. According to one exemplary embodiment, the coupling member (44) is configured to frictionally couple and at least temporarily retain a screw (48), such as a pedicle screw that is to be inserted into the vertebral body (12). In one exemplary embodiment, the coupling member (44) includes a number of serrations (46) configured to engage and retain the screw (48) when the driver (26) is rotated in a first direction (50). After the screw (48) is placed in a bone, or the vertebral body (12) for instance, the driver (26) can be turned in a second direction (52) to release the serrations (46) of the coupling member (44) from the screw (48). One exemplary type of pedicle screw (48) that may be used with the present exemplary system and method is described in detail in a U.S. Patent Application, filed on Jul. 28, 2006, entitled “Thread on a Bone Screw,” having Express Mail No. EV 895433933 US and corresponding to Attorney Docket No. 40359-0064, which application is incorporated herein by reference in its entirety. Additionally, the present exemplary systems and methods are in no way limited to use with a pedicle screw. Rather, the present systems and methods may be used with any number of orthopedic fasteners or implants.
Continuing with the figures,
It is also understood that the distal portions (36) of the blade members (32) may be expanded an amount that provides a surgeon access to the complete surgical site (10) within the region formed by the expanded blade members (32). In the illustrated and exemplary embodiment, the blade members (32) are expanded over the vertebral bodies (12a, 12b, 12c), which have intervertebral disks (58) located therebetween. Thus, the surgeon can access a number of adjacent screws (48) that may have been previously secured into the vertebral bodies (12a, 12b, 12c), for example. It is understood and appreciated that the surgeon controls the amount of expansion of the blade members (32) by selective manipulation of the driver (26). Further details of the operation of the present exemplary percutaneous tool (24) will be provided below.
Percutaneous Surgical Method
The insertion of the wire (60) establishes a small channel through the tissue layers (14,16) and further through the paraspinous tissue (14). One advantage of finding and then guiding the wire (60) through the interstices (64) is to avoid puncturing, cutting, or otherwise damaging the paraspinous tissue (14), in particular the multifidus muscle. In one exemplary embodiment, the wire (60) is guided, as described above, with the assistance of an x-ray imager, a fluoroscopic imager, some other type of two and/or three-dimensional imager, and/or some combination of the above.
Once the wire (60) is placed, a drill may be passed over the wire.
With the desired opening drilled in the vertebral body (12), internal threads may be formed in the vertebral body, according to one exemplary embodiment.
According to one exemplary embodiment, once the desired orifice is formed and threaded, as described above, the driver and blade assembly may be inserted through the orifice and guided down the wire (60).
After the driver (26) and blade members (32) have been inserted to a desired position through the tissue layers (14,16, 18), the sleeve (76) may be removed to allow for further operations.
Specifically,
Once the blade members (32) are in their expanded position, they allow the surgeon to work in a variety of locations within the surgical site (10), which may comprise a number of intervertebral disks (58) located between portions of the vertebral body (12). By way of example, the surgeon may determine that a compressed disk (58) needs to be repaired, which may involve separating and then fusing adjacent portions of the vertebral body (12) together using a pedicle screw system. One type of pedicle screw system and the installation thereof is described in detail in U.S. Provisional Patent Application No. 60/665,032, filed on Mar. 23, 2005, which application is incorporated herein by reference in its entirety.
After preparing the opening in the vertebral body (12), securing the screw (48) therein, placing and expanding the blade members (32), the surgeon may elect to insert a minimally invasive surgical (MIS) retractor or MIS port (78) as shown in
In conclusion, the present exemplary systems and methods provide a variety of ways to minimize the trauma and damage that may occur to the tissue in the vicinity of a surgical site. Specifically, a tool includes an elongated driver having an expander and a plurality of blade members, each having a proximal portion and a distal portion. According to this exemplary embodiment, the distal portions of the plurality of blades are positioned around and proximate to the expander. The plurality of blades is moveable from a retracted position to an expanded position. When in the retracted position, the distal portions of the plurality of blades are located a first distance from the driver. However, when in the expanded position, the distal portions of the plurality of blades are located further from the driver than when in the retracted position.
Various embodiments of the present assemblies, devices, and systems have been described herein. It should be recognized, however, that these embodiments are merely illustrative of the principles of the present assemblies, devices, and systems. Numerous modifications and adaptations thereof will be apparent to those skilled in the art without departing from the spirit and scope of the present assemblies, devices, and systems.
The various embodiments described above can be combined to provide further embodiments. All of the above U.S. patents, patent applications and publications referred to in this specification, are incorporated herein by reference, in their entirety. Aspects of the invention can be modified, if necessary, to employ devices, features, and concepts of the various patents, applications and publications to provide yet further embodiments of the invention.
The preceding description has been presented only to illustrate and describe exemplary embodiments of the present system and method. It is not intended to be exhaustive or to limit the system and method to any precise form disclosed. Many modifications and variations are possible in light of the above teaching. It is intended that the scope of the system and method be defined by the following claims.
This application claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application No. 60/708,731, filed Aug. 15, 2005 titled “Minimally Invasive Surgical Retractor,” which application is incorporated herein by reference in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| 60708731 | Aug 2005 | US |
