US20090270871A1 - Impulsive percussion instruments for endplate preparation - Google Patents

Abstract

A hand-held instrument, with a rotary power input to a camshaft, has cam and follower arrangement to provide a reciprocating shaft output. A cutter is provided on the output shaft. In one example, rotating cam percussion is transmitted to the cutter by engaging the cutter with the tissue to be cut, and pushing the instrument forward toward the cutter. In another example, rotating cam percussion is transmitted to the cutter by engaging the cutter with the tissue to be cut, and pulling the instrument back toward the user while maintaining engagement of the cutter with the tissue. In both examples, the cutter remains in idle condition until an axially directed load, forward in the one example, or backward on the other example, is placed on the cutter by moving the instrument forward or backward, respectively, while the camshaft is rotating. A distractor with frame is used to spread and maintain space between vertebral bodies, enabling entrance of the cutter.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• The present Application claims foreign priority benefits of European Patent Application Number 03292241.1, filed Sep. 11, 2003, the contents of which are hereby incorporated by reference.
BACKGROUND
• This invention relates generally to surgery tools and more particularly to power cutting instruments for vertebral endplate preparation in spinal surgery.
• Following removal of some disc materials during spinal surgery, it is important to prepare the endplates of the vertebral bodies for reception of inter-body implant materials. It is desirable to provide devices and procedures for safer, more controlled and more efficient disc space cleaning and endplate preparation. The present invention is directed to providing an additional option for surgeons for improvement in these regards.
SUMMARY
• In general, the present invention provides power-operated, hand-held instruments adapted to reception of different types of tissue treatment tools, and drives them in a reciprocating motion.
• Further, the invention provides for conversion from a rotary input power source to a reciprocating source, and percussion action in the forward direction in one embodiment, and percussion action in the reverse direction in another embodiment. More specifically, in one embodiment the invention enables use with treatment tools expected to perform more effectively during a forward motion and, in another embodiment, the invention enables use with treatment tools expected to perform more effectively during a reverse motion. Such tools have preferred performance directions, forward or reverse. The invention further comprises treatment tool configurations particularly suitable to the direction and type of cutting action sought. For tools that perform well in either direction, either of the embodiments of the invention may be used. The invention further provides a distractor and keeper arrangement for maintaining distracted disc space height during endplate preparation, the keeper being shaped for convenient use with the powered instruments according to the present invention.
BRIEF DESCRIPTION OF THE FIGURES
• FIG. 1 is an elevation view of a percussion instrument according to one embodiment of the present invention.
• FIG. 1A is a perspective view of the embodiment shown inFIG. 1 and showing, schematically, an example of an air powered rotary motor and air supply line from a foot pedal operated compressor.
• FIG. 2 is a partial section through it taken at line2-2 inFIG. 1 and viewed in the direction of the arrows.
• FIG. 2A is a perspective view of the instrument with a quarter section.
• FIG. 2B is an enlarged perspective view of the proximal end portion ofFIG. 2.
• FIG. 3 is a left-hand end view thereof.
• FIG. 4 is an enlarged elevation view of the camshaft thereof.
• FIG. 5 is a section taken at line5-5 inFIG. 4 and viewed in the direction of the arrows and showing a square cam cross-section.
• FIG. 6 is an enlarged sectional view of the spring guide and seat member ofFIG. 2.
• FIG. 7 is an enlarged elevation view of one type of cutter-shaft combination of the embodiment ofFIGS. 1 and 2 but on a larger scale, and with a portion broken out to conserve space in the drawing.
• FIG. 8 is a section taken at line8-8 inFIG. 7 and viewed in the direction of the arrows.
• FIG. 9 is an enlarged view of the shaft guide and spring chamber.
• FIG. 10 is a left-hand end view thereof.
• FIG. 11 is a sectional view of the end closure ring for the spring chamber.
• FIG. 12 is a fragmentary elevation view of the proximal end portion of the instrument body ofFIG. 1 but on a larger scale and without the end cap and internal parts.
• FIG. 13 is a left-hand end view thereof.
• FIG. 14 is an elevation view of a second embodiment of the present invention featuring reversed percussion movements (pull back impacts).
• FIG. 15 is a view, partially in section taken at line15-15 inFIG. 14, and viewed in the direction of the arrows.
• FIG. 16 is an enlarged elevation view of the camshaft.
• FIG. 17 is an end view of the camshaft.
• FIG. 18 is a top (overhead) view of the cutter drive shaft.
• FIG. 19 is a view of the version of reversed percussion cutter shaft as shown inFIGS. 14 and 15, but with a portion of the length thereof broken away to conserve space in the drawing.
• FIG. 20 is an axial view of the camshaft end bearing.
• FIG. 21 is a cross section at line21-21 inFIG. 20 and viewed in the direction of the arrows.
• FIG. 22 is an inside face view of the proximal end cap usable in theFIG. 2 andFIG. 15 embodiments of the invention.
• FIG. 23 is a section taken at line23-23 inFIG. 22 and viewed in the direction of the arrows.
• FIG. 24 is a top (overhead) view of a combination distractor and distractor blade housing used to establish and maintain the desired disc space during use of the instruments ofFIGS. 1-23.
• FIG. 25 is a section taken at line25-25 inFIG. 24 and viewed in the direction of the arrows and showing application into the disc space.
• FIG. 26 is a top (overhead) view of the distractor itself with a portion broken away from the middle to conserve space in the drawing.
• FIG. 27 is a section taken at line27-27 inFIG. 26 and viewed in the direction of the arrows.
• FIG. 28 is a left-hand end view thereof.
• FIG. 29 is a top (overhead) view of the distractor blade housing which serves also as the disc space keeper.
• FIG. 30 is a section view taken at line30-30 inFIG. 29 and viewed in the direction of the arrows.
• FIG. 31 is a left-hand view thereof.
• FIG. 32 is a right-hand view thereof.
• FIG. 33 is an enlarged perspective view of the cutter illustrated in theFIGS. 1,2,7 and8 illustrations.
• FIG. 34 is a perspective view of another type of cutter.
• FIG. 35 is an elevation view of the cutter and shaft for the cutter ofFIG. 34, with a portion broken away to conserve space in the drawing.
• FIG. 36 is a perspective view of another embodiment of cutter useful in theFIG. 1 embodiment of the invention.
• FIG. 37 is an enlarged overhead view of the complete cutter and shaft for the cutter ofFIG. 36 with a portion broken away to conserve space in the drawing.
• FIG. 38 is an end view thereof.
• FIG. 39 is a section therethrough taken at line39-39 inFIG. 37 and viewed in the direction of the arrows.
• FIG. 40 is a perspective view of another cutter useful with theFIG. 1 embodiment of the invention.
• FIG. 41 is a perspective view of still another cutter similar to that ofFIG. 33 but narrower.
• FIG. 42 is a perspective view of the cutter shown in the illustrations ofFIGS. 14,15 and19 for the pull-back embodiment of the invention.
• FIG. 43 is an elevation view of another embodiment of the cutter and shaft used with the pull-back embodiment of the invention ofFIGS. 14 and 15.
• FIG. 44 is a section therethrough taken at line44-44 inFIG. 43 and viewed in the direction of the arrows.
DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS
• For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is hereby intended, such alterations and further modifications in the illustrated devices, and such further applications of the principles of the invention as illustrated herein being contemplated as would normally occur to one skilled in the art to which the invention relates.
Forward Percussion Embodiment
• Referring now to the drawings in detail, particularlyFIGS. 1-3,12 and13, the instrument has a one-pieceelongated body11 having acam housing portion12, aspring chamber portion13,guide barrel portion14, andend cap16. Acamshaft17 is received in the cam housing portion.
• A cutter-shaft21 is received in the guide barrel and has a shaft portion withproximal end22 and a cutter portion withdistal end23. A spring housing26 (FIGS. 2,9 and10) is received in thebore27 of the spring chamber portion of thebody11. As best shown inFIGS. 9 and 10, this spring housing has oneend wall29 with acentral aperture31 which receives and guides the proximal end portion of thecutter shaft21.Housing26 hasstop tabs32 and33 at the end wall and which are received ingrooves34 and36 (FIG. 13, and dashed lines inFIG. 1). These grooves extend longitudinally forward from the proximal end37 (FIGS. 1 and 12) of the body, and end atplane35 as shown inFIG. 1. They provide abutments to prevent movement of thehousing26 in the direction ofarrow78, beyond the location shown inFIG. 2. Also, thetabs32 and33 ingrooves34 and36, respectively, prevent rotational movement of the spring housing within thebody11.
• Thehole31 in theproximal end wall29 serves as a proximal end bearing for thecutter shaft21. Forward portions of theshaft21 are slidably received and guided by contact of the outer wall of the shaft with the inner wall of theguide barrel portion14 of the body1.
• A spring guide and end stop38 (FIGS. 2 and 6) is slidably received on the proximal end portion of theshaft21. Itsouter rim39 is slidably received in the bore41 (FIG. 9) of thehousing26. A coil spring42 (FIG. 2) is received around the stepped-downportion43 of themember38. Theshoulder44 at the step from thecylindrical surface39 to thecylindrical surface43 serves as a seat for the distal end of thespring42. Theinside face46 of theend wall29 of thehousing26 serves as a spring seat for the proximal end ofspring42.
• The right-hand end portion47 ofhousing26 is internally threaded at48 and receives end closure ring49 (FIG. 11) which is screwed into thehousing26. This prevents themember38 and spring therewith, from sliding out of the assembly when one cutter shaft is removed and replaced by another one having a different type of cutter. Normally, however, a screw51 (FIGS. 1 and 2) is screwed into thebody11 and extends through anelongated hole52 in theshaft21. This screw normally retains theshaft21 in the body. The length ofhole52 in the axial direction permits a range of shaft reciprocation from engagement with low points on the cam surface to slightly beyond the maximum height of the cam surface. To change cutters, the screw must be removed and then theshaft21 can be dropped or pulled out from thedistal end53 of theguide barrel14 followed by installation of the replacement cutter shaft.
• Referring now more particularly toFIGS. 4 and 5 along withFIG. 2, thecamshaft17 is generally cylindrical about theaxis56 and hascylindrical flanges57 and58 which abutflanged bushings59 and61 received in upper and lower, rearwardly openingyokes62 in the cam housing portion of the body11 (FIGS. 1 and 12). Similarly, end cap16 (FIGS. 22 and 23) has yoke portions which receive thebushings59 and61 when the end cap is fastened to the body with the four screws66 (FIG. 3). Thebushings59 and61 can be engaged by the outboard faces of theflanges57 and58 of the camshaft, so they provide location and thrust bearings for the camshaft as well as radial bearings for the smoothcylindrical surfaces67 and68 (FIG. 4) of the camshaft. It is seen that theyokes62 of the body and64 of theend cap16, capture thebushings59 and61 and thereby capture the cam shaft in the assembly for centering thecamshaft axis56 colinear with the axes ofbushings59 and61, when the end cap is secured in place by thescrews66.
• The cam surface itself shown generally at71 inFIGS. 4 and 5, is square shaped, having fourlow areas72 and fourhigh points73. Other cam surface profiles may also be used. One example is shown in dotted lines inFIG. 5 in the form of a hexagon. It is the square cam shape which is shown inFIG. 2, with the shaft end22 (rounded as shown inFIG. 8) engaging a low point on the cam and serving as the cam follower surface. Normally, however,spring42 urges thespring seat44 on member38 (FIG. 6) to the right (in the direction of arrow78). Abutting engagement of thewall76 ofmember38 with the annular shoulder77 (FIGS. 7 and 8) of thecutter shaft21 urges the shaft in the outward direction of arrow78 (FIG. 2) to an extent limited by the engagement of theproximal end79 ofhole52 with thestop screw51. Therefore, in this normal rest position of the cutter shaft, theproximal end22 thereof will be located, as shown by the dottedline22R (FIG. 2), spaced away from the circular path of the high points of the cam.
• Since this is a power operated instrument, converting rotary motion to reciprocating motion, the cam shaft hasflat surfaces81 for reception of a coupler, and acircular notch82 for reception of a spring clip or clamp of a coupler from an external rotary power source. This may be any of a variety of power sources such as, electric, hydraulic or more likely an air or nitrogen powered turbine motor85 (FIG. 1A) coupled to the camshaft. Air may be supplied throughtubing85A from acompressor85B withspeed control pedal85C. Any other available source of air or other gas with pressure and/or volume control may be used.
OperationForward Percussion Embodiment
• As an example of the operation of this embodiment of the invention, the user may select the treatment tool to be used, insert it in thebarrel14 and install thescrew51. The tissue treatment tool referred to above and hereinafter is referred to broadly hereinafter as a cutter, and this term is intended to include tools which chisel, file, shape, rasp, polish, broach or otherwise perform the intended effect on or with the body tissue treated.
• Before or after installation of the cutter shaft, the user may connect the power source to the camshaft. After positioning thedistal end23 of the cutter at the endplate treatment site and engaging the tissue to be treated, the user may apply force in the forward direction ofarrow78, which is the forward cutting direction of the cutters to be used with this embodiment of the invention. The forward force will compress thespring42 and move the cam surface toward the shaft end (the cam follower surface)22. If the camshaft is rotating, percussion action will begin as soon as the shaft end is touched by the high points of the rotating cam, and reciprocating action of the cutter will begin. The speed of such action can be controlled by speed control of the power source, whether by a motor at the instrument (as shown inFIG. 1A), or through a cable or hose and foot control or whatever speed control is desired or available. The percussion impact will depend on how much force the user applies in the direction ofarrow78, as thespring38 is compressed by increasing force and thereby permits the end of theshaft22 to project farther into the path of the cam surface as the cam surface moves about therotational axis56 of the camshaft.
• From the foregoing discussion, it can be recognized that cutter shafts other thanshaft21 shown specifically inFIGS. 1,2,7 and8, may be used in the practice of the present invention. Examples are different types of chisels, shavers and rasps to decorticate the endplate from the disc materials and the cartilage layer. Some are shown inFIGS. 34,35,36-39,40 and41. It is only necessary to remove thescrew51 and drop or pullcutter shaft21, select a cutter shaft having a different distal end cutter (the shaft portion from the cutter to theproximal end22 being of the same configuration as shown inFIGS. 7 and 8), and insert the proximal end of the cutter shaft through the distal end of thebarrel14 and through the bore andspring seat member38 and into thebore31 of thehousing26. Of course, it is preferable to have the power source turned off or disconnected from the camshaft during the cutter shaft installation to avoid the risk of having theproximal end22 struck by the cam and driving the tool back out of the barrel before the limit screw has been installed. Such event might otherwise occur, depending upon whether the cutter shaft is pushed in with enough force to compress thespring42.
Reverse Percussion Embodiment
• This embodiment is discussed with reference toFIGS. 14 through 23, although it will be seen that several of the components described above with reference to the first (forward percussion) embodiment also are used in the reversed percussion embodiment. In this second embodiment of the invention illustrated inFIGS. 14 through 23, some of the components are very similar to those in the first described embodiment. For example, thebody86 has acam housing portion87, aspring housing88 and aguide barrel portion89. Thebody86 is very similar to thebody11 of the first embodiment, and theend cap91 is virtually identical to theend cap16 of the first embodiment.
• Referring particularly toFIGS. 14-23, and in contrast to the direction of percussion impulse from the cam in the first embodiment, the direction of impulse from the cam in this second embodiment is in the reverse direction so that it pulls thecutter edge93 in the rearward direction ofarrow92. For that purpose, there is acam shaft94 mounted for rotation in thecam housing portion87 of the body. It operates acutter drive shaft96 slidably received in theguide barrel portion89. Itsproximal end portion97 is associated with the camshaft, while itsdistal end portion98 receives aproximal end portion99 of a cutter shaft having thecutter93 at its distal end.
• Referring now toFIGS. 16 and 17 along withFIG. 15, the camshaft74 is mounted in the body inbushings101 and102 which are received and located in the housing in essentially the same way as arebushings59 and61 described above with reference to the first embodiment. The camshaft itself has a smooth cylindrical surface at103 receiving radial bearing support bybushing102. It also has acylindrical flange104 havingouter face106 engagingbushing102 for thrust bearing support. The outer end portion of the camshaft has a pair of diametrically opposedflat surfaces108 on the otherwise cylindrical surface103 which provide anti-rotation cooperation with a connector of a rotary power source in the same manner as for the first described embodiment. Likewise, it has a stem withannular groove109 andhead111 to cooperate with the power source connector and retain it in place. Accordingly, the drive for this camshaft is like that for the first embodiment.
• In this embodiment, the cam surface itself is shown at112 as a square, having fourhigh points113 and fourflat surfaces114, the center of each flat114, as in the square cam of the first embodiment, being a low point in the cam travel. The cam can have other cross sectional shapes as mentioned above. One of several possible shapes could be hexagonal as designated by thedash line116 inFIG. 17. At theend face117 of thecam112, there is a step inward to ahexagonal post118 non-rotatably received in bearing119 (FIGS. 20 and 21) and secured to the bearing by asocket head screw121 screwed into the end of the camshaft. Thehexagonal post118 on the camshaft is received in thehexagonal aperture122 of thebearing119 which is rotatably received inbushing101. Thus, thecylindrical surface123 of thebearing119 rotating in thebushing101 provides radial bearing support for the camshaft, and thecircular face124 of the bearing119 slidingly engaging the lower face ofbushing101 provides thrust bearing support for the camshaft.
• Referring now particularly toFIGS. 15 and 18, thecutter drive shaft96 for the cutter shaft has a camfollower end portion97 configured for following thecam112. It is illustrated in the form of anelongate hole126 with straightparallel sidewalls127 and128 and asemi-circular end wall129 having a radius equal to half the distance between thesidewalls127 and128 and centered at131. This radius is slightly greater than the distance diametrically across thehigh points113 of the cam and is centered on thecam axis130. Thefollower end portion97 framing thehole126 has ashoulder133. A spring134 (FIG. 15) is a compression spring having a right-hand end136 bearing onwall137 of the spring chamber portion of thebody86. The left-hand end of the spring abuttingly engages theshoulder133 of the follower end portion of theshaft96. Therefore, the spring normally pushes theshaft96 to the left in the direction ofarrow92.
• Anelongate hole141 throughshaft96 receivestravel limit screw142, which is screwed into theinstrument body86. When the instrument is idle, thespring134 moves thedrive shaft96 to the left until the right-hand end143 of thehole141 engages and is stopped by thescrew142. This is the normal rest position of the shaft and places it such that thecenter131 of thecurved surface129 of the camshaft frame hole126 is spaced slightly outboard of the circle defined by the four high points of the cam when the camshaft is rotated.
• The left-hand end wall146 of thecam follower portion97 is provided with extra thickness resulting in abulge147 at thelongitudinal axis148 of thecutter drive shaft96 and serves as the cam follower surface ofcutter drive shaft96.
• This embodiment of the invention can be provided with a variety of cutters of various configurations and types useful, particularly when pulled toward the surgeon. Some examples are different types of curettes, scrapers and pull shavers. One example is thecutter shaft99 shown in elevation view inFIG. 19 and partially shown inFIGS. 14 and 42 and shown partially in section inFIG. 15. Thiscutter shaft99 has acylindrical body portion151 slidably received on the inside bore of thebarrel89 of the instrument. Astem portion152 of the tool has less diameter than thebody portion151 and is slidably received in abore153 in the distal end portion of thecutter drive shaft96. Thebarrel89 of the instrument has anelongate hole154 at one location in the wall. A hole156 (FIG. 18) incutter drive shaft96 is normally aligned or in registry with thehole154 in the housing when the cutter drive shaft is in rest position dictated by the engagement of thestop screw142 with theend wall143 ofhole141 in the cutter drive shaft. This is under the urging of thespring134. So when the cutter shaft is installed in the direction ofarrow92 into theopen end157 of the instrument body, it can be advanced to the left so that thecutter stem152 received inbore153 has the threadedhole158 of thecutter stem152 located in registry or lined up with thehole156 in thecutter drive shaft96. Then screw159 can be inserted through thehole154 in theguide barrel89 and screwed into thecutter shaft hole158 to fasten thecutter shaft99 to thecutter drive shaft96. The screw head is stopped so that it resides in thehole156 in the cutter drive shaft, retaining the cutter shaft in place but recessed slightly from the inside wall of thebarrel89 to avoid interference with reciprocation of the cutter shaft. Besides, thehole154 in thewall89 is long enough that the screw can move forward and backward in the direction ofarrow92 within thehole154 during reciprocation of thedrive shaft96. With this arrangement, thecutter shaft99 can be readily removed from the guide barrel by simply removingscrew159 and pulling the cutter shaft out of the barrel. Another cutter shaft with a different configuration of the cutter portion but with the same configuration otherwise, can then be inserted through theend157 in the direction ofarrow92. When theanchor hole158 thereof is lined up with thehole154, thescrew159 is installed to fix the new cutter shaft to thedrive shaft96 in preparation for using the new cutter.
OperationReverse Percussion Embodiment
• As mentioned above, the surgeon can run the cam constantly if desired, or can start it and stop it at the beginning and end of a cutting operation. Depending upon the power source available, the speed of rotation may be varied and thus, the speed of the cutter strokes would vary. A reciprocating action begins when the surgeon has engaged the cutter with the surface to be treated and pulls the instrument in the direction ofarrow92 with thecutter edge93 engaging the surface to be prepared. The force of impact between thecutter edge93 and material to be cut, is determined largely by the force with which the instrument is pulled in the direction ofarrow92, which thereby compresses thespring134 and enables the cam engagingfollower surface147 of the cam follower to impinge on the path of rotation of the high points of the cam. The rate of impulses depends upon the speed of the camshaft as determined by the surgeon.
• It can be understood that some cutters may be useful and which can treat the tissue in a useful way regardless of whether the cutter is driven in the forward or reverse direction. Such cutters can be used in either the forward or reverse percussion type instrument described above, if the proximal end portion of the cutter shaft is shaped and located to work with the cam and follower arrangement provided in the instrument. One example is a cutter as shown inFIGS. 34 and 35. With the shaft as shown in those figures, the cutter will work with the forward percussion instrument. If the shaft is made as shown inFIGS. 43 and 44, the cutter will work with the reverse percussion instrument.
Disc Height Maintenance
• Referring now toFIGS. 24-30, there is shown apparatus used according to the present invention to facilitate use of either of the two previously described embodiments. Referring first toFIGS. 24 and 25, a combination distractor and disc space keeper is shown. As shown specifically inFIGS. 26-28, the illustrateddistractor171 includes ahandle portion172,shaft portion173,head portion174, andwedge portion176. Aforwardly opening hook177 is fixed atop the shaft portion near the head portion. The wedge portion has atransverse groove178 at the tip.Abutments179 are provided at the transition from tip portion to head portion and are slightly arcuate in shape, as shown inFIG. 26. The upper and lower surfaces of the tip portion converge at a five degree total angle, half above and half below a plane containing theaxis181 of the shaft and handle portions. Referring particularly toFIGS. 29-32, adistractor blade housing186 and which serves as the disc space keeper, is made in the form of a frame and includesparallel side members187, arear cross member188, anintermediate cross member189 serving as a hinge pin, and afront cross member191.
• In the use of this device, and after the removal of the disc from the space between vertebral bodies shown schematically at191 and192 inFIGS. 24 and 25, thedistractor171 is assembled with theblade housing186 by inserting the wedge portion between the housing side members and moving it forward to engagement of thegroove178 of the distractor tip with thefront cross member191 of the blade housing and simultaneously receiving thehinge pin189 in thehook177, as shown inFIG. 25. Then, approaching from the anterior side of the spine, the space from which the disc material has been previously removed is approached in the direction of thearrow193, and thehandle172 is pushed in that direction to open up the space to approximately eight or ten millimeters, or to such other extent as desired, and by hammer or other impulses on thehandle end194, if needed. After the desired disc height is established in this manner, the distractor handle is pulled out in the direction ofarrow196, while theblade housing186 remains in place and maintains the disc height as desired, thus serving as the disc space keeper. Because of the offset between the plane197 (FIG. 30) containing theframe cross member191, and theparallel plane198 containing the axis of therear cross member188, there is ample room for entry and manipulation of a cutter in the space between the vertebral bodies and entry of the percussion instrument in the space between theplane197 and thepivot pin189 andrear cross member188 of the keeper frame.
• While the views inFIGS. 24 and 25 show the combination with thehook177 of the distractor and therear cross member188 of the keeper above theaxis181 of the distractor, the assembly can be used with the orientation inverted relative to that shown inFIG. 25. As with the cutting instruments themselves, the orientation will depend upon the preferences of the surgeon.
• The preferred material for the larger components is stainless steel; however, the used of other materials suitable for the intended functions are also contemplated as falling within the scope of the invention.
• While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that all changes and modifications that come within the spirit of the invention are desired to be protected.

Claims (21)

1.-34. (canceled)

35. A surgical method for treating vertebral endplates, comprising:

selecting an elongate disc space keeper frame having two side members and front, intermediate and rear cross members;

engaging with the frame a distractor having a wedge portion, head portion, handle portion and a hook;

receiving the front cross member of the frame in a groove defined in a front tip of the wedge portion of the distractor;

receiving the intermediate cross member of the frame in the hook on the distractor; and

inserting the frame into the intervertebral disc space from an anterior approach by displacing the distractor.

36. The method ofclaim 35 and further comprising:

removing the distractor from the frame while leaving the distractor front cross member and portions of the side members in the disc space to maintain the disc space for insertion of cutter instruments adapted for the preparation of vertebral endplates for receipt of an interbody fusion device.

37. A combination distractor and disc space keeper for use in spinal surgery, comprising:

an elongate frame having two side members and front, intermediate and rear cross members; and

a distractor having a wedge portion, head portion, handle portion and a forward facing hook;

the wedge portion of the distractor having a tip at the front of the wedge portion and having a forward facing groove in the tip; and

the front cross member of the frame being received in the groove in the tip of the wedge portion, and the intermediate cross member of the frame being received in the hook of the distractor.

38. The combination ofclaim 37 and wherein:

the wedge portion of the distractor is located between the frame side members.

39. The combination ofclaim 38 and wherein:

the head portion of the distractor is located between portions of the side members of the frame.

40. The combination ofclaim 38 and wherein:

portions of the wedge portion are adjacent frontal portions of the side members and diverge vertically in a rearward direction from a rounded tip to a shoulder at the head portion.

41. The combination ofclaim 40 and wherein:

the frontal portions of the side members of the frame adjacent the wedge portion diverge in a manner similar to the wedge portion from the front cross member rearward.

42. The combination ofclaim 41 and wherein:

the handle portion and wedge portion and front cross member lie in a first plane; and

the side members have portions intermediate the frontal portions and extending rearward from the frontal portions and away from the first plane to the rear cross member in a second plane offset from the first plane to admit a powered instrument to the space between the planes upon separation of the distractor from the frame.

43. The combination ofclaim 42 and wherein:

the departure of the intermediate portions of the side members from the first plane to the second plane is sufficient to admit a cutter instrument into the space between the planes.

44. A combination distractor and disc space keeper for use in spinal surgery, comprising:

a distractor extending along a longitudinal axis and including a wedge portion, an elongate shaft portion, and a forward facing engagement portion, the wedge portion having a distal tip and upper and lower surfaces that diverge away from one another from the distal tip in a rearward direction toward the shaft portion;

an elongate frame having two side members laterally offset from one another to define a housing space therebetween, the frame including a transverse cross member between the side members; and

wherein the distractor and the frame are removably assembled together with the wedge portion of the distractor positioned within the housing space between the side members of the frame and with the forward facing engagement portion of the distractor engaged with the transverse cross member of the frame.

45. The combination ofclaim 44, wherein the frame includes a front transverse cross member and a rear transverse cross member each extending between the side members.

46. The combination ofclaim 44, wherein the distal tip of the wedge portion of the distractor has a forward facing transverse groove; and

wherein the frame includes a front transverse cross member extending between the side members; and

wherein the front transverse cross member of the frame is received in the transverse groove in the distal tip of the wedge portion when the wedge portion is positioned within the housing space between the side members of the frame.

47. The combination ofclaim 44, wherein the forward facing engagement portion of the distractor comprises a forward facing hook; and

wherein the transverse cross member of the frame comprises a transverse pin; and

wherein the transverse pin is received in the forward facing hook when the wedge portion of the distractor is positioned within the housing space between the side members of the frame.

48. The combination ofclaim 47, wherein the forward facing hook of the distractor extends transversely from the shaft portion of the distractor.

49. The combination ofclaim 44, wherein the distractor further includes a head portion between the wedge portion and the shaft portion, the distractor defining abutment shoulders at the transition from the wedge portion to the head portion and extending outward from the upper and lower surfaces of the wedge portion, respectively.

50. The combination ofclaim 49, wherein the abutment shoulders have an arcuate shape.

51. The combination ofclaim 44, further comprising a cutter instrument having a cutting head sized for insertion into the housing space between the side members of the frame and adapted for preparation of vertebral endplates.

52. The combination ofclaim 44, wherein the wedge portion is positioned adjacent frontal portions of the side members of the frame; and

wherein the frontal portions of the side members include upper and lower frame surfaces that diverge in a manner similar to the upper and lower surfaces of the wedge portion in the rearward direction.

53. The combination ofclaim 44, wherein the side members have frontal portions positioned adjacent the wedge portion of the distractor and lying in a first plane, intermediate portions extending rearward from the frontal portions away from the first plate, and rear portions extending rearward from the intermediate portions and lying in a second plane offset from the first plane, the first and second planes spaced apart to admit a cutter instrument in a space between the first and second planes upon removal of the distractor from the frame.

54. The combination ofclaim 53, wherein the transverse cross member of the frame is offset from the first plane.

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