US20060229627A1 - Variable angle spinal surgery instrument - Google Patents

Abstract

An instrument for use in a procedure for inserting a spinal implant between human vertebrae may include a shaft and an end member. The end member may rotate with respect to the shaft. An angle of the end member with respect to the shaft may be varied when the end member is in a disc space between the human vertebrae. The instrument may include a slide for securing the end member at selected angles relative to the shaft. The end member may be separable from the shaft when the end member is in a selected orientation with the shaft. An instrument kit may include a shaft assembly and modular end members for various steps in a surgical procedure, such as disc space preparation, disc space evaluation, and spinal implant insertion.

Description

• The present application claims priority to U.S. Provisional Application Ser. No. 60/623,274, filed on Oct. 29, 2004, hereby incorporated in its entirety by reference.
BACKGROUND
• 1. Field of Invention
• The present invention generally relates to the field of medical devices. Some embodiments of the invention relate to instruments used during surgical procedures to install a spinal implant in a human spine. Some embodiments of the invention relate to instruments used in evaluating and/or preparing a disc space for a spinal implant. Some embodiments of the invention relate to an instrument used to manipulate and/or position a spinal implant between human vertebrae.
• 2. Description of Related Art
• An intervertebral disc may degenerate. Degeneration may be caused by trauma, disease, and/or aging. An intervertebral disc that becomes degenerated may have to be partially or fully removed from a spinal column. Partial or full removal of an intervertebral disc may destabilize the spinal column. Destabilization of a spinal column may result in alteration of a natural separation distance between adjacent vertebrae. Maintaining the natural separation between vertebrae may prevent pressure from being applied to nerves that pass between vertebral bodies. Excessive pressure applied to the nerves may cause pain and/or nerve damage. During a spinal fixation procedure, a spinal implant may be inserted in a space created by the removal or partial removal of an intervertebral disc between adjacent vertebrae. The spinal implant may maintain the height of the spine and restore stability to the spine. Bone growth may fuse the implant to adjacent vertebrae.
• A spinal implant may be inserted during a spinal fixation procedure using an anterior, lateral, posterior, or transverse spinal approach. A discectomy may be performed to remove or partially remove a defective or damaged intervertebral disc. The discectomy may create a space for one or more spinal implants. The amount of removed disc material may correspond to the size and type of the spinal implant or spinal implants to be inserted.
• Spinal surgery may be complex due in part to the proximity of the spinal cord and/or the cauda equina. Preparation instruments and spinal implants may need to be carefully inserted to avoid damage to nerve tissue. Alignment and spacing of a spinal implant that is to be inserted into a patient may be determined before surgery. Achieving the predetermined alignment and spacing during surgery may be important to achieve optimal fusion of adjacent vertebrae.
• U.S. Pat. No. 6,682,534 to Patel et al., which is incorporated by reference as if fully set forth herein, describes an endplate preparation instrument for preparing endplates of adjacent vertebral bodies. The instrument includes an elongated member that rotates in a housing member. The elongated member includes a cutting element that penetrates and removes bone from the endplates when the elongated member is rotated.
• U.S. Pat. No. 6,599,294 to Fuss et al., which is incorporated by reference as if fully set forth herein, describes a surgical instrument for introducing a spinal implant between two vertebrae. The instrument includes two mutually opposing guide bodies. The guide bodies combine to form a guideway for lateral insertion of a spinal implant in the intervertebral space.
• Some spinal implants may be inserted using a lateral (transverse) approach. U.S. patent application Ser. No. 10/633,371 to Mitchell et al., which is incorporated by reference as if fully set forth herein, describes spinal implants that may be inserted using a lateral (transverse) approach.
SUMMARY
• An instrument may be used in a procedure to insert a spinal implant. In some embodiments, the spinal implant may be inserted into an intervertebral disc space. The spinal implant may provide stability and promote fusion of adjacent vertebrae. In an embodiment, an instrument may include a shaft assembly and an end member. The end member may rotate with respect to the shaft assembly. In some embodiments, an angle of the end member relative to the shaft assembly may be varied while the end member is in a disc space. The ability to rotate an end member relative to a shaft assembly may simplify and facilitate positioning of the end member at a desired location in the disc space. The ability to rotate the end member relative to the shaft assembly may decrease the size of an incision and opening needed to provide room for preparing a disc space and inserting a spinal implant in the disc space.
• In certain embodiments, an instrument set for a spinal fusion procedure may include end members that are coupled to shaft assemblies such that separation of the end members from the shaft assemblies is inhibited. The end members may be coupled to the shaft assemblies by rivets, press fit connections, adhesives, or other fastening systems. An end member may be rotated and set in desired positions relative to a shaft assembly prior to insertion of the end member into a patient and during use of the end member.
• In certain embodiments, an instrument set may include a shaft assembly and modular end members. Various end members may be removably coupled to the shaft assembly. The instrument set may include end members for various steps in a procedure for installing a spinal implant, such as disc preparation, disc space evaluation, and implantation.
• In some instrument embodiments, an end member of an instrument may be separable from a shaft assembly of the instrument when the end member is placed in a selected orientation relative to the shaft assembly. An end member may include a slot. A portion of the shaft assembly may engage the slot to allow the end member to be selectively coupled to or separated from the shaft assembly.
• In some instrument embodiments, a shaft assembly of an instrument may include a slide. The slide may engage an end member of the instrument to secure the end member at a selected angle with respect to the shaft assembly. The slide and the end member may include cooperative capture elements. The capture elements may engage to inhibit rotation of the end member with respect to the shaft assembly. In some embodiments, the capture elements may be frictional surfaces. In some embodiments, the capture elements include meshing teeth that form an interference fit to inhibit undesired rotation of the end member relative to the shaft assembly. The shaft assembly may include a locking member to lock a slide in position against an end member. In certain embodiments, a shaft assembly may include a biasing member to urge a slide into engagement with an end member.
• In some embodiments, an end member of an instrument may be a rasp for abrading surfaces of vertebrae adjacent to a disc space. Upper and lower surfaces of the rasp may be textured to cut vertebral bone. In an embodiment, a surgeon may vary an angle of the rasp with respect to a shaft assembly while the rasp is in the disc space to selectively position the rasp relative to the vertebrae.
• In certain embodiments, an end member of an instrument may be a trial member for evaluating a size and/or shape of a disc space. An instrument set may include trial members of various sizes that can be removably coupled to a shaft assembly. Sizes of the trial members may correspond to the sizes of implants available to a surgeon. In an embodiment, a surgeon may vary an angle of the trial member with respect to the shaft assembly to facilitate positioning of the trial member in the disc space.
• In some embodiments, an end member of an instrument may be a tamp for positioning a spinal implant in a disc space. The tamp may include an end that engages the spinal implant to advance the spinal implant in the disc space. In an embodiment, a surgeon may vary an angle of the tamp with respect to a shaft assembly during insertion to facilitate positioning of the spinal implant in a desired location.
• In certain embodiments, an angle of an end member relative to a shaft assembly may be controlled during a surgical procedure to allow a proximal end of a shaft assembly to be maintained in a relatively small range at an incision at a surface of the body. The angle of the end member relative to the shaft assembly may be adjusted at selected points of advancement of the instrument into a disc space. The angle of the end member relative to the shaft assembly may also be adjusted during removal of the end member from the disc space.
• In some embodiments, an end member may be secured at a first angle relative to a shaft assembly. An end member may be moved to a first position along a path in a disc space while the end member is secured at the first angle. A capture element of the end member may be disengaged to allow the end member to rotate with respect to the shaft assembly. The angle of the end member with respect to the shaft assembly may be adjusted to a second angle. The end member may be secured to the shaft assembly at the second angle. The end member may be advanced to a second position on the path while the end member is secured at the second angle. The end member may be successively adjusted and advanced until the end member is in a desired position in the disc space.
BRIEF DESCRIPTION OF THE DRAWINGS
• Advantages of the present invention will become apparent to those skilled in the art with the benefit of the following detailed description and upon reference to the accompanying drawings in which:
• FIG. 1 depicts a perspective view of an embodiment of an instrument including a shaft assembly and a separable end member.
• FIG. 2 depicts a perspective view of an embodiment of an instrument with a non-separable end member.
• FIG. 3 depicts a front view of an embodiment of a shaft assembly.
• FIG. 4 depicts a side view of an embodiment of a shaft assembly.
• FIG. 5 depicts a cross-sectional view of the embodiment of the shaft assembly, taken substantially along line5-5 ofFIG. 4.
• FIG. 6 depicts a detail view of the embodiment of the locking member shown inFIG. 5.
• FIG. 7 depicts a detail view of an embodiment of a locking mechanism.
• FIG. 8 depicts a detail view of an embodiment of a distal portion of a shaft assembly in a closed position.
• FIG. 9 depicts a detail view of an embodiment of a distal portion of a shaft assembly in an open position.
• FIG. 10 depicts a detail view of an embodiment of teeth on a collar of a shaft.
• FIG. 11 depicts an end view of an embodiment of a collar of a shaft.
• FIG. 12 depicts a perspective view an embodiment of a shaft assembly with a portion of a bias section of the shaft assembly shown in cut-away to show a biasing member of the shaft assembly.
• FIG. 13 depicts a top view of an embodiment of a rasp.
• FIG. 14 depicts a front view of an embodiment of a rasp.
• FIG. 15 depicts a top view of an embodiment of a trial member.
• FIG. 16 depicts a front view of an embodiment of a trial member.
• FIG. 17 depicts a top view of an embodiment of a tamp.
• FIG. 18 depicts a front view of an embodiment of a tamp.
• FIGS. 19A-19D depict schematic representations of installation of an end member onto a shaft assembly.
• FIGS. 20A-20E depict-schematic representations of use of a rasp to prepare a disc space.
• FIGS. 21A-21D depict schematic representations of use of a tamp to position a spinal implant in a disc space.
• While the invention is susceptible to various modifications and alternative forms, specific embodiments thereof are shown by way of example in the drawings and will herein be described in detail. The drawings may not be to scale. It should be understood that the drawings and detailed description are not intended to limit the invention to the particular form disclosed, but on the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the present invention as defined by the appended claims.
DETAILED DESCRIPTION
• An instrument may be used in a procedure to insert a spinal implant between human vertebrae. In an embodiment, the instrument may include a shaft assembly and an end member. The end member may rotate (e.g., pivot or angulate) with respect to the shaft assembly. The shaft assembly may include a slide that engages the end member to secure the end member at a selected angle with respect to the shaft assembly. To facilitate use of the instrument, the angle of the end member relative to the shaft assembly may be adjusted while the end member is in use in a patient.
• Components of instruments may be made of materials including, but not limited to, metals, ceramics, and/or polymers. The metals may include, but are not limited to, stainless steel, titanium, and titanium alloys. Some components of instruments may be autoclaved and/or chemically sterilized. Components that may not be autoclaved and/or chemically sterilized may be made of sterile materials.
• In some embodiments, an instrument may include end members that are coupled to shaft assemblies such that separation of the end members from the shaft assemblies is inhibited. The end members may be coupled to the shaft assemblies by rivets, press fit connections, adhesives, threaded connectors or other fastening systems. An end member may be rotated and set in desired positions relative to a shaft assembly prior to insertion of the end member into a patient and during use of the end member.
• In some embodiments, an instrument set may include a shaft assembly and modular end members. The end members may be removably coupled to the shaft assembly. An instrument set may include different end members for various steps of a procedure, including, but not limited to, distraction, disc preparation, disc space evaluation, and implantation. End members used for disc preparation may include, but are not limited to, rasps, trials, chisels, curettes, or distractors. End members used for implantation may include, but are not limited to, inserters, tamps, or guides.
• An instrument including an adjustable end member may allow preparation of a disc space and insertion of a spinal implant between human vertebrae to be effected from above an incision in a patient through a relatively small opening in the patient. The instrument may allow simple, efficient, and safe preparation of a disc space for receiving a spinal implant, including preparation of the contralateral (opposite) side of the disc space. The instrument may allow spinal implant insertion through a relatively small opening in the patient while maintaining maneuverability and visibility of the surgical site, spinal implant, and instruments during the procedure.
• FIG. 1 depicts a perspective view of an embodiment ofinstrument50.Instrument50 may includeshaft assembly52 andend member54.End member54 may be pivotably coupled toshaft assembly52. In some embodiments,end member54 may be separable fromshaft assembly52.Shaft assembly52 may be included in a modular instrument set having one or more end members.
• Shaft assembly52 may includeshaft56,slide58, handle60, lockingmember62, andconnector64.Handle60 may be coupled toshaft56. In some embodiments, slide58 ofshaft assembly52 is able to move longitudinally relative toshaft56. A distal portion ofslide58 may engage an end member to inhibit undesired rotation of the end member relative toshaft56. Lockingmember62 may limit movement ofshaft56 relative to slide58 to fix an angular position of an end member coupled toshaft assembly52. As used herein, “slide” includes any element that moves (e.g., translates and/or rotates) with respect to another element. The slide may be positioned outside, inside, or along side the other element. A slide may be, but is not limited to, a shaft, a tube, a rod, a bar, a beam, or a combination thereof. In certain embodiments, a slide may threadably engage another element.
• As shown inFIG. 1, slide58 may be an outer shaft that surrounds a portion ofshaft56.Distal end66 ofslide58 may engageend member54 to hold the end member at a desired angle relative toshaft56. Lockingmember62 may be coupled to slide58. Lockingmember62 may be operated to control axial position ofslide58 relative toshaft56. In some embodiments, lockingmember62 may include a spring or other bias element that applies force to moveslide58 towardsconnector64 ofshaft56.
• In some embodiments,shaft56 ofinstrument50 may be a single member. In certain embodiments, a shaft may include multiple members.Distal portion68 ofshaft56 may includeconnector64.Connector64 may be oriented perpendicular to a longitudinal axis ofshaft56.Connector64 may form a “tee” shape indistal portion68 ofshaft56.
• End member54 may includebody opening70, and surfaces72,74.End member54 may be coupled toconnector64 ofdistal portion68 ofshaft56. Pivotingend member54 relative toshaft56 aboutconnector64 may allow the end member to be positioned at various angles relative to the shaft during use ofinstrument50. A rotational range of motion ofend member54 relative toshaft assembly52 may be limited by a surface of the end member that definesopening70. In some embodiments, the surface of the end member that defines opening70 is a planar surface so that the range of motion ofend member54 relative toshaft assembly52 is 180°. In other embodiments, the surface of the end member that defines opening70 may be angled or curved so that the range of motion ofend member54 relative toshaft assembly52 is less than or greater than 180°.
• In some embodiments,end member54 may be separable fromshaft assembly52. In certain embodiments,end member54 may be separated fromshaft assembly52 when the end member is in a selected orientation with respect to the shaft assembly. For example,end member54 may be separable fromshaft assembly52 whendistal portion68 ofshaft56 is aligned inslot76. Toseparate end member54 fromshaft assembly52,end member54 may be rotated aboutconnector64 untildistal portion68 ofshaft56 is aligned inslot76.Slide58 may be retracted fromconnector64, and endmember54 may be removed fromdistal portion68.
• In some embodiments, slide58 andend member54 may include complementary capture elements. As used herein, “capture element” includes any element that directly or indirectly contacts or engages another element to at least partially inhibit relative motion (e.g., translation, rotation) of the elements. A capture element may include, but is not limited to, a detent, a spring, a groove, a ridge, a tab, a pin, a projection, a slot, a hole, a notch, roughened or textured surfaces or threading. For example, as shown inFIG. 1, slide58 may includeteeth78 andend member54 may includecomplementary teeth80. A capture element may be a separate component or may be a part of another element. In some embodiments, a capture element may automatically release when a predetermined amount of force is applied to the element that is captured. In other embodiments, release of a capture element may require a separate action by a user (e.g., user actuated movement of the slide relative to the shaft).
• Capture elements may be positioned over a subset of the range that endmember54 is able to rotate relative toshaft assembly52 to define an instrument use range of the end member relative to the shaft assembly. In some embodiments,teeth80 may be formed onend member54 so that the instrument use range of the end member relative to the shaft assembly is from about 20° to about 180°, where 0° is the angle formed between the shaft assembly and the end member when a shaft of the shaft assembly is positioned inslot76 such that the shaft assembly can be removed from the end member. In other embodiments, the instrument use range of the end member relative to the shaft assembly may be less or greater than the range of 20° to 180° (e.g., 30° to 180°, 10° to 180°, 10° to 190°, 45° to 135°).
• In some embodiments, a slide of a shaft assembly may include detents or pins that engage holes or slots in an end member. In other embodiments, a slide of a shaft assembly may include holes or slots that engage detents or pins on an end member. In some embodiments, engaging surfaces of a slide and/or end member may be textured to inhibit relative motion between a shaft assembly and an end member when the slide is biased against the end member.
• In an embodiment, turning (e.g., clockwise rotation) lockingmember62 in a first direction (e.g., clockwise) may moveslide58 towardend member54.Distal end66 ofslide58 may engageend member54. Turning lockingmember62 in an opposite direction (e.g., counterclockwise) may moveslide58 away fromend member54.Distal end66 ofslide58 may disengage fromend member54. Withdistal end66 disengaged fromend member54,end member54 may pivot with respect toshaft56 aboutconnector64.
• FIG. 2 depicts an embodiment ofinstrument50 that hasend member54 fixed toshaft assembly52.Connector64 may be a pin that is press fit intoend member54. A portion of the pin passes throughshaft56 so that end member is able to rotate relative toshaft assembly52 aboutconnector64. Lockingmember62 may move slide58 so that capture elements of the slide engage with, or disengage from, capture elements ofend member54.
• FIG. 3 andFIG. 4 depict front and side views of an embodiment ofshaft assembly52.FIG. 5 depicts a cross-sectional view of an embodiment ofshaft assembly52.Shaft56 may includetip82,body84, andsleeve86.Tip82,body84, andsleeve86 may be coupled by various methods including, but not limited to, application of an adhesive, welding, press-fitting, threading, pins, and/or rivets.Tip82 may have an elongated section andconnector64. A cross-sectional shape of the elongated section perpendicular to the longitudinal axis of the elongated section may be substantially square.Handle60 may be coupled tosleeve86 andshaft56 by a pin.
• Slide58 may includetube88 andcollar90. In some embodiments,tube88 may have a substantially cylindrical outer surface. An opening throughcollar90 may have a substantially square shape that corresponds to a shape of the elongated section oftip82. The shape of the opening incollar90 and the shape of the elongated section oftip82 may inhibit rotation ofslide58 relative toshaft56.
• Slide58 may includeindicia92.Indicia92 may indicate insertion depth of an end member into a patient.
• Handle60 may be used to holdshaft assembly52. In some embodiments, lockingmember62 may be rotated with fingers of the same hand with which a user is holdinghandle60. A top ofhandle60 may be an impact surface. A mallet or other impact instrument may strike the impact surface to drive an end member coupled to the shaft assembly into a disc space. As shown inFIG. 5, some embodiments ofhandle60 may includespring94 andpin96. An end of a slap hammer may include a keyway that engagespin96 to couple the slap hammer toshaft assembly52.Spring94 may apply force to the slap hammer that holds the shaft assembly and the slap hammer together. The slap hammer may be used to remove an end member from a disc space.
• FIG. 6 depicts a detail view of an embodiment of lockingmember62. Lockingmember62 may includeportions62A and62B.Portions62A and62B may be fixedly coupled (e.g., by adhesive, welding, threads, or soldering) after the portions are properly positioned relative toshaft56 andslide58.Capture washer98 may be coupled to a distal end ofportion62A.Capture washer98 may engagerim100 ofslide58 when lockingmember62 is rotated to move the slide away from a connector of the shaft assembly.Belleville washers102 may be positioned betweenend face104 ofslide58 and end face106 ofportion62B. When lockingmember62 is rotated to moveslide58 towards connector64 (depicted inFIGS. 3-5),end face106 may push againstBelleville washers102.Belleville washers102 may push againstslide58 to move the slide towards the connector.
• Threading108 onportion62B may mate with threading110 ofsleeve86. Lockingmember62 may be rotated in a first direction to moveslide58 towards a connector of a shaft assembly. Teeth of the slide may engage teeth of an end member to fix the angular position of the end member relative to the shaft assembly. Lockingmember62 may be rotated in an opposite direction to moveslide58 away from the connector. When the slide is moved away from the connector, teeth of the slide may disengage from teeth of the end member to allow the angular position of the end member relative to the shaft to be changed.
• To assemble shaft assembly52 (depicted inFIGS. 3-5),collar90 may be placed ontip82.Tip82 may be welded tobody84.Retainer washer98 may be welded toportion62A.Portion62A may be placed ontube88.Tube88 may be welded tocollar90.
• Sleeve86 may be press-fit intohandle60.Portion62B may be threaded ontothread110 ofsleeve86. Belleville washers may be placed aboutshaft56. An opening insleeve86 may be aligned with an opening inshaft56 and a pin may be press fit into the openings to couple the sleeve and handle60 to the shaft.Portion62A may be positioned againstportion62B.Portion62A andportion62B may be welded together to form lockingmember62 and the complete shaft assembly.
• FIG. 7 depicts a cross-sectional view of a portion of an embodiment of a shaft assembly.Capture washer98 may be positioned onslide58. A tip may be placed in a collar. The tip may be coupled to a body. The body may be positioned inslide58. The collar may be coupled to slide58. Lockingmember62 may be positioned onslide58. An adhesive (e.g., Loctite Engineering Adhesive) may be applied to threading ofcapture washer98.Capture washer98 may be threaded on lockingmember62.Sleeve86 may be press fit inhandle60 so that an opening through the sleeve aligns with an opening through the handle.Sleeve86 may be threaded in lockingmember62 until an opening inbody84 aligns with the openings through the sleeve and handle60.Pin111 may be positioned in handle to fix the position ofbody84 relative tosleeve86 and handle60. Rotating lockingmember62 advances or retractsslide58 relative to handle60.
• FIG. 8 depicts a distal portion of a shaft assembly when a locking member of the shaft assembly is rotated to driveslide58 towardsconnector64 ofshaft56.FIG. 9 depicts a distal portion of an embodiment of a shaft assembly when the locking member of the shaft assembly is disengaged to driveslide58 away fromconnector64 ofshaft56.
• FIG. 10 depicts a detail view of an embodiment ofteeth78 ofcollar90 of a slide. In) some embodiments,collar90 may include from 1 to about 8teeth78. In an embodiment,collar90 includes 4 teeth. In some embodiments, an angular spacing betweenteeth78 may be from about 5 to about 30°. In an embodiment, the angular spacing between teeth is about 14°. In some embodiments, an angle between sides oftooth78 may be from about 150° to about 5°. In an embodiment, the angle between sides of a tooth is about 60°.
• FIG. 11 depicts an end view of an embodiment of a collar of a slide. Opening112 may receive a tip of a shaft of a shaft assembly. In some embodiments, opening112 may have a shape other than square or rectangular, such as, but not limited to, circular, diamond-shaped, or hexagonal. A slide of an instrument may translate on a shaft without rotation of the slide relative to the shaft. Engaging surfaces of the shaft and the collar may inhibit rotation of the shaft with respect to the collar. If a shape of an opening of the collar is circular, a shaft positioned in the collar may include a slot. A pin may be press fit into the slide through the slot so that rotation of the shaft relative to the slide is inhibited, while still allowing for axial movement of the slide relative to the shaft.
• In an embodiment, a shaft assembly may include a biasing member that urges a slide toward a distal portion of a shaft assembly. A biasing member may include, but is not limited to, a coil spring, Belleville washers, or an elastomeric member.FIG. 12 depictsshaft assembly52 includingshaft56 andslide58.Shaft56 may include a distal portion and a proximal portion.Distal portion68 may includeconnector64.Proximal portion114 may includeknob116.Knob116 may be an impact surface that allows an end member that is coupled toconnector64 to be driven into a disc space.Knob116 may also be positioned against a user's palm or thumb during use to allow a user to moveslide58 relative toshaft56.
• Shaft assembly52 may includebias section118. A portion ofbias section118 ofFIG. 12 is shown in cut-away to reveal some of the inner features of the bias section.Bias section118 may include biasingmember120, and grips122. A first end of biasingmember120 may be positioned against a portion ofbias section118. A second end of biasingmember120 may be positioned againstledge124 ofshaft56. In some embodiments,ledge124 may be formed by reducing a diameter of a portion ofshaft56. In some embodiments, a ledge may be formed by placing a weld bead or other obstruction on the shaft. In some embodiments, a ledge may be formed by a pin or washer coupled to the shaft.Biasing member120 may provide a force to slide58 that moves the slide towardsconnector64 ofshaft56. A user may graspgrips122 with fingers whileknob116 is positioned against the user's palm or thumb.Grips122 may be pulled away fromconnector64 to moveslide58 away from the connector. When grips122 are released, biasingmember120 may moveslide58 towardsconnector64.
• An end member may be coupled toconnector64.Teeth78 may engage portions of the end member to set a desired angle of the end member relative toshaft assembly52. The angle of the end member relative to the shaft assembly may be adjusted during use by repositioningslide58 relative to the end member.
• In some embodiments,shaft assembly52 may includelock126.Lock126 may include thread that complements a threaded portion ofshaft56. When an end member that is coupled toconnector64 is at a desired angle relative toshaft assembly52,lock126 may be rotated to position an end of the locking member againstbias section118. Positioning lockingmember126 against biasingsection118 may inhibit movement ofslide58 relative to the end member, thus inhibiting rotation of the end member relative toshaft assembly52. When it is desired to change the angle ofshaft assembly52 relative to the end member, lockingmember126 may be rotated to move the locking member away frombias section118 so thatslide58 can be moved to allow the teeth of the slide to be repositioned with respect to the end member.
• In an embodiment, an end member may be a rasp that is used to abrade surfaces of vertebrae.FIGS. 13 and 14 depict top and front views, respectively, ofrasp128.Rasp128 may include opening70,slot76, andhole130.Rasp128 may couple with a shaft of a shaft assembly.Hole130 may receive a portion of a connector of the shaft.Opening70 may allowrasp128 to pivot relative to the shaft of the shaft assembly.
• Rasp128 may includeposterior side132 andanterior side134.Sides132,134 may be curved.Sides132,134 may have substantially the same curvature as a spinal implant to be inserted in a disc space formed using the rasp. In some embodiments, the curvature ofposterior side132 may be substantially the same as the curvature ofanterior side134. In some embodiments, the curvature ofposterior side132 may be different than the curvature ofanterior side134. In some embodiments,posterior side132 may have a smaller radius of curvature thananterior side134. In some embodiments,posterior side132 and/oranterior side134 may include no significant curvature.
• Distal end136 ofrasp128 may be tapered and/or curved. Tapered and/or curved surfaces ofdistal end136 may facilitate insertion ofrasp128 in a disc space. In some embodiments, the tapered and/or curved surfaces ofdistal end136 may be textured. The textured surface may facilitate removal of intervertebral disc material during use. In some embodiments,distal end136 may not be tapered and/or curved.Proximal end138 ofrasp128 may be blunt and/or rounded. In some embodiments,upper surface72 andlower surface74 ofrasp128 may be angled relative to each other. Angledupper surface72 andlower surface74 may facilitate removal of intervertebral disc material during use.
• Upper surface72 andlower surface74 ofrasp128 may be textured to abrade and/or cut vertebral bone. Texturing may be provided by methods including, but not limited to, sanding the surface, forming grooves in the surface, shot peening the surface, scoring the surface using an electrical discharge process, and/or embedding hard particles in the surface.
• Rasp128 may includeteeth80.Teeth80 may engage cooperating elements of a slide of a shaft assembly to secure a position ofrasp128 relative to the shaft.Teeth80 may allow an angle ofrasp128 relative to a shaft to be selectively set in range R. In some embodiments, range R may be at least about 90°. In some embodiments, range R may be about 150°, about 120°, about 90°, or about 45°.Slot76 may allowrasp128 to be separated from the shaft assembly when a portion of the shaft is aligned withslot76.Slot76 may be located onrasp128 such that the portion of the shaft cannot be aligned withslot76 when the rasp is positioned between vertebrae in a patient.
• In an embodiment, an end member may be a trial member used to evaluate size and/or shape of a disc space.FIGS. 15 and 16 depict top and front views, respectively, oftrial member140.Trial member140 may include various tapered, curved and/or flat outer surfaces.Trial member140 may include opening70,slot76, andhole130 that allow the trial member to be removably coupled to a shaft of a shaft assembly.Slot76 may be located ontrial member140 such that the shaft of the shaft assembly cannot be aligned withslot76 when the trial member is positioned between vertebrae in a patient.Trial member140 may includeteeth80.Teeth80 may allow the trial member to be set at a desired angle relative to the shaft of the shaft assembly.Trial member140 may includemarker142.Marker142 may be color coded or include indicia to indicate to which instrument set the trial belongs.
• An instrument set may include trial members of various sizes. The instrument set may include a trial member for each spinal implant size included in the instrument set. In some embodiments, a trial member may have the same dimensions as the dimensions of a corresponding spinal implant. In some embodiments, one or more dimensions of a trial member may differ from those of a corresponding spinal implant. For example, a height of each trial member may be undersized relative to a height of a corresponding spinal implant for each trial.
• In an embodiment, an end member may be a tamp used to position a spinal implant in a disc space.FIGS. 17 and 18 depict top and front views, respectively, of tamp144. Tamp144 may include opening70,slot76, andhole130 that allow the tamp to be removably coupled to a shaft of a shaft assembly.Slot76 may be located on tamp144 such that the shaft of the shaft assembly cannot be aligned withslot76 when the tamp is positioned between vertebrae in a patient. Tamp144 may includeteeth80 that allow the tamp to be set at a desired angle relative to the shaft of the shaft assembly. Tamp144 may includeend face146 andtips148.End face146 may contact a spinal implant that is partially inserted into a disc space. An instrument formed of a shaft assembly and tamp144 may be pushed or impacted with a mallet to advance the spinal implant into a desired position in a disc space.
• End face146 may include any of a variety of profiles, including, but not limited to, flat, convex, concave, arcuate, wedge-shaped, u-shaped, or vee-shaped.End face146 may have various surface contours, including, but not limited to, smooth, textured, or padded. In certain embodiments, a tamp may include elements such as tabs, pins, or protrusions for engaging a portion of a spinal implant. Such elements may facilitate manipulation of the spinal implant with the tamp. For example, tips148 (shown inFIG. 17) on tamp144 may engage a groove or notch on a spinal implant to facilitate placement of the spinal implant using the tamp.
• FIGS. 19A-19D depict coupling ofend member54 withshaft assembly52.Pin64 may be aligned with hole130 (shown inFIGS. 13-18). As depicted inFIG. 19A,distal portion68 ofshaft56 may be aligned withslot76.Pin64 anddistal portion68 may be placed inslot76.FIG. 19B depictspin64 may engaged with hole130 (shown inFIGS. 13-18).End member54 may be pivoted aboutpin64. As depicted inFIG. 19C,distal portion68 ofshaft56 may be positioned in opening70 away fromslot76.Slide58 may be translated towardend member54. As depicted inFIG. 19D,teeth78 ondistal end66 ofslide58 may engageteeth80 ofend member54. Engagement ofteeth78,80 may inhibit rotation ofend member54 relative toshaft assembly52.
• In an embodiment, an instrument may be used in a procedure to insert a spinal implant in a disc space between adjacent vertebrae. The spinal implant may replace all or a portion of an intervertebral disc that has degenerated due to wear, trauma, and/or disease. The spinal implant may restore a normal separation distance between adjacent vertebrae and promote fusion of the vertebrae. In certain embodiments, a spinal implant may be inserted in a space formed between two portions of a bone to extend the length of the bone.
• A discectomy may be performed to remove disc material from a disc space. A distractor may be positioned in the disc space to establish a separation distance between the vertebrae. A disc space may be prepared using instruments such as, but not limited to, scalpels, drills, curettes, chisels, or rongeurs. A chisel may be used to remove portions of vertebral bone and form channels in the vertebral endplates adjacent to the disc space.
• In some embodiments, an angle of an end member relative to a shaft assembly may be adjusted while the end member is in a disc space. Pivoting the end member may facilitate positioning of the end member in various regions of the disc space. The ability to pivot an end member may allow a user to maintain the shaft assembly of an instrument in a desired range without requiring a large working space. For example, an angle of the end member relative to the shaft assembly may be controlled such that a position of the shaft assembly is maintained in a relatively small range within a surgical opening in the patient at a surface of the body as the end member is advanced in the disc space. The angle may be adjusted at selected points of advancement of the instrument into and/or withdrawal of the instrument from a disc space. In one embodiment, an angle of an end member with respect to a shaft assembly is adjusted twice during advancement of the end member and twice during withdrawal of the end member. In other embodiments, an angle of the end member with respect to the shaft assembly is adjusted three or more times during advancement of the end member and three and/or more times during withdrawal of the end member.
• In some embodiments, an end member may be allowed to pivot freely relative to the shaft assembly as the end member is withdrawn from an incision. The end member may deflect as the end member encounters tissue during withdrawal. Pivoting of an end member during withdrawal may reduce damage to tissue that might occur if the end member were locked at a fixed angle during withdrawal of the end member.
• Vertebral surfaces may require preparation before insertion of a spinal implant in a disc space. A rasp may be inserted in an intervertebral disc space from a posterior or transverse approach to abrade vertebral surfaces. Vertebral surfaces may be abraded to remove osteophytes and/or to smooth rough surfaces. In some embodiments, an instrument with an end member that is a rasp may be used to roughen vertebral endplates. Roughening of vertebral endplates may initiate a healing response that promotes bone growth. The bone growth may promote fusion of adjacent vertebrae with an installed spinal implant.
• In an embodiment, an instrument including a rasp may be used to prepare a disc space for a spinal implant. An angle of the rasp with respect to a shaft assembly of the instrument may be adjusted to facilitate positioning of the rasp in the disc space.FIGS. 20A-20E depict use ofinstrument50 includingrasp128.Rasp128 may be placed indisc space150 at various angles relative toshaft assembly52 ofinstrument50. Vertebral surfaces may be abraded by movingshaft assembly52 back and forth withrasp128 indisc space150.
• An angle ofrasp128 relative toshaft assembly52 may be selected to allowrasp128 to be inserted indisc space150 during a transverse approach. After insertion, an angle ofrasp128 relative toshaft assembly52 may be adjusted to allowinstrument50 to be positioned and used at different locations withindisc space150, including but not limited to the area across midline of the vertebral body.Shaft assembly52 may be pivoted relative to rasp128 by moving a slide of the shaft assembly and angling the shaft assembly relative to rasp128. After a desired angle is obtained, the slide may be moved againstrasp128 to secure the position of the rasp relative toshaft assembly52.Rasp128 may be forced against an endplate of a first vertebra.Rasp128 may be moved to treat the vertebral surface of the first vertebra.Rasp128 may be forced against the endplate of a second vertebra.Rasp128 may be moved to treat the vertebral surface of the second vertebra.
• A discectomy may be performed to remove a portion of an intervertebral disc. The discectomy may form an initial path between vertebrae. After formation of the initial path,rasp128 may be used to extend the path in a desired trajectory. Referring toFIG. 20A,rasp128 may be initially secured in first orientation A relative toshaft assembly52.Rasp128 may be advanced indisc space150 in an initial space formed during a discectomy. Withrasp128 indisc space150,shaft assembly52 may be adjusted from orientation A to orientation B. Frictional engagement ofrasp128 withadjacent disc152 may stabilize rasp128 sufficiently to allowshaft assembly52 to be angled by moving a slide of the shaft assembly and angling the shaft assembly. After obtaining desired angle B, the slide may be moved so that the slide engages capture members ofrasp128.Rasp128 may be used to extenddisc space150 formed between vertebrae.FIG. 20B depicts a representation ofdisc152 afterrasp128 has been used to extenddisc space150.Shaft assembly52 may be adjusted from orientation B toorientation C. Rasp128 may be further advanced into disc into152 to establish desireddisc space150, as depicted inFIG. 20C.
• Instrument50 may be removed fromdisc space150 by reversing the steps used for insertion of the instrument. For example, withshaft assembly52 at orientation C,rasp128 may be partially withdrawn from disc space150 (FIG. 20D).Shaft assembly52 may be adjusted toorientation B. Rasp128 may be further withdrawn from disc space150 (FIG. 20E).Shaft assembly52 may be adjusted to orientation A, andinstrument50 may be removed from the incision.
• In an embodiment, an instrument including a trial member may be used to gauge a disc space before insertion of a spinal implant. In an insertion procedure that uses modular end members, a rasp may be removed from a shaft assembly after a disc space is prepared. A trial may be attached to the shaft assembly. The instrument with the trial attached may be inserted into the disc space. The trial may have the same outer shape as the shape of a spinal implant in an instrumentation set provided for the spinal implant insertion procedure. If the trial is easily inserted into the disc space, the corresponding spinal implant may not have sufficient height. If the trial cannot be inserted, the corresponding spinal implant may have too much height. Insertion of the trial should be achieved with some impact on an end of the shaft assembly. The trial may be fully inserted along the established disc space to ensure that the corresponding spinal implant will be able to follow the same path. The angle of the shaft assembly relative to the trial may be adjusted during insertion of the trial into the disc space. After complete insertion, the trial may be removed from the disc space.
• In an embodiment, an instrument may be used to position, guide, and/or manipulate a spinal implant in a disc space.FIGS. 21A-21D depict positioning ofspinal implant156 indisc space150. In some embodiments, bone growth promoting material may be placed in the disc space and/or in openings in the spinal implant to minimize or eliminate gaps between the spinal implant and walls defining the disc space. The bone growth promoting material may be, but is not limited to, autologous bone, allograft bone, xenograft bone, calcium phosphates, collagen, calcium sulfates, demineralized bone matrix, bone morphogenetic proteins, platelet derived growth factors, bone marrow aspirate, and/or blood.Spinal implant156 may be placed in an initial position indisc space150 using a spinal implant inserter158 (FIG. 21A).
• As depicted inFIG. 21B,instrument50 with tamp144 andshaft assembly52 may be coupled tospinal implant156. Tamp144 may be angled relative toshaft assembly52 in orientationA. Shaft assembly52 may be advanced to drive tamp144 andspinal implant156 in disc space150 (FIG. 21C). In certain embodiments, a mallet may be used to strikeshaft assembly52 ofinstrument50 to advancespinal implant156 indisc space150.
• Shaft assembly52 may be changed from orientation A to orientation B while tamp144 remains in place indisc space150. In some embodiments,instrument50 may be withdrawn slightly fromspinal implant156 to facilitate angular adjustment. Tamp144 may be secured toshaft assembly52 when the tamp is positioned inorientation B. Instrument50 may be used to further advancespinal implant156 intodisc space150. Tamp144 may be used to pushspinal implant156 fully intodisc space150. A position ofspinal implant156 may be monitored using radiological techniques. After full insertion ofspinal implant156,instrument50 may be withdrawn from the surgical site.
• In this patent, certain U.S. patents have been incorporated by reference. The text of such U.S. patents is, however, only incorporated by reference to the extent that no conflict exists between such text and the other statements and drawings set forth herein. In the event of such conflict, then any such conflicting text in such incorporated by reference in such U.S. patents is specifically not incorporated by reference in this patent.
• Further modifications and alternative embodiments of various aspects of the invention will be apparent to those skilled in the art in view of this description. Accordingly, this description is to be construed as illustrative only and is for the purpose of teaching those skilled in the art the general manner of carrying out the invention. It is to be understood that the forms of the invention shown and described herein are to be taken as the presently preferred embodiments. Elements and materials may be substituted for those illustrated and described herein, parts and processes may be reversed, and certain features of the invention may be utilized independently, all as would be apparent to one skilled in the art after having the benefit of this description of the invention. Changes may be made in the elements described herein without departing from the spirit and scope of the invention as described in the following claims.

Claims (43)

1. An instrument for use in spinal surgery, comprising:

a shaft;

an end member rotatably coupled with the shaft, wherein the end member is configured to be positioned between vertebrae; and

a slide coupled to the shaft;

wherein the slide is configured to selectively couple with the end member to inhibit rotation of the end member with respect to the shaft.

2. The instrument ofclaim 1, wherein the end member is separable from the shaft when the end member is placed in a selected orientation with respect to the shaft.

3. The instrument ofclaim 1, wherein the slide comprises one or more capture elements, wherein the end member comprises one or more capture elements, and wherein at least one capture element of the slide is configured to selectively couple with at least one capture element of the end member to inhibit rotation of the end member with respect to the shaft.

4. The instrument ofclaim 3, wherein the capture elements of the end member and the capture elements of the slide are configured to selectively inhibit rotation of the end member with respect to the shaft over a range of at least 90°.

5. The instrument ofclaim 3, wherein the capture elements of the end member comprise teeth.

6. The instrument ofclaim 1, further comprising a locking member coupled to the slide, wherein the locking member is configurable to lock the end member relative to the shaft.

7. The instrument ofclaim 1, further comprising a biasing member coupled to the slide, wherein the biasing member is configured to urge the slide toward the end member.

8. The instrument ofclaim 1, wherein the end member comprises a rasp.

9. The instrument ofclaim 1, wherein the end member comprises a trial member.

10. The instrument ofclaim 1, wherein the end member comprises a tamp.

11. An instrument for performing a spinal surgical procedure, comprising:

a shaft; and

an end member configured to rotatably couple with the shaft, wherein the end member is configured to be positioned between vertebrae,

wherein the end member is separable from the shaft when the end member is placed in a selected orientation with respect to the shaft.

12. The instrument ofclaim 11, wherein the end member comprises a slot, wherein a portion of the shaft is configured to pass through the slot when the end member is rotated to a selected angle to allow the end member to separate from the shaft.

13. The instrument ofclaim 11, wherein the end member comprises a surface configured to face an endplate of a human vertebrae during use, wherein the slot opens on the surface.

14. The instrument ofclaim 11, wherein the end member comprises a hole, wherein the shaft comprises a connector, wherein the connector is configured to pivotably couple with the hole.

15. The instrument ofclaim 11, wherein a distal end of the shaft comprises a tee portion, wherein the end member comprises a hole, wherein at least part of the tee portion is configured to pivotably couple with the hole.

16. The instrument ofclaim 11, further comprising a slide coupled to the shaft, wherein the slide is configured to selectively couple with the end member to inhibit rotation of the end member with respect to the shaft.

17. The instrument ofclaim 16, further comprising a biasing member coupled to the slide, wherein the biasing member is configured to urge the slide toward the end member.

18. The instrument ofclaim 16, further comprising a locking member coupled to the slide, wherein the locking member is configurable to lock the end member in a selected orientation relative to the shaft.

19. An end member for a spinal surgical instrument, wherein the end member is configured to rotatably couple with a shaft of the spinal surgical instrument, and wherein the end member is configured to separate from the shaft when the end member is placed in a selected orientation with respect to the shaft.

20. The end member ofclaim 19, wherein the end member comprises a slot configured to allow a portion of the shaft to pass through when the end member is rotated to a selected angle with respect to the shaft.

21. The end member ofclaim 19, further comprising at least one capture element configured to couple with a portion of a slide on the shaft to inhibit rotation of the end member with respect to the shaft.

22. The end member ofclaim 19, wherein the end member comprises a rasp.

23. The end member ofclaim 19, wherein the end member comprises a trial member.

24. The end member ofclaim 19, wherein the end member comprises a tamp.

25. A shaft assembly for a spinal surgical instrument comprising:

a shaft configured to rotatably couple with an end member that is configured to be positioned between vertebrae; and

a slide coupled to the shaft;

wherein the slide is configured to couple with an end member to inhibit rotation of the end member with respect to the shaft.

26. The surgical instrument ofclaim 25, further comprising a biasing member coupled to the slide, wherein the biasing member is configured to urge the slide toward the end member.

27. The surgical instrument ofclaim 25, further comprising a locking member coupled to the slide, wherein the locking member is configurable to lock the end member relative to the shaft.

28. The surgical instrument ofclaim 25, wherein the slide comprises indicia.

29. A method of using a spinal surgical instrument, comprising:

securing an end member at a first angle relative to a shaft;

moving the end member to a first position between vertebrae at a surgical site;

loosening the end member relative to the shaft;

rotating the shaft relative to the end member;

securing the end member at a second angle relative to the shaft; and

moving the end member to a second position at the surgical site.

30. The method ofclaim 29, wherein rotating the shaft relative to the end member comprises angling the shaft while the end member is at least partially in a disc space between human vertebrae.

31. The method ofclaim 29, wherein the first position is deeper in the surgical site than the second position.

32. The method ofclaim 29, wherein the second position is deeper in the surgical site than the first position.

33. The method ofclaim 29, further comprising:

loosening the end member relative to the shaft; and

removing the end member from the surgical site while the end member remains loosened with respect to the shaft.

34. The method ofclaim 29, wherein moving the end member to the second position comprises abrading disc material to extend a disc space between vertebrae.

35. The method ofclaim 29, wherein moving the end member to the second position comprises abrading bone with a surface of the end member.

36. The method ofclaim 29, wherein the end member comprises a trial member, further comprising gauging a height of a disc space with the trial member.

37. The method ofclaim 29, wherein moving the end member to the second position comprises pushing a spinal implant in a disc space between human vertebrae.

38. The method ofclaim 29, further comprising engaging a spinal implant with the end member and rotating the spinal implant with respect to the surgical site.

39. The method ofclaim 29, further comprising coupling the end member to the shaft before securing the end member at the first angle.

40. A method, comprising:

placing an end member of a surgical instrument at a selected orientation with respect to a shaft, wherein the end member is configured to be positioned between vertebrae;

passing a portion of the shaft through a slot in the end member; and

pivoting the end member with respect to the shaft.

41. The method ofclaim 40, further comprising securing the end member at a selected angle relative to the shaft.

42. The method ofclaim 40, further comprising securing the end member at a selected angle relative to the shaft, wherein securing the end member comprises coupling a slide with the end member.

43. The method ofclaim 40, further comprising securing the end member at a selected angle relative to the shaft and inserting the end member between portions of bone.

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