US20010031965A1 - Spine distraction implant and method - Google Patents

Abstract

A spine distraction implant alleviates pain associated with spinal stenosis and facet arthropathy by expanding the volume in the spine canal and/or neural foramen. The implant provides a spinal extension stop while allowing freedom of spinal flexion.

Description

CROSS REFERENCE TO RELATED APPLICATION
• This application is a continuation-in-part of the U.S. patent application entitled SPINE DISTRACTION IMPLANT AND METHOD having U.S. Ser. No. 08/778,093, and filed on Jan. 2, 1997.[0001]
BACKGROUND OF THE INVENTION
• As the present society ages, it is anticipated that there will be an increase in adverse spinal conditions which are characteristic of older people. By way of example, with aging comes increases in spinal stenosis (including but not limited to central canal and lateral stenosis), the thickening of the bones which make up the spinal column and facet arthropathy. Spinal stenosis is characterized by a reduction in the available space for the passage of blood vessels and nerves. Pain associated with such stenosis can be relieved by medication and/or surgery. Of course, it is desirable to eliminate the need for major surgery for all individuals and in particular for the elderly.[0002]
• Accordingly, there needs to be developed procedures and implants for alleviating such condition which are minimally invasive, can be tolerated by the elderly and can be performed preferably on an outpatient basis.[0003]
SUMMARY OF THE INVENTION
• The present invention is directed to providing a minimally invasive implant and method for alleviating discomfort associated with the spinal column.[0004]
• The present invention provides for apparatus and method for relieving pain by relieving the pressure and restrictions on the aforementioned blood vessels and nerves. Such alleviation of pressure is accomplished in the present invention through the use of an implant and method which distract the spinous process of adjacent vertebra in order to alleviate the problems caused by spinal stenosis and facet arthropathy and the like. While the implant and method particularly address the needs of the elderly, the invention can be used with individuals of all ages and sizes where distraction of the spinous process would be beneficial.[0005]
• In one aspect of the invention, an implant is provided for relieving pain comprising a device positioned between a first spinous process and a second spinous process. The device includes a spinal column extension stop and a spinal column flexion non-inhibitor.[0006]
• In another aspect of the invention, the implant is positioned between the first spinous process and the second spinous process and includes a distraction wedge that can distract the first and second spinous processes as the implant is positioned between the spinous processes.[0007]
• In yet another aspect of the present invention, the implant includes a device which is adapted to increasing the volume of the spinal canal and/or the neural foramen as the device is positioned between adjacent spinous processes.[0008]
• In yet a further aspect of the present invention, a method is presented for relieving pain due to the development of, by way of example only, spinal stenosis and facet arthropathy. The method is comprised of the steps of accessing adjacent first and second spinal processes of the spinal column and distracting the processes a sufficient amount in order to increase the volume of the spinal canal in order to relieve pain. The method further includes implanting a device in order to maintain the amount of distraction required to relieve such pain.[0009]
• In yet a further aspect of the invention, the method includes implanting a device in order to achieve the desired distraction and to maintain that distraction.[0010]
• In yet a further aspect of the invention, the implant includes a first portion and a second portion. The portions are urged together in order to achieve the desired distraction.[0011]
• In still a further aspect of the invention, the implant includes a distracting unit and a retaining unit. The distracting unit includes a body which can be urged between adjacent spinous processes. The body includes a slot. After the distracting unit is positioned, the retaining unit can fit into the slot of the retaining unit and be secured thereto.[0012]
• Other implants and methods within the spirit and scope of the invention can be used to increase the volume of the spinal canal thereby alleviating restrictions on vessels and nerves associated therewith, and pain.[0013]
BRIEF DESCRIPTION OF THE FIGURES
• FIGS. 1 and 2 depict an embodiment of an implant of the invention which is adjustable in order to select the amount of distraction required. FIG. 1 depicts the implant in a more extended configuration than does FIG. 2.[0014]
• FIGS. 3[0015]aand3bdepict side and end views of a first forked and of the embodiment of FIG. 1.
• FIGS. 4[0016]aand4bdepict side sectioned and end views of an interbody piece of the implant of FIG. 1.
• FIGS. 5[0017]aand5bdepict side and end views of a second forked end of the embodiment of FIG. 1.
• FIGS. 6, 7,[0018]8,9 and10 depict apparatus and method for another embodiment of the present invention for creating distraction between adjacent spinous processes.
• FIGS. 11, 12 and[0019]13 depict yet a further embodiment of the invention for creating distraction between adjacent spinous processes.
• FIGS. 14 and 15 depict a further apparatus and method of an embodiment of the invention for creating distraction.[0020]
• FIGS. 16, 16[0021]a, and17 depict yet another embodiment of the present invention.
• FIGS. 18, 19 and[0022]20 depict yet a further apparatus and method of the present embodiment.
• FIGS. 21 and 22 depict still a further embodiment of the present invention.[0023]
• FIGS. 23, 24 and[0024]25 depict another embodiment of the present invention.
• FIGS. 26, 27 and[0025]28 depict another embodiment of the invention.
• FIGS. 29 and 30 depict side elevational views of differently shaped implants of embodiments of the present invention.[0026]
• FIGS. 31, 32 and[0027]33 depict various implant positions of an apparatus of the present invention.
• FIGS. 34 and 35 depict yet another apparatus and method of the present invention.[0028]
• FIGS. 36, 37 and[0029]38 depict three different embodiments of the present invention.
• FIGS. 39 and 40 depict yet another apparatus and method of an embodiment of the present invention.[0030]
• FIGS. 41, 42 and[0031]43 depict yet further embodiments of an apparatus and method of the present invention.
• FIG. 44 is still a further embodiment of an implant of the invention.[0032]
• FIG. 45 is yet another depiction of an apparatus and method of the invention.[0033]
• FIGS. 46 and 47 depict still a further apparatus and method of an embodiment of the invention.[0034]
• FIGS. 48, 49,[0035]50 and51 depict yet a further apparatus and method of the invention.
• FIGS. 52, 53,[0036]54,55aand55bdepict another apparatus and method of the invention.
• FIGS. 56, 57 and[0037]58 depict yet a further apparatus and method of the invention.
• FIGS. 59 and 60 depict still a further embodiment of the invention.[0038]
• FIG. 61 depict another embodiment of the invention.[0039]
• FIGS. 62 and 63 depict yet another embodiment of the present invention.[0040]
• FIGS. 64 and 65 depict still a further embodiment of the present invention.[0041]
• FIG. 66 depicts another embodiment of the invention.[0042]
• FIGS. 67 and 68 depict yet another embodiment of the present invention.[0043]
• FIGS. 69, 70,[0044]71 and71adepict a further embodiment of the present invention.
• FIGS. 72 and 73 depict still another embodiment of the invention.[0045]
• FIGS. 74, 75,[0046]76,77, and78 depict still other embodiments of the invention.
• FIGS. 79, 80,[0047]80a,81,82,83,83a,84,85,86 and87 depict still a further embodiment of the present invention.
• FIGS. 88, 89,[0048]90 and91 depict yet another embodiment of the present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
• Embodiment of FIGS.[0049]1-5a,5b
• A first embodiment of the invention is shown in FIGS.[0050]1-5a,5b.Implant20 includes first and second forked ends22 and24, each defining asaddle26,28 respectively. The forked ends22,24 are mated using aninterbody piece30. As can be seen in FIGS. 3a,3b, the first forkedend22 includes a threadedshaft32 which projects rearwardly from thesaddle26. The threadedshaft32 fits into the threaded bore34 (FIG. 4a) of theinterbody piece30.
• The second forked end[0051]24 (FIGS. 5a,5b) includes a smoothcylindrical shaft36 which can fit into thesmooth bore38 of theinterbody piece30.
• FIG. 1 shows the[0052]implant20 in a fully extended position, while FIG. 2 shows the implant in an unextended position. In the unextended position, it can be seen that the threadedshaft32 of the first forkedend22 fits inside the hollowcylindrical shaft36 of the second forkedend24.
• For purposes of implantation between adjacent first and second spinous processes of the spinal column, the[0053]implant20 is configured as shown in FIG. 2. The first and second spinous processes are exposed using appropriate surgical techniques and thereafter, theimplant20 is positioned so thatsaddle26 engages the first spinous process, and saddle28 engages the second spinous process. At this point, theinterbody piece30 can be rotated by placing an appropriate tool or pin into the cross holes40 and upon rotation, thesaddle26 is moved relative to thesaddle28. Such rotation spreads apart or distracts the spinous processes with the resultant and beneficial effect of enlarging the volume of the spinal canal in order to alleviate any restrictions on blood vessels and nerves.
• It is noted that this implant as well as the several other implants described herein act as an extension stop. That means that as the back is bent backwardly and thereby placed in extension the spacing between adjacent spinous processes cannot be reduced to a distance less than the distance between the lowest point of[0054]saddle26 and the lowest point ofsaddle28. This implant, however, does not inhibit or in any way limit the flexion of the spinal column, wherein the spinal column is bent forward.
• Preferably, such a device provides for distraction in the range of about 5 mm to about 15 mm. However, devices which can distract up to and above 22 mm may be used depending on the characteristics of the individual patient.[0055]
• With all the ligaments (such as the superspinous ligament) and tissues associated with the spinous processes left intact, the[0056]implant20 can be implanted essentially floating in position in order to gain the benefits of the aforementioned extension stop and flexion non-inhibitor. If desired, one of thesaddles26 can be laterally pinned withpin29 to one of the spinous processes and the other saddle can be loosely associated with the other spinous processes by using atether31 which either pierces or surrounds the other spinous process and then is attached to the saddle in order to position the saddle relative to the spinous process. Alternatively, both saddles can be loosely tethered to the adjacent spinous process in order to allow the saddles to move relative to the spinous processes.
• The shape of the saddles, being concave, gives the advantage of distributing the forces between the saddle and the respective spinous process. This ensures that the bone is not resorbed due to the placement of the[0057]implant20 and that the structural integrity of the bone is maintained.
• The[0058]implant20 in this embodiment can be made of a number of materials, including but not limited to, stainless steel, titanium, ceramics, plastics, elastics, composite materials or any combination of the above. In addition, the modulus of elasticity of the implant can be matched to that of bone, so that theimplant20 is not too rigid. The flexibility of the implant can further be enhanced by providing additional apertures or perforations throughout the implant in addition to theholes40 which also have the above stated purpose of allowing theinterbody piece30 to be rotated in order to expand the distance between thesaddle26,28.
• In the present embodiment, it is understood that the spinous processes can be accessed and distracted initially using appropriate instrumentation, and that the[0059]implant20 can be inserted and adjusted in order to maintain and achieve the desired distraction. Alternatively, the spinous process can be accessed and theimplant20 appropriately positioned. Once positioned, the length of the implant can be adjusted in order to distract the spinous processes or extend the distraction of already distracted spinous processes. Thus, the implant can be used to create a distraction or to maintain a distraction which has already been created.
• The placement of implants such as[0060]implant20 relative to the spinous process will be discussed hereinbelow with other embodiments. However, it is to be noted that ideally, theimplant20 would be placed close to the instantaneous axis of rotation of the spinal column so that the forces placed on theimplant20 and the forces that theimplant20 places on the spinal column are minimized.
• Further, it is noted that during the actual process of installing or implanting the[0061]implant20, that the method uses the approach of extending the length of the implant20 a first amount and then allowing the spine to creep or adjust to this distraction. Thereafter,implant20 would be lengthened another amount, followed by a period where the spine is allowed to creep or adjust to this new level of distraction. This process could be repeated until the desired amount of distraction has been accomplished. This same method can be used with insertion tools prior to the installation of an implant. The tools can be used to obtain the desired distraction using a series of spinal distraction and spine creep periods before an implant is installed.
• Embodiment of FIGS. 6, 7,[0062]8,9 and10
• The embodiment of the invention shown in the above FIGS. 6, 7,[0063]8,9 and10 includes distraction orspreader tool50 which has first andsecond arms52,54.Arms52,54 are pivotal aboutpivot point56 and releaseable frompivot point56 in order to effect the implantation ofimplant58. As can be seen in FIG. 6, in cross-section, thearms52,54 are somewhat concave in order to cradle and securely hold the firstspinous process60 relative toarm52 and the secondspinous process62 relative toarm54. Thedistraction tool50 can be inserted through a small incision in the back of the patient in order to address the space between the firstspinous process60 and the secondspinous process62. Once thetool50 is appropriately positioned, thearms52,54 can be spread apart in order to distract the spinous processes. After this has occurred, animplant58 as shown in FIGS. 8 and 9, or of a design shown in other of the embodiments of this invention, can be urged between thearms52,54 and into position between the spinous processes. After this occurs, thearms52,54 can be withdrawn from the spinous processes leaving theimplant58 in place. Theimplant58 is urged into place using atool64 which can be secured to theimplant58 through a threadedbore66 in the back of the implant. As can be seen in FIG. 10, theimplant58 includessaddles68 and70 which cradle the upper and lowerspinous processes60,62 in much the same manner as the above first embodiment and also in much the same manner as the individual arms of thetool50. The saddles as described above tend to distribute the load between the implant and the spinous processes and also assure that the spinous process is stably seated at the lowest point of the respective saddles.
• Embodiment of FIGS. 11, 12 and[0064]13
• Another embodiment of the apparatus and method of the invention is shown in FIGS. 11, 12 and[0065]13. In this embodiment, the spreader ordistraction tool80 includes first andsecond arms82,84 which are permanently pivoted atpivot point86. The arms include L-shaped ends88,90. Through a small incision, the L-shaped ends88,90 can be inserted between the first and second spinous processes92,94. Once positioned, thearms82,84 can be spread apart in order to distract the spinous processes. Theimplant96 can then be urged between the spinous processes in order to maintain the distraction. It is noted thatimplant96 includes wedged surfaces orramps98,100. As theimplant96 is being urged between the spinous processes, the ramps further cause the spinous processes to be distracted. Once theimplant96 is fully implanted, the full distraction is maintained by theplanar surfaces99,101 located rearwardly of the ramps. It is to be understood that the cross-section of theimplant96 can be similar to that shown forimplant58 or similar to other implants in order to gain the advantages of load distribution and stability.
• Embodiments of FIGS. 14, 15,[0066]16,16a, and17
• In FIGS. 14 and 15, yet another embodiment of the invention is depicted. In this embodiment, the[0067]implant110 includes first and second conically shapedmembers112,114.Member112 includes amale snap connector116 andmember114 includes afemale snap connector118. Withmale snap connector116 urged intofemale snap connector118, thefirst member112 is locked to thesecond member114. In this embodiment, a distraction orspreader tool80 could be used. Once the spinous process has been spread apart, animplantation tool120 can be used to position and snap together theimplant110. Thefirst member112 ofimplant110 is mounted on one arm andsecond member114 is mounted on the other arm oftool120. Themember112,114 are placed on opposite sides of the space between adjacent spinous processes. Themembers112,114 are urged together so that theimplant110 is locked in place between the spinous processes as shown in FIG. 15. It is to be noted that theimplant110 can also be made more self-distracting by causing thecylindrical surface122 to be more conical, much assurface124 is conical, in order to holdimplant110 in place relative to the spinous processes and also to create additional distraction.
• An alternative embodiment of the implant can be seen in FIGS. 16 and 17. This[0068]implant130 includes first andsecond members132,134. In this particular embodiment, the implants are held together using a screw (not shown) which is inserted through countersunkbore136 and engages a threadedbore138 of thesecond member134.Surfaces139 are flattened (FIG. 17) in order to carry and spread the load applied thereto by the spinous processes.
• The embodiment of[0069]implant130 is not circular in overall outside appearance, as is theembodiment110 of FIGS. 14 and 15. In particular, with respect to the embodiment ofimplant130 of FIGS. 16 and 17, this embodiment is truncated so that thelateral side140,142 are flattened with the upper andlower sides144,146 being elongated in order to capture and create a saddle for the upper and lower spinous processes. The upper and lower sides,144,146 are rounded to provide a more anatomical implant, which is compatible with the spinous processes.
• If it is desired, and in order to assure that the[0070]first member132 and thesecond member134 are aligned, key148 andkeyway150 are designed to mate in a particular manner.Key148 includes at least one flattened surface, such as flattenedsurface152, which mates to an appropriately flattenedsurface154 of thekeyway150. In this manner, the first member is appropriately mated to the second member in order to form appropriate upper and lower saddles holding theimplant130 relative to the upper and lower spinous processes.
• FIG. 16[0071]adepictssecond member134 in combination with a rounded nose lead-inplug135. Lead-inplug135 includes abore137 which can fit snugly overkey148. in this configuration, the lead-inplug135 can be used to assist in the placement of thesecond member134 between spinous processes. Once thesecond member134 is appropriately positioned, the lead-inplug135 can be removed. It is to be understood that the lead-inplug135 can have other shapes such as pyramids and cones to assist in urging apart the spinous processes and soft tissues in order to position thesecond member134.
• Embodiment of FIGS. 18, 19 and[0072]20
• The[0073]implant330 as shown in FIG. 18 is comprised of first andsecond mating wedges332 and334. In order to implant thesewedges332,334, the spinous processes are accessed from both sides and then a tool is used to push the wedges towards each other. As the wedges are urged towards each other, the wedges move relative to each other so that the combined dimension of theimplant330 located between the upper and lowerspinous processes336,338 (FIG. 20), increases, thereby distracting the spinous processes. It is noted that thewedges332,334 includesaddle340,342, which receiving thespinous processes336,338. These saddles have the advantages as described hereinabove.
• The first or[0074]second wedges332,334 have a mating arrangement which includes achannel344 and a projection of346 which can be urged into the channel in order to lock thewedges332,334 together.
• The[0075]channel334 is undercut in order to keep the projection from separating therefrom . Further, as in other devices described herein, a detent can be located in one of the channel and the projection, with a complimentary recess in the other of the channel and the projection. Once these two snap together, the wedges are prevented from sliding relative to the other in thechannel344.
• While the above embodiment was described with respect to wedges, the wedges could also have been designed substantially as cones with all the same features and advantages.[0076]
• Embodiments of FIGS. 21 and 22[0077]
• The[0078]implant370 is comprised of first andsecond distraction cone372,374. These cones are made of a flexible material. The cones are positioned on either side of thespinous processes376,378 as shown in FIG. 21. Using appropriate tool as shown hereinabove, thedistraction cones372,374 are urged together. As they are urged together, the cones distract the spinous processes as shown in FIG. 22. Once this has occurred, an appropriate screw or other type offastening mechanism380 can be used to maintain the position of thedistraction cones372,374. The advantage of this arrangement is that theimplant370 is self-distracting and also that the implant, being flexible, molds about the spinous processes as shown in FIG. 22.
• Embodiments of FIG. 23, 24 and[0079]25
• In FIGS. 23 and 24, another embodiment of the[0080]implant170 is depicted. This implant is guided in place using an L-shapedguide172 which can have a concave cross-section such as thecross-section52 ofretraction tool50 in FIG. 6 in order to cradle and guide theimplant170 in position. Preferably a small incision would be made into the back of the patient and the L-shapedguide tool172 inserted between the adjacent spinous processes. Theimplant170 would be mounted on the end ofinsertion tool174 and urged into position between the spinous processes. The act of urging the implant into position could cause the spinous processes to be further distracted if that is required. Prior to the insertion of the L-shapedguide tool172, a distraction tool such as shown in FIG. 13 could be used to initially distract the spinous processes.
• [0081]Implant170 can be made of a deformable material so that it can be urged into place and so that it can somewhat conform to the shape of the upper and lower spinous processes. This deformable material would be preferably an elastic material. The advantage of such a material would be that the load forces between the implant and the spinous processes would be distributed over a much broader surface area. Further, the implant would mold itself to an irregular spinous process shape in order to locate the implant relative to spinous processes.
• With respect to FIG. 25, this[0082]implant176 can be inserted over a guide wire, guide tool orstylet178. Initially, theguide wire178 is positioned through a small incision to the back of the patient to a position between the adjacent spinous processes. After this has occurred, the implant is threaded over theguide wire178 and urged into position between the spinous processes. This urging can further distract the spinous processes if further distraction is required, Once the implant is in place, theguide tool178 is removed and the incision closed. The insertion tools of FIGS. 23 and 24 can also be used if desired.
• Embodiment of FIGS. 26, 27 and[0083]28
• The embodiment shown in FIGS. 26, 27 and[0084]28 uses an implant similar to that depicted in FIGS. 8 and 9 with different insertion tools. As can be seen in FIG. 26, an L-shapeddistraction tool190 is similar to L-shaped distraction tool80 (FIG. 12), is used to distract the first and secondspinous processes192,194. After this has occurred, aninsertion tool196 is placed between thespinous processes192,194.Insertion tool196 includes ahandle198 to which is mounted a square-shapedring200.
• The[0085]distraction tool190 can be inserted through a small incision in the back in order to spread apart the spinous processes. Through the same incision which has been slightly enlarged laterally, anupper end202 ofring200 can be initially inserted followed by the remainder of thering200. Once the ring is inserted, the ring can be rotated slightly by movinghandle198 downwardly in order to further wedge the spinous processes apart. Once this has been accomplished, an implant such asimplant204 can be inserted through the ring and properly positioned usingimplant handle206. Thereafter, theimplant handle206 and theinsertion tool196 can be removed.
• Embodiments of FIGS. 29, 30,[0086]31,32 and33
• As can be seen in FIGS. 29 and 30, the[0087]implants210,212, can have different shapes when viewed from the side. These implants are similar to the above-referenced implants58 (FIG. 8) and204 (FIG. 28). These implants have cross-sections similar to that shown in FIG. 10 which includes saddles in order to receive and hold the adjacent spinous processes.
• As can be seen in FIGS. 31, 32 and[0088]33, these implants can be placed in different positions with respect to thespinous process214. Preferably as shown in FIG. 33, theimplant210 is placed closest to thelamina216. Being so positioned, theimplant210 is close to the instantaneous axis ofrotation218 of the spinal column, and the implant would experience least forces caused by movement of the spine. Thus, theoretically, this is the optimal location for the implant.
• As can be seen in FIGS. 31 and 32, the implant can be placed midway along the spinous process (FIG. 32) and towards the posterior aspect of the spinous process (FIG. 31). As positioned shown in FIG. 31, the greatest force would be placed on the[0089]implant210 due to a combination of compression and extension of the spinal column.
• Embodiment of FIGS. 34 and 35[0090]
• Another embodiment of the invention is shown in FIGS. 34 and 35. In these figures,[0091]implant220 is comprised of a plurality ofindividual leaves222 which are substantially V-shaped. The leaves include interlocking indentations ordetents224. That is, each leaf includes an indentation with a corresponding protrusion such that a protrusion of one leaf mates with an indentation of an adjacent leaf. Also associated with this embodiment is aninsertion tool226 which has ablunt end228 which conforms to the shape of anindividual leaf222. For insertion of this implant into the space between the spinous processes as shown in FIG. 29, theinsertion tool226 first insert asingle leaf220. After that has occurred, the insertion tool then inserts a second leaf with theprotrusion224 of the second leaf snapping into corresponding indentation made by theprotrusion224 of the first leaf. This process would reoccur with third and subsequent leaves until the appropriate spacing between the spinous processes was built up. As can be seen in FIG. 29, thelateral edges229 of the individual leaves222 are slightly curved upwardly in order to form a saddle for receiving the upper and lower spinous processes.
• Embodiments of FIGS. 36, 37 and[0092]38
• The embodiments of FIGS. 36, 37 and[0093]38 which includeimplants230,232, and234 respectively, are designed in such a manner so the implant locks itself into position once it is properly positioned between the spinous processes.Implant220 is essentially a series of truncated cones and includes a plurality of ever expandingsteps236. These steps are formed by the conical bodies starting with thenose body238 followed there behind byconical body240. Essentially, theimplant234 looks like a fir tree placed on its side.
• The[0094]implant230 is inserted laterally throughout the opening between upper and lower spinous processes. Thefirst body238 causes the initial distraction. Each successive conical body distracts the spinous processes a further incremental amount. When the desired distraction has been reached, the spinous processes are locked into position bysteps236. At this point, if desired, theinitial nose body238 of the implant andother bodies240 can be broken, snapped or sawed off if desired in order to minimize the size of theimplant230. In order for a portion of theimplant230 to be broken or snapped off, the intersection between bodies such asbody238 and240, which isintersection line242, would be somewhat weaken with the appropriate removal of material. It is noted that only the intersection lines of the initial conical bodies need to be so weakened. Thus,intersection line244 between the bodies which remain between the spinous processes would not need to be weaker, as there would be no intention that the implant would be broken off at this point.
• FIG. 37 shows implant[0095]232 positioned between upper and lower spinous processes. This implant is wedge-shaped or triangular shaped in cross-sectioned and includes borepluralities245 and246. Through these bores can be placed lockingpins248 and250. The triangular or wedged-shaped implant can be urged laterally between and thus distract the upper and lower spinous processes. Once the appropriate distraction is reached,pins248,250 can be inserted through the appropriate bores of thebore pluralities245 and246 in order to lock the spinous processes in a V-shaped valley formed bypins248,250 on the one hand and the rampedsurface233,235 on the other hand.
• Turning to FIG. 38, the[0096]implant234 has a triangular-shaped or wedge-shaped body similar to that shown in FIG. 32. In this embodiment,tab252,254 are pivotally mounted to the triangularshaped body234. Once theimplant234 is appropriately positioned in order to distract the spinous processes to the desired amount, thetabs252,254 rotate into position in order to hold theimplant234 in the appropriate position.
• Embodiment of FIGS. 39 and 40[0097]
• In the embodiment of FIGS. 39 and 40,[0098]cannula258 is inserted through a small incision to a position between upper and lower spinous processes. Once the cannula is properly inserted, animplant260 is s pushed through thecannula258 using aninsertion tool262. Theimplant260 includes a plurality of ribs or indentation264 that assist in positioning theimplant260 relative to the upper and lower spinal processes. Once theimplant260 is in position, thecannula258 is withdrawn so that theimplant260 comes in contact with and wedges between the spinous processes. Thecannula258 is somewhat conical in shape with thenose end266 being somewhat smaller than thedistal end268 in order to effect the insertion of the cannula into the space between the spinous processes.
• Further, a plurality of cannula can be used instead of one, with each cannula being slightly bigger than one before. In the method of the invention, the first smaller cannula would be inserted followed by successively larger cannula being placed over the previous smaller cannula. The smaller cannula would then be withdrawn from the center of the larger cannula. Once the largest cannula is in place, and the opening of the skin accordingly expanded, the implant, which is accommodated by only the larger cannula, is inserted through the larger cannula and into position.[0099]
• Embodiments of FIGS. 41, 42 and[0100]43
• The[0101]precurved implant270 in FIGS. 41 and 42, andprecurved implant272 in FIG. 43 have common introduction techniques which includes a guide wire, guide tool, orstylet274. For both embodiments, theguide wire274 is appropriately positioned through the skin of the patient and into the space between the spinous processes. After this is accomplished, the implant is directed over the guide wire and into position between the spinous processes. The precurved nature of the implant assist in (1) positioning the implant through a first small incision in the patient's skin on one side of the space between two spinous processes and (2) guiding the implant toward a second small incision in the patient's skin on the other side of the space between the two spinous processes. With respect to theimplant270, the implant includes aconical introduction nose276 and adistal portion278. As thenose276 is inserted between the spinous processes, this causes distraction of the spinous processes.Break lines280,282 are established at opposite sides of theimplant270. Once the implant is properly positioned over the guide wire between the spinous processes, thenose portion276 and thedistal portion278 can be broken off along the break lines, through the above two incisions, in order to leave theimplant270 in position.
• Although only two[0102]break lines280,282 are depicted, multiple break lines can be provided onimplant270 so that the implant can continue to be fed over theguide wire278 until the appropriate width of theimplant270 creates the desired amount of distraction. As described hereinabove, the break lines can be created by perforating or otherwise weakening theimplant270 so that the appropriate portions can be snapped or sawed off.
• With respect to the[0103]precurved implant272, this implant is similar in design to theimplant230 shown in FIG. 36. Thisimplant272 in FIG. 47, however, is precurved and inserted over aguide wire274 to a position between the spinous processes. As withimplant230 in FIG. 43, once the appropriate level of this distraction has been reached and if desired, sections of theimplant272 can be broken, snapped or sawed off as described hereinabove in order to leave a portion of the implant wedged between the upper and lower spinous processes.
• Embodiment of FIG. 44[0104]
• A further embodiment of the invention is shown in FIG. 44. This embodiment includes a combination insertion tool and[0105]implant290. The insertion tool andimplant290 is in the shape of a ring which is hinged atpoint292. The ring is formed by a first elongated and conically shapedmember294 and a second elongated and conically shapedmember296.Members294 and296 terminate in points and through the use ofhinge292 are aligned and meet. Through similar incisions on both sides of the spinous processes, first member and second member are inserted through the skins of the patient and are mated together between the spinous processes. After this has occurred, theimplant290 is rotated, for example clockwise, so that increasingly widening portions of thefirst member292 are used to distract the first and second spinous processes. When the appropriate level of distraction has occurred, the remainder of the ring before and after the section which is located between the spinous processes can be broken off as taught hereinabove in order to maintain the desired distraction. Alternatively, with a small enough ring, the entire ring can be left in place with the spinous processes distracted.
• Embodiment of FIG. 45[0106]
• In FIG. 45, the[0107]implant300 is comprised of a plurality of rods orstylets302 which are inserted between the upper and lower spinous processes. The rods are designed much as described hereinabove so that they may be broken, snapped or cut off. Once these are inserted and the appropriate distraction has been reached, the stylets are broken off and a segment of each stylet remains in order to maintain distraction of the spinous process.
• Embodiment of FIGS. 46 and 47[0108]
• [0109]Implant310 of FIGS. 46 and 47 is comprised of a shape memory material which coils upon being released. The material is straightened out in adelivery tool312. The delivery tool is in position between upper and lowerspinous processes314,316. The material is then pushed through the delivery tool. As it is released from thedelivery end318 of the delivery tool, the material coils, distracting the spinous processes to the desired amount. Once this distraction has been achieved, the material is cut and the delivery tool removed.
• Embodiments of FIGS. 48, 49,[0110]50 and51
• As can be seen in FIG. 48, the[0111]implant320 is delivered between upper and lowerspinous processes322 and324, bydelivery tool326. Once theimplant320 is in place between the spinous processes, the delivery tool is given a 90° twist so that the implant goes from the orientation as shown in FIG. 49, with longest dimension substantially perpendicular to the spinous processes, to the orientation shown in FIG. 50 where the longest dimension is in line with and parallel to the spinous processes. This rotation causes the desired distraction between the spinous processes.Implant320 includes opposedrecesses321 and323 located at the ends thereof. Rotation of theimplant320 causes the spinous processes to become lodged in these recesses.
• Alternatively, the[0112]insertion tool326 can be used to insertmultiple implants320,321 into the space between thespinous processes322,324 (FIG. 51).Multiple implants320,321 can be inserted until the appropriate amount of distraction is built up. It is to be understood in this situation that one implant would lock to another implant by use of, for example, a channel arrangement wherein a projection from one of the implants would be received into and locked into a channel of the other implant. Such a channel arrangement is depicted with respect to the other embodiment.
• Embodiment of FIGS. 52, 53,[0113]54,55aand55b
• The embodiment of FIGS. 52 through 55[0114]bis comprised of a fluid-filleddynamic distraction implant350. This implant includes amembrane352 which is placed overpre-bent insertion rod354 and then inserted through an incision on one side of thespinous process356. The bent insertion rod, with theimplant350 thereover, is guided between appropriate spinous processes. After this occurs, theinsertion rod354 is removed leaving the flexible implant in place. Theimplant350 is then connected to a source of fluid (gas, liquid, gel and the like) and the fluid is forced into the implant causing it to expand as shown in FIG. 54, distracting the spinal processes to the desired amount. Once the desired amount of distraction has occurred, theimplant350 is closed off as is shown in FIG. 55a. Theimplant350 being flexible, can mold to the spinous processes which may be of irregular shape, thus assuring positioning. Further, implant350 acts as a shock absorber, damping forces and stresses between the implant and the spinous processes.
• A variety of materials can be used to make the implant and the fluid which is forced into the implant. By way of example only, viscoelastic substances such as methylcellulose, or hyaluronic acid can be used to fill the implant. Further, materials which are initially a fluid, but later solidify, can be inserted in order to cause the necessary distraction. As the materials solidify, they mold into a custom shape about the spinous processes and accordingly are held in position at least with respect to one of two adjacent spinous processes. Thus, it can be appreciated that using this embodiment and appropriate insertion tools the implant can be formed about one spinous process in such a manner that the implant stays positioned with respect to that spinous process (FIG. 55[0115]b). With such an embodiment, a single implant can be used as an extension stop for spinous process located on either side, without restricting flexion of the spinal column.
• It is to be understood that many of the other implants disclosed herein can be modified so that they receive a fluid in order to establish and maintain a desired distraction much in the manner as[0116]implant350 receives a fluid.
• Embodiment of FIGS. 56, 57 and[0117]58
• The[0118]implant360 as shown in FIG. 56 is comprised of a shape memory material such as a plastic or a metal. A curvedintroductory tool362 is positioned between the appropriate spinous processes as described hereinabove. Once this has occurred, bore364 of the implant is received over the tool. This act can cause the implant to straighten out. The implant is then urged into position and thereby distracts the spinous processes. When this has occurred, theinsertion tool362 is removed, allowing the implant to assume its pre-straightened configuration and is thereby secured about one of the spinous processes. Such an arrangement allows for an implant that is an extension stop and does not inhibit flexion of the spinous column. Alternatively, the implant can be temperature sensitive. That is to say that the implant would be more straightened initially, but become more curved when it was warmed by the temperature of the patient's body.
• Embodiments of FIGS. 59 and 60[0119]
• In this embodiment, the[0120]implant380 is comprised of a plurality of interlocking leaves382. Initially, a first leaf is positioned between opposedspinous processes384,386. Then subsequently,leafs382 are interposed between the spinous processes until the desired distraction has been built up. The leaves are somewhat spring-like in order to absorb the shock and can somewhat conform to the spinous processes.
• Embodiment of FIG. 61[0121]
• The[0122]implant390 of FIG. 61 includes the placement ofshields392,394 over adjacentspinous processes396,398. The shields are used to prevent damage to the spinous processes. These shields include apertures which receives a self-tappingscrew400,402. In practice, the shields are affixed to the spinous processes and the spinous processes are distracted in the appropriate amount. Once this has occurred, arod404 is used to hold the distracted position by being screwed into each of the spinous processes through the aperture in the shields using the screws as depicted in FIG. 61.
• Embodiment of FIGS. 62 and 63[0123]
• [0124]Implant410 of FIGS. 62, 63 is comprised of first andsecond members412,414 which can be mated together using an appropriate screw and threaded bore arrangement to form theimplant410.Main member412 andmating member414form implant410. Accordingly, theimplant410 would have a plurality ofmembers414 for use with a standardizedfirst member412. FIGS. 62 and 64 show different types ofmating members414. In FIG. 62, themating member414 includesprojections416 and418 which act like shims. These projections are used to project into the space ofsaddles420,422 of thefirst member412. Theseprojections416,418 can be of varying lengths in order to accommodate different sizes of spinous processes Agroove424 is placed between theprojections416,418 and mates with anextension426 of thefirst member412.
• As shown in FIG. 63, the projections of the embodiment shown in FIG. 62 are removed and recesses[0125]428,430 are substituted therefor. These recesses expand the area of thesaddles420,422 in order to accommodate larger spinous processes.
• Embodiment of FIGS. 64, 65 and[0126]66
• The embodiments of FIGS. 64, 65 and[0127]66 are similar in design and concept to the embodiment of FIGS. 62 and 63. In FIG. 64, theimplant500 includes the first andsecond members502,504. These members can be secured together with appropriate screws or other fastening means as taught in other embodiments.Implant500 includes first andsecond saddles506,508 which are formed between the ends of first andsecond members502,504. Thesesaddles506,508 are used to receive and cradle the adjacent spinous processes. As can be seen in FIG. 64, eachsaddle506,508 is defined by a single projection orleg510,512, which extends from the appropriate first andsecond members502,504. Unlike the embodiment found in FIGS. 62 and 63, each of the saddles is defined by only a single leg as the ligaments and other tissues associated with the spinous processes can be used to ensure that the implant is held in an appropriate position. With the configuration of FIG. 64, it is easier to position the implant relative to the spinous processes as each saddle is defined by only a single leg and thus the first and second members can be more easily worked into position between the various tissues.
• In the embodiment of FIG. 65, the[0128]implant520 is comprised of a singlepiece having saddles522 and524. The saddles are defined by asingle leg526,528 respectively. In order for thisimplant520 to be positioned between the spinous processes, an incision is made between lateral sides of adjacent spinous processes. Thesingle leg526 is directed through the incision to a position adjacent to an opposite lateral side of the spinous process with the spinous process cradled in thesaddle522. The spinous processes are then urged apart untilsaddle524 can be pivoted into position into engagement with the other spinous process in order to maintain the distraction between the two adjacent spinous processes.
• The embodiment of FIG. 66 is similar to that of FIG. 65 with an[0129]implant530 and first andsecond saddles532 and534. Associated with each saddle is atether536,538 respectively. The tethers are made of flexible materials known in the trade and industry and are positioned through bores in theimplant530. Once appropriately positioned, the tethers can be tied off. It is to be understood that the tethers are not meant to be used to immobilize one spinous process relative to the other, but are used to guide motion of the spinous processes relative to each other so that theimplant530 can be used as an extension stop and a flexion non-inhibitor. In other words, thesaddles532,534 are used to stop spinal column backward bending and extension. However, the tethers do not inhibit forward bending and spinal column flexion.
• Embodiments of FIGS. 67, 68[0130]
• The[0131]implant550 is Z-shaped and includes acentral body552 and first andsecond arms554,556, extending in opposite directions therefrom. Thecentral body552 of theimplant550 includes first andsecond saddles558 and560. The first andsecond saddles558 and560 would receive upper and lowerspinous processes562,568. Thearms554,556 are accordingly located adjacent the distal end566 (FIG. 68) of thecentral body552. The first andsecond arms554,556, act to inhibit forward movement, migration or slippage of theimplant550 toward the spinal canal and keep the implant in place relative to the first and second spinal processes. This prevents the implant from pressing down on the ligamentum flavum and the dura. In a preferred embodiment, the central body would have a height of about 10 mm with each of thearms554,556 have a height of also about 10 mm. Depending on the patient, the height of the body could vary from about less than 10 mm to about greater than 24 mm. As can be seen in FIGS. 67 and 68, the first andsecond arms554,556 are additionally contoured in order to accept the upper and lowerspinous processes556,558. In particular, thearms554,556 as can be seen with respect toarm554 have a slightly outwardly bowed portion568 (FIG. 68) with adistal end570 which is slightly inwardly bowed. This configuration allows the arm to fit about the spinous process with thedistal end570 somewhat urged against the spinous process in order to guide the motion of the spinous process relative to the implant. Thesearms554,556 could if desired to be made more flexible than thecentral body552 by makingarms554,556 thin and/or with perforations, and/or other material different than that of thecentral body550. As with the last embodiment, this embodiment can be urged into position between adjacent spinous processes by directing an arm into a lateral incision so that thecentral body552 can be finally positioned between spinous processes.
• Embodiment of FIGS. 69, 70,[0132]71 and71a
• FIGS. 69, 70 and[0133]71 are perspective front, end, and side views ofimplant580 of the invention. This implant includes acentral body582 which has first andsecond saddles584,586 for receiving adjacent spinous processes. Additionally, theimplant580 includes first andsecond arms588 and590. The arms, as with the past embodiment, prevent forward migration or slippage of the implant toward the spinal canal.First arm588 projects outwardly from thefirst saddle584 andsecond arm590 projects outwardly from thesecond saddle586. In a preferred embodiment, thefirst arm588 is located adjacent to thedistal end600 of thecentral body582 and proceeds only partly along the length of thecentral body582. Thefirst arm588 is substantially perpendicular to the central body as shown in FIG. 70. Further, thefirst arm588, as well as thesecond arm590, is anatomically rounded.
• The[0134]second arm590, projecting fromsecond saddle586, is located somewhat rearward of thedistal end600, and extends partially along the length of thecentral body582. Thesecond arm590 projects at a compound angle from thecentral body582. As can be seen in FIGS. 70 and 71, thesecond arm590 is shown to be at about an angle of 45° from the saddle586 (FIG. 70). Additionally, thesecond arm590 is at an angle of about 45° relative to the length of thecentral body580 as shown in FIG. 71. It is to be understood that other compound angles are within the spirit and scope of the invention as claimed.
• In a preferred embodiment, the first and[0135]second arms588,590 have a length which is about the same as the width of thecentral body582. Preferably, the length of each arm is about 10 mm and the width of the central body is about 10 mm. However, the bodies with the widths of 24 mm and greater are within the spirit and scope of the invention, along with first and second arms ranging from about 10 mm to greater than about 24 mm. Further, it is contemplated that the embodiment could include a central body having a width of about or greater than 24 mm with arms being at about 10 mm.
• It is to be understood that the embodiment of FIGS. 69, 70 and[0136]71 as well as the embodiment of FIGS. 67 and 68 are designed to preferably be positioned between the L4-L5 and the L5-S1 vertebral pairs. The embodiment of FIGS. 69, 70,71 is particularly designed for the L5-S1 position with the arms being designed to conform to the sloping surfaces found therebetween. The first and second arms are thus contoured so that they lie flat against the lamina of the vertebra which has a slight angle.
• The embodiment of FIG. 69, 70, and[0137]71 as with the embodiment of FIGS. 67 and 68 is Z-shaped in configuration so that it may be inserted from one lateral side to a position between adjacent spinous processes. A first arm, followed by the central body, is guided through the space between the spinous processes. Such an arrangement only requires that a incision on one side of the spinous process be made in order to successfully implant the device between the two spinous processes.
• The[0138]implant610 of FIG. 71ais similar to that immediately above with thefirst arm612 located on the same side of the implant as thesecond arm614. The first andsecond saddle616,618 are slightly modified in thatdistal portion620,622 are somewhat flattened from the normal saddle shape in order to allow the implant to be positioned between the spinous processes from one side. Once in position, the ligaments and tissues associated with the spinous processes would hold the implant into position. Tethers also could be used if desired.
• Embodiment of FIGS. 72, 73[0139]
• [0140]Implant630 is also designed so that it can be inserted from one side of adjacent spinous processes. Thisinsert630 includes acentral body632 with the first andsecond arms634,636 extending on either side thereof. As can be seen in FIG. 72, aplunger638 is positioned to extend from an end of thecentral body632. As shown in FIG. 72, theplunger638 is fully extended and as shown in FIG. 73, theplunger638 is received within thecentral body632 of theimplant630. With the plunger received into theimplant632, the third and fourth arms or hooks640,642 can extend outwardly from thecentral body632. The third and fourth arms or hooks640,642 can be comprised of a variety of materials, such as for example, shape memory metal materials or materials which have a springy quality.
• For purposes of positioning the[0141]implant630 between adjacent spinous processes, theplunger638 is pulled outwardly as shown in FIG. 72. Thecentral body632 is then positioned between adjacent spinous processes and theplunger638 is allowed to move to the position of FIG. 73 so that the third andfourth arms640,642 can project outwardly from thecentral body632 in order to hold theimplant630 in position between the spinous processes.
• [0142]Plunger638 can be spring biased to the position as shown in FIG. 73 or can include detents or other mechanisms which lock it into that position. Further, the third and fourth arms themselves, as deployed, can keep the plunger in the position as shown in FIG. 73.
• Embodiments of FIGS. 74, 75,[0143]76,77, and78
• Other embodiments of the invention are shown in FIGS. 74 through 78. FIGS. 74, 75 and[0144]76disclose implant700.Implant700 is particularly suited for implantation between the L4-L5 and L5-S1 vertebra. As can be seen in FIG. 74, theimplant700 includes acentral body702 which has abore704 provided therein.Bore704 is used in order to adjust the modulus of elasticity of the implant so that it is preferably approximately two times the anatomical load placed on the vertebra in extension. In other words, theimplant700 is approximately two times stiffer than the normal load placed on the implant. Such an arrangement is made in order to ensure that the implant is somewhat flexible in order to reduce potential resorption of the bone adjacent to the implant. Other modulus values can be used and be within the spirit of the invention.
• [0145]Implant700 includes first andsecond saddle706,708 which are used to receive and spread the load from the upper and lower spinous processes. Thesaddle706 is defined by first andsecond arms710 and712. Thesecond saddle708 is defined by third andfourth arms714 and716. As can be seen in FIG. 74, thefirst arm710, in a preferred embodiment, is approximately two times the length of thebody702 with the second arm being approximately less than a quarter length of the body.Third arm714 is approximately one times the length of thebody702 with thefourth arm716 being, in this preferred embodiment, approximately one and a half times the length of thebody702. The arms are designed in such a way that the implant (1) can be easily and conveniently inserted between the adjacent spinous processes, (2) will not migrate forwardly toward the spinal canal, and (3) will hold its position through flexion and extension as well as lateral bending of the spinal column.
• [0146]First arm710 is in addition designed to accommodate the shape of the vertebra. As can be seen in FIG. 74, thefirst arm710 becomes narrower as it extends away from thebody702. Thefirst arm710 includes a slopingportion718 followed by asmall recess720 ending in arounded portion722 adjacent to theend724. This design is provided to accommodate the anatomical form of for example the L4 vertebra. It is to be understood that these vertebra have a number of surfaces at roughly 30° angles and that the sloping surfaces of this embodiment and the embodiments shown in FIGS. 77 and 78 are designed to accommodate these surfaces. These embodiments can be further modified in order to accommodate other angles and shapes.
• The[0147]second arm712 is small so that it is easy to insert between the spinous processes, yet still define thesaddle706. The fourth arm TO716 is larger than thethird arm714, both of which are smaller than thefirst arm710. The third and fourth arms are designed so that they define thesaddle706, guide the spinous processes relative to theimplant700 during movement of the spinal column, and yet are of a size which makes the implant easy to position between the spinous processes.
• The procedure, by way of example only, for implanting the[0148]implant700 can be to make an incision laterally between two spinous processes and then initially insertfirst arm710 between the spinous processes. The implant and/or appropriate tools would be used to distract the spinous processes allowing thethird leg714 and thecentral body702 to fit through the space between the spinous processes. Thethird leg714 would then come to rest adjacent the lower spinous processes on the opposite side with the spinous processes resting in the first andsecond saddle706,708. The longerfourth leg716 would then assist in the positioning of theimplant700.
• FIG. 77 includes an[0149]implant740 which is similar toimplant700 and thus have similar numbering. Thesaddle706,708 ofimplant740 have been cantered or sloped in order to accommodate the bone structure between, by way of example, the L4-L5 and the L5-S1 vertebra. As indicated above, the vertebra in this area have a number of sloping surfaces in the range of about 30°. Accordingly,saddle706 is sloped at less than309 and preferably about 20° whilesaddle708 is sloped at about 30° and preferably more than 30°.
• The[0150]implant760 as shown in FIG. 78 is similar toimplant700 in FIG. 74 and is similarly numbered.Implant760 includes third andfourth legs714,716 which have slopingportions762,764 which slope toward ends766,768 of third andfourth arm714,716 respectively. The sloping portions accommodate the form of the lower vertebra against which they are positioned. In the preferred embodiment, the sloping portions are of about 30°. However, it is to be understood that sloping portions which are substantially greater and substantially less than 30° can be included and be within the spirit and scope of the invention.
• Embodiment of FIG. 79, 80,[0151]80a,81,82,83,83a,84,8586 and87
• Another embodiment of the invention is shown in FIGS.[0152]79-87 and includes implant800 (FIG. 86).Implant800 includes adistracting unit802 which is shown in left side, plan, and right side views of FIGS. 79, 80 and81. A perspective view of the distraction unit is shown in FIG. 84. The distracting unit as can be seen in FIG. 80 includes adistracting body804, withlongitudinal axis805, whichbody804 has agroove806 and a rounded orbulbous end808 which assist in the placement of the distracting body between adjacent spinous process so that an appropriate amount of distraction can be accomplished. Extending from thedistracting body804 is afirst wing810 which in FIG. 80 is substantially perpendicular to thedistracting body804. Such wings which are not perpendicular to the body are within the spirit and scope of the inventionFirst wing810 includes aupper portion812 and alower portion814. The upper portion810 (FIGS. 79) includes arounded end816 and asmall recess818. Therounded end816 and thesmall recess818 in the preferred embodiment are designed to accommodate the anatomical form or contour of the L4 (for a L4-L5 placement) or L5 (for a L5-S1 placement) superior lamina of the vertebra. It is to be understood that the same shape or variations of this shape can be used to accommodate other lamina of any vertebra. Thelower portion814 is also rounded in order to accommodate in the preferred embodiment in order to accommodate the vertebrae. The distracting unit further includes a threadedbore820 which in this embodiment accepts a set screw822 (FIG. 86) in order to hold a second wing824 (FIGS. 82, 83) in position as will be discussed hereinbelow. The threaded bore820 in this embodiment slopes at approximately 45° angle and intersects theslot806. With thesecond wing824 in position, theset screw822 when it is positioned in the threadedbore820 can engage and hold thesecond wing824 in position in theslot806.
• Turning to FIGS. 82, 83 and[0153]85, left side, plan and perspective views of thesecond wing824 are depicted. Thesecond wing824 is similar in design to the first wing. The second wing includes anupper portion826 and alower portion828. The upper portion includes arounded end830 and asmall recess832. In addition, thesecond wing824 includes aslot834 which mates with theslot806 of thedistracting unit802. Thesecond wing824 is the retaining unit of the present embodiment.
• As can be seen in FIG. 83 and[0154]86, the second wing or retainingunit824 includes theupper portion826 having a first width “a” and thelower portion828 having a second width “b”. In the preferred embodiment, the second width “b” is larger than first width “a” due to the anatomical form or contour of the L4-L5 or L5-S1 laminae. As can be seen in FIG. 83ain second wing or retainingunit824, the widths “a” and “b” would be increased in order to, as described hereinbelow, accommodate spinous processes and other anatomical forms or contours which are of different dimensions. Further, as appropriate, width “a” can be larger than width “b”. Thus, as will be described more fully hereinbelow, the implant can include a universally-shapeddistracting unit802 with a plurality of retainingunits824, with each of the retaining units having different widths “a” and “b”. During surgery, the appropriatelysized retaining unit824, width with the appropriate dimensions “a” and “b” can be selected to match to the anatomical form of the patient.
• FIG. 86 depicts an assembled[0155]implant800 positioned adjacent to upper andlower laminae836,838 (which are shown in dotted lines) of the upper and lower vertebrae. Thevertebrae836,838 are essentially below theimplant800 as shown in FIG. 86. Extending upwardly from thevertebrae836,838, and between the first andsecond wings810,824, are the upper and lowerspinous processes840,842. It is to be understood that in a preferred embodiment, the fit of the implant between the spinous processes can be such tha the wings do not touch the spinous processes, as shown in FIG. 86, and be within the spirit and scope of the invention.
• The[0156]implant800 includes, as assembled, anupper saddle844 and thelower saddle846. Theupper saddle844 has an upper width identified by the dimension “UW”. Thelower saddle846 has a lower width identified by the dimension “LW”. In a preferred embodiment, the upper width is greater than the lower width. In other embodiments, the “UW” can be smaller than the “LW” depending on the anatomical requirements. The height between the upper andlower saddles844,846 is identified by the letter “h”. These dimensions are carried over into FIG. 87 which is a schematic representation of the substantially trapezoidal shape which is formed between the upper and lower saddles. The table below gives sets of dimensions for the upper width, lower width, and height as shown in FIG. 87. This table includes dimensions for some variations of this embodiment.

  	TABLE
  	Variation

  	1	2	3

  	Upper Width	8	7	6
  	Lower Width	7	6	5
  	Height	10	9	8

• For the above table, all dimensions are given in millimeters.[0157]
• For purposes of surgical implantation of the[0158]implant800 into a patient, the patient is preferably positioned on his side (arrow841 points up from an operating table) and placed in a flexed (tucked) position in order to distract the upper and lower vertebrae.
• In a preferred procedure, a small incision is made on the midline of the spinous processes. The spinous processes are spread apart or distracted with a spreader. The incision is spread downwardly toward the table, and the[0159]distracting unit802 is preferably inserted upwardly between thespinous processes840 and842 in a manner that maintains the distraction of spinous processes. Thedistracting unit802 is urged upwardly until the distracting orbulbous end808 and theslot806 are visible on the other wide of the spinous process. Once this is visible, the incision is spread upwardly away from the table and the retaining unit orsecond wing824 is inserted into theslot806 and thescrew822 is used to secure the second wing in position. After this had occurred, the incisions can be closed.
• An alternative surgical approach requires that small incisions be made on either side of the space located between the spinous processes. The spinous processes are spread apart or distracted using a spreader placed through the upper incision. From the lower incision, the[0160]distracting unit802 is preferably inserted upwardly between thespinous processes840 and842 in a manner that urges the spinous processes apart. Thedistracting unit802 is urged upwardly until the distracting orbulbous end808 and theslot806 are visible through the second small incision in the patient's back. Once this is visible, the retaining unit orsecond wing824 is inserted into theslot806 and thescrew822 is used to secure the second wing in position. After this has occurred, the incisions can be closed.
• The advantage of either of the above present surgical procedures is that a surgeon is able to observe the entire operation, where he can look directly down onto the spinous processes as opposed to having to view the procedure from positions which are to the right and to the left of the spinous processes. Generally, the incision is as small as possible and the surgeon is working in a bloody and slippery environment. Thus, an implant that can be positioned directly in front of a surgeon is easier to insert and assemble than an implant which requires the surgeon to shift from side to side. Accordingly, a top-down approach, as an approach along a position to anterior line is preferred so that all aspects of the implantation procedure are fully visible to the surgeon at all times. This aides in the efficient location of (i) the distracting unit between the spinous processes, (ii) the retaining unit in the distracting unit, and (iii) finally the set screw in the distracting unit. FIG. 80[0161]ashows an alternative embodiment of thedistracting unit802a. Thisdistracting unit802ais similar todistracting unit802 in FIG. 80 with the exception that thebulbous end808ais removable from the rest of thedistracting body804aas it is screwed into the threadedbore809. Thebulbous end808ais removed once thedistracting unit802ais positioned in the patient in accordance with the description associated with FIG. 86. Thebulbous end808acan extend past the threadedbore820 by about 1 cm in a preferred embodiment.
• Embodiment of FIGS. 88, 89,[0162]90 and91
• Another embodiment of the invention is shown in FIGS. 88, 89,[0163]90 and91. In this embodiment, the implant is identified by thenumber900. Other elements ofimplant900 which are similar toimplant800 are similarly numbered but in the900 series. For example, the distracting unit is identified by thenumber902 and this is in parallel with thedistracting unit802 of theimplant800. The distracting body is identified by thenumber904 in parallel with thedistracting body804 of theimplant800. Focusing on FIG. 90, thedistracting unit902 is depicted in a perspective view. The distracting unit includesslot906 which is wider at the top than at the bottom. The reason for this is that the wider upper portion of theslot906, which is wider than the second wing924 (FIG. 89), is used to allow the surgeon to easily place thesecond wing924 into theslot906 and allow the wedge-shapedslot906 to guide thesecond wing924 to its final resting position. As can be see in FIG. 91, in the final resting position, the largest portion of theslot906 is not completely filled by thesecond wing924.
• The[0164]end908 ofimplant900 is diferent in that it is more pointed, havingsides909 and911 which are provided at about 45° angles (other angles, such as by way of example only, from about 30° to about 60° are within the spirit of the invention), with a smallflat tip913 so that thebody904 can be more easily urged between the spinous processes.
• The[0165]distracting unit902 further includes a tongue-shapedrecess919 which extends from theslot906. Located in the tongue-shaped recess is a threadedbore920.
• As can be seen in FIG. 89, a[0166]second wing924 includes atongue948 which extends substantially perpendicular thereto and between the upper andlower portions926,928. Thetab948 includes abore950. With thesecond wing924 positioned in theslot906 of thedistracting unit902 andtab948 positioned inrecess919, a threadedset screw922 can be positioned through thebore950 and engage the threaded bore920 in order to secure the second wing or retainingunit924 to thedistracting unit902. Theembodiment900 is implanted in the same manner asembodiment800 previously described. In addition, as thebore922 is substantially perpendicular to the distracting body904 (and not provided at an acute angle thereto), the surgeon can even more easily secure the screw in place from a position directly behind the spinous processes.
• Industrial Applicability[0167]
• From the above, it is evident that the present invention can be used to relieve pain caused by spinal stenosis in the form of, by way of example only, central canal stenosis or foraminal (lateral) stenosis. These implants have the ability to flatten the natural curvature of the spine and open the neural foramen and the spacing between adjacent vertebra to relieve problems associated with the above-mentioned lateral and central stenosis. Additionally, the invention can be used to relieve pain associated with facet arthropathy. The present invention is minimally invasive and can be used on an outpatient basis.[0168]
• Additional aspects, objects and advantages of the invention can be obtained through a review of the appendant claims and figures. it is to be understood that other embodiments can be fabricated and come within the spirit and scope of the claims.[0169]

Claims (40)

We claim:

1. An implant for relieving pain associated with the spinal column which is positionable between adjacent spinous processes of the spinal column, comprising:

a first unit including a guide and a first wing;

a second wing;

said body including a groove that can receive said second wing, said body adapted for positioning between the adjacent spinous processes, with the first wing positionable along side the adjacent spinous processes and the second wing positionable along side the spinous processes and opposite to the first wing; and

a device that secures the second wing to the guide.

2. The implant of

claim 1

wherein:

said first wing has upper and lower portions;

said second wing has upper and lower portions;

an upper saddle is defined among the body and the upper portions of the first and second wings;

a lower saddle is defined among the body and the lower portions of the first and second wing;

wherein the upper width of the upper saddle is defined between the upper portions of the first and second wings;

wherein the lower width of the lower saddle is defined between the lower portions of the first and second wings;

the implant comprising multiple second wings with each second wing having said lower portion of a different thickness; and

wherein the lower width can be selected by choosing said second wing with said lower portion of the desired thickness.

3. The implant of

claim 2

wherein:

each second wing has said upper portion with a different thickness; and

wherein the upper width can be selected by choosing said second wing with said upper portion of the desired thickness.

4. The implant of

claim 1

wherein:

said first wing has upper and lower portions;

said second wing has upper and lower portions;

an upper saddle is defined among the body and the upper portions of the first and second wings;

a lower saddle is defined among the body and the lower portions of the first and second wing;

wherein the upper width of the upper saddle is defined between the upper portions of the first and second wings;

wherein the lower width of the lower saddle is defined between the lower portions of the first and second wings;

the implant comprising multiple second wings with each second wing having said upper portion of a different thickness; and

wherein the upper width can be selected by choosing said second wing with said portion of the desired thickness.

5. The implant of

claim 1

wherein:

at least one of said first wing and said second wing include a recess in order to accommodate the anatomical form of the vertebrae.

6. The implant of

claim 1

wherein:

said first wing has upper and lower portions;

said second wing has upper and lower portions; and

at least one upper portion has a recess in order to accommodate the anatomical form of the vertebrae.

7. The implant of

claim 1

wherein the spinous processes of the spinal column extend from respective vertebral bodies and wherein:

at least one of the first and the second wings has an upper portion;

said upper portion has a recess in order to accommodate the anatomical form of the spinal column; and

wherein said recess is located adjacent to laminae of the vertebrae.

8. The implant of

claim 1

wherein:

said groove is wider at the top than the bottom in order to assist the seating of the second wing in the groove.

9. The implant of

claim 1

wherein:

said body has an end that is located distally from the first wing; and

wherein said end is bulbous.

10. The implant of

claim 1

wherein:

said body has an end that is located distally from the first wing; and

wherein said end is shaped in a manner that assists in the placement of the body between adjacent spinous processes.

11. The implant of

claim 1

wherein:

said body has an end that is located distally from the first wing; and

wherein said end is pointed.

12. The implant of

claim 1

wherein:

said body has an end that is located distally from the first wing; and

wherein said end has first and second sides that are provided at an angle of about 30° to about 60° from a longitudinal axis of the body.

13. The implant of

claim 1

wherein:

said device includes a bore in said body which is provided at an acute angle to the body.

14. The implant of

claim 1

wherein:

said device includes a bore in said body which is provided at about perpendicular to the body.

15. The implant of

claim 1

wherein:

said device includes a first bore in the body;

said second wing has tab extending therefrom, which tab includes a second bore there through;

wherein with said second wing is received in said groove of said body said first and second bores are aligned; and

said device includes a member that is positioned through the first and the second bores in order to secure the second wing to the body.

16. The implant of

claim 10

wherein:

said end is removable from said body.

17. An implant for relieving pain associated with the spinal column which is positionable between adjacent spinous processes of the spinal column, comprising:

a first unit including a guide and a first wing;

a second wing;

said body including a means for engaging said second wing along a direction from an posterior position along a line toward an anterior position, said body adapted for positioning between the adjacent spinous processes, with the first wing positionable along side the adjacent spinous processes and the second wing positionable along side the spinous processes and opposite to the first wing; and

said engaging means is operable along a direction from an posterior position along a line toward an anterior position.

18. The implant of

claim 1

which does not limit flexion of the spinal column while limiting extension of the spinal column.

19. The implant of

claim 17

which does not limit flexion of the spinal column while limiting extension of the spinal column.

20. The implant of

claim 15

wherein:

said body includes a recess that can receive said tab of said second wing.

21. The implant of

claim 1

wherein:

said first wing has upper and lower portions;

said second wing has upper and lower portions;

an upper saddle is defined among the body and the upper portions of the first and second wings;

a lower saddle is defined among the body and the lower portions of the first and second wing;

wherein the upper width of the upper saddle is defined between the upper portions of the first and second wings;

wherein the lower width of the lower saddle is defined between the lower portions of the first and second wings; and

wherein at least one of the upper width and the lower width is wider than a spinous process around which the implant is positioned.

22. An implant for relieving pain associated with the spinal column which implant is positionable between adjacent spinous processes of the spinal column, comprising:

a distracting unit including a body and a first wing;

a retaining unit including a second wing and a tab extending from said second wing; said distracting unit defining a groove for receiving at least a portion of said second wing and said distraction unit also defining a recess for receiving said tab;

said body including a first bore;

said tab including a second bore;

said first and second bores being alignable with the second wing received in said groove; and

a device that is positionable through the first and second bores in order to secure the retaining unit to the distraction unit.

23. The implant of

claim 22

wherein:

said first bore is threaded; and said device is a screw.

24. The implant of

claim 22

:

wherein said first and second bores are alignable along a line extending from a posterior position toward an anterior position relative to the spinal column.

25. A method of relieving pain due to the development of spinal stenosis and the like in the spinal column including the steps of:

accessing adjacent first and second spinous processes of the spinal column;

implanting a distracting unit between the spinous processes, which distracting unit has (1) a body that can maintain a distraction between the first and second spinous processes and (2) a wing which extends from said body along the spinous processes; and

securing a retaining unit to the distracting unit along a line which is from a posterior position to an anterior position.

26. The method of

claim 25

wherein the securing step includes:

positioning the retaining unit in the distracting unit along a line which is from a posterior position to an anterior position.

27. The method of

claim 25

wherein the securing step includes:

positioning a screw through the retaining unit and the distracting unit along a line which from a posterior position to an anterior position in order to secure the retaining unit to the distracting unit.

28. The method of

claim 26

wherein the securing step includes:

positioning a screw through the retaining unit and the distracting unit along a line which from a posterior position to an anterior position in order to secure the retaining unit to the distracting unit.

29. The method of

claim 25

wherein said first and second wings have first and second planes respectively, and the method includes positioning said second wing relative to the first wing by moving the second wing such that the second plane of the second wing remains substantially parallel to the first plane of the first wing as the second wing is moved into engagement with the distracting unit.

30. The method of

claim 30

wherein the second wing is secured to the first wing with a fastener which moved along a line that is substantially parallel to the second plane of the second wing in order to secure the retaining unit to the distracting unit.

31. The method of

claim 25

including the step of:

distracting the first and second spinous processes apart prior to inserting the distracting unit between the first and second spinous processes.

32. The method of claim of25 wherein:

said inserting step includes using the distracting unit to distract the first and the second spinous processes as the distracting unit is inserted between the first and the second spinous processes.

33. The implant of

claim 1

wherein:

said first wing has upper and lower portions;

said second wing has upper and lower portions;

an upper saddle is defined among the body and the upper portions of the first and second wings;

a lower saddle is defined among the body and the lower portions of the first and second wing;

wherein the upper width of the upper saddle is defined between the upper portions of the first and second wings;

wherein the lower width of the lower saddle is defined between the lower portions of the first and second wings;

there is a height between the upper and the lower saddles; and

wherein the upper width is from about 6 mm to about 8 mm, with the lower width being from about 5 mm to about 7 mm and the height is from about 8 mm to about 10 mm.

34. The implant of

claim 1

wherein:

said first wing has upper and lower portions;

said second wing has upper and lower portions;

an upper saddle is defined among the body and the upper portions of the first and second wings;

a lower saddle is defined among the body and the lower portions of the first and second wing;

wherein the upper width of the upper saddle is defined between the upper portions of the first and second wings;

wherein the lower width of the lower saddle is defined between the lower portions of the first and second wings; and

there is a height between the upper and the lower saddles; and

wherein a trapezoidal shape is defined between the upper width, the lower width and the height.

35. The implant of

claim 1

wherein:

said first wing has upper and lower portions;

said second wing has upper and lower portions;

an upper saddle is defined among the body and the upper portions of the first and second wings;

a lower saddle is defined among the body and the lower portions of the first and second wing;

wherein the upper width of the upper saddle is defined between the upper portions of the first and second wings;

wherein the lower width of the lower saddle is defined between the lower portions of the first and second wings;

there is a height between the upper and the lower saddles; and

the implant has at least one of the following combinations of dimensions:

(a) an upper width of about 6 mm, a lower width of about 5 mm and a height of about 8 mm;

(b) an upper width of about 7 mm, a lower width of about 6 mm and a height of about 9 mm; and

(c) an upper width of about 8 mm, a lower width of about 7 mm and a height of about 1 mm.

36. The implant of

claim 1

wherein:

a portion of said body located between the first and second wings defines a trapezoidal shape.

37. An implant for relieving pain associated with the spinal column which implant is positionable between adjacent spinous processes of the spinal column, comprising:

a distracting unit including a body and a first wing;

a retaining unit including a second wing which is securable to the body;

the first and second wings having upper portions and lower portions respectively;

the upper portions of the first and second wings and the portion of the body located there between defining an upper saddle;

the lower portions of the first and second wings and the portion of the body located there between defining a lower saddle; and

the portion of the body located between the first and the second saddles defining a trapezoidal shape.

38. An implant for relieving pain associated with the spinal column which implant is positionable between adjacent spinous processes of the spinal column, comprising:

a distracting unit including a body;

a retaining unit which is securable to the body;

said distracting unit and the retaining unit together defining a first saddle and a second saddle, each saddle adapted for receiving a spinous process; and

wherein the first saddle has a first width and the second saddle has a second width and wherein the first width is different from the second width.

39. The implant of

claim 38

wherein:

said first saddle is for receiving an upper spinous process and the second saddle is for receiving a lower spinous process.

40. The implant of

claim 38

wherein:

a portion of the body located between the first and the second saddles is substantially trapezoidal shaped.

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