US20100222829A1 - Spinal plug for a minimally invasive joint fusion system - Google Patents
Spinal plug for a minimally invasive joint fusion systemDownload PDFInfo
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- US20100222829A1 US20100222829A1US12/719,290US71929010AUS2010222829A1US 20100222829 A1US20100222829 A1US 20100222829A1US 71929010 AUS71929010 AUS 71929010AUS 2010222829 A1US2010222829 A1US 2010222829A1
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- facet joint
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
- A61B17/7062—Devices acting on, attached to, or simulating the effect of, vertebral processes, vertebral facets or ribs ; Tools for such devices
- A61B17/7064—Devices acting on, attached to, or simulating the effect of, vertebral facets; Tools therefor
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
- A61B17/1604—Chisels; Rongeurs; Punches; Stamps
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
- A61B17/1662—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body
- A61B17/1671—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body for the spine
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
- A61L27/36—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix
- A61L27/3604—Materials for grafts or prostheses or for coating grafts or prostheses containing ingredients of undetermined constitution or reaction products thereof, e.g. transplant tissue, natural bone, extracellular matrix characterised by the human or animal origin of the biological material, e.g. hair, fascia, fish scales, silk, shellac, pericardium, pleura, renal tissue, amniotic membrane, parenchymal tissue, fetal tissue, muscle tissue, fat tissue, enamel
- A61L27/3608—Bone, e.g. demineralised bone matrix [DBM], bone powder
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
- A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/28—Bones
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/4405—Joints for the spine, e.g. vertebrae, spinal discs for apophyseal or facet joints, i.e. between adjacent spinous or transverse processes
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/44—Joints for the spine, e.g. vertebrae, spinal discs
- A61F2/4455—Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30772—Apertures or holes, e.g. of circular cross section
- A61F2002/30784—Plurality of holes
- A61F2002/30785—Plurality of holes parallel
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30878—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves with non-sharp protrusions, for instance contacting the bone for anchoring, e.g. keels, pegs, pins, posts, shanks, stems, struts
- A61F2002/30879—Ribs
- A61F2002/30881—Circumferential ribs, flanges or fins
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00359—Bone or bony tissue
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
- A61L2430/00—Materials or treatment for tissue regeneration
- A61L2430/02—Materials or treatment for tissue regeneration for reconstruction of bones; weight-bearing implants
Definitions
- the present inventionrelates generally to minimally invasive spine surgery and, more particularly, to using an arthroscopic type portal or open facet joint fusion surgical instrumentation for insertion of either pre-made, pre-shaped synthetic cortical bone or harvested and compacted iliac crest grafts, autologous or cadaveric allografts.
- the graft and fusion systemis limited to the forty-eight facet joints located on the spine, C1-C2 through L5-S1.
- One of the root causes of back pain, particularly the persistent and disabling kind,are facet joints, small joints located behind adjacent vertebrae in the spine that allow for spinal motion.
- pre-shaped, harvested or synthetic boneas a structural fixation for facet joint fusion offers three distinct advantages over pedicle or compression screws, which are presently used in facet fusion procedures; i.e., (1) using bone instead of metal allowing for natural bone ingrowth and a stronger, permanent fusion; and (2) the natural or synthetic graft cannot work its way loose over time, a concern with screw type fixation.
- the grafts and systemare specifically designed for use in a minimum invasive or an arthroscopic type portal for stand-alone procedures and provide a stronger, unique and superior fusion when used as an adjunct to instrumented vertebral fusion by greatly reducing risk of facet joint pain resulting from persistent facet joint motion.
- the minimally invasive facet joint fusion for the treatment of a diseased or painful facet joint that is not appropriate for resurfacing or replacementinvolves the use of instrumentation and autograft, cadaveric allograft or FDA approved pre-made, pre-shaped synthetic cortical bone graft for use in minimally invasive, outpatient, arthroscopic spine surgery or classic open surgery and, more specifically, to fuse spinal facet joints from C1-C2 through L5-S1. This system serves as a primary or a revision surgery.
- the present inventionaccomplishes a superior spinal facet joint fusion by providing a grafting alternative to facilitate fusion using arthroscopic portal or open surgical techniques of the C1-C2 through L5-S1 spinal facet joints.
- the arthroscopic facet joint fusion systemcomprises a punch or drill that creates a hole through both sides of the facet joint in a conical pattern.
- the holeis filled with either the patient's own harvested and compacted bone plug using iliac crest autograft, pre-made, pre-shaped cortical cadaveric allograft (the autograft or allograft formed by bone plug press or machining) or FDA approved pre-made, pre-shaped synthetic grafts.
- the punch or drillincludes any number of components capable of performing the creation of a hole through both sides of the spinal facet joint using an arthroscope or similar portal to access the joint or during classic open surgery.
- the punch/drillincludes a hand actuator that will create sufficient pressure to create a specific sized hole through both sides of the spinal facet joint using a mechanical arrangement similar to that of common pliers resized to work through an arthroscopic opening.
- a drill guidecan be placed and a specifically sized and shaped drill bit can be used to create the opening, either in a horizontal or vertical direction through the facet joint.
- the bone plug press(graft forming or compression instrument) includes any number of components capable of using harvested autograft, cadaveric allograft cortical bone or a synthetic alternative to match the bone tunnel made by the punch or drill.
- the bone plug pressincludes a mechanism similar to common pliers or a more standard hand press that will transfer sufficient force to form bone plugs by squeezing the handles together to form the bone plug and compress the bone or synthetic alternative to the proper density and shape.
- the impactor or tampincludes any number of components capable of pushing and compressing the bone plug into the bone tunnels.
- a suture or metallic overlayalso can be applied to provide additional structural stability to the joint during graft incorporation.
- FIG. 1shows a frustum shaped bone plug of this invention for employment in a facet joint fusion
- FIG. 2shows a tapered drill used to prepare for the bone plug
- FIG. 3shows a hole prepared for the bone plug
- FIG. 4shows a bone plug inserted in the hole of FIG. 3 and with an application tube for inserting synthetic or biologic material
- FIG. 5is a cross-section along line 5 - 5 of FIG. 4 ;
- FIG. 6is a cross-section along line 6 - 6 of FIG. 4 ;
- FIG. 7is a cross-section according to FIG. 6 showing synthetic or biologic material cementing the bone plug in place;
- FIG. 8shows a first alternative frustum shaped bone plug
- FIG. 9shows a cross-section of the frustum shaped bone plug of FIG. 8 along lines 9 - 9 ;
- FIG. 10shows a second alternative frustum shaped bone plug.
- FIG. 11shows an instrument and arthroscopic portal according to an embodiment of the invention.
- FIG. 12shows an instrument and arthroscopic portal according to an embodiment of the invention.
- the bone plug of this inventionis an inverted frustum shaped device 10 having a vertical central channel 12 for insertion of a synthetic or biologic material to assist in fusing the bone plug 10 in place in a spinal joint 15 .
- the bone plug 10has multiple side parts 14 and 16 for excretion of the synthetic or biologic material from the central channel 12 .
- a pair of opposed flanges 18 and 20 on the same planepartially circumvent the bone plug 10 near bottom end 22 having a smaller diameter than the top end 24 .
- a tapered drill 26In order to fuse a spinal facet joint, a tapered drill 26 , shown in FIG. 2 , is employed to prepare a hole 28 shown in FIG. 3 between two bones 30 and 32 .
- a drill guide 31may be used to guide the tapered drill 26 to prepare the hole 28 in the correct location.
- Drill guide 31may be secured to the facet joint by teeth 33 to prevent displacement during hole preparation.
- an application tube 34is inserted in channel 12 to permit insertion of a synthetic or biologic material 36 into bone plug 10 .
- the biologic material 36flows down channel 12 as shown in FIG. 5 , and excess biologic material flows out of side parts 14 and 16 through channels 42 and 44 , respectively, into a space 38 between the bones 30 and 32 , and an exterior side wall 40 of the bone plug 10 .
- the flanges 18 and 20act as detents to hold the bone plug 10 in place within hole 28 .
- the biologic material 36flows outwardly from openings 14 and 16 into a space 38 to cement the plug 10 in place
- FIGS. 8 and 9An alternative plug 10 a is shown in FIGS. 8 and 9 .
- a central channel 12 afeeds biologic material to side channels 46 , 42 and 44 a .
- biologic material 36flows out through openings 52 , 14 a and 16 a and promotes bonding to the bone.
- a second parallel pair of flanges 48 and 50are added to flanges 18 a and 20 a to increase the strength of the plug 10 a in the hole 28 .
- Side wall 40 a in like manner to plug 10is narrower in diameter at a bottom end 22 a than its top end 24 a.
- the present inventionis directed at overcoming, or at least improving upon, the disadvantages of the prior art by achieving the following:
- Outpatient versus inpatient surgery(about 20 minutes per joint versus hours). Note: this procedure may also be performed during open surgery at the discretion of the physician;
- the present inventionis directed at overcoming, or at least improving upon, the disadvantages of the prior art.
- the tapered drillis specifically used through an arthroscopic type portal allowing access to the joint through a small incision and progressive dilation of the intervening soft tissue.
- the instrument designdoes not preclude its use in a classic open surgery or by access to the facet joint through an otherwise limited incision.
- the opening 28is marginally smaller than the bone plug 10 to create proper fixation of the plug 10 and the joint.
- a fused facet joint plug 10 , 10 a or 10 bis shown with one shaped autograft, cadaveric allograft or FDA approved synthetic pre-made, pre-shaped cortical bone plug.
- the anterior end 22 or 22 a of the plug 10 or 10 ais 3-8 mm and the posterior end 24 or 24 a of the plug 10 , 10 a or 10 b is 4-12 mm in diameter in a frustum shape with the wider portion located in the posterior portion to facilitate fixation during bone graft incorporation.
- the procedureis envisioned to require only one bone plug per facet joint and two per level. Permanent fixation occurs when bone in-growth occurs into the joint itself and into the plug over time.
- the frustum shaped bone graft 10 bas shown in FIG. 10 , can be employed when no additional biologic material is required.
- FIG. 11illustrates a bone punch instrument as an embodiment of the invention shown without representation of a press accessory, which can be attached to the punch tips 4 and used to press a bone plug into place.
- the instrumentis specifically invented to be used through an arthroscopic type portal 1 allowing access to the joint through a small incision and progressive dilation of the intervening soft tissue.
- arthroscopic type portal 1comprises a cylindrical tube configured to provide access to a facet joint during surgery.
- the arthroscopic type portal 1has an outer surface that prevents the encroachment of surrounding biological material into the surgical site at the facet joint and has an inner surface that forms a substantially cylindrical space that provides access to the facet joint for the surgical tools.
- a separating handle 2is specifically designed to provide sufficient mechanical advantage to the punch tips 4 .
- Punch tips of different sizesto create an appropriate opening to receive the sized bone plug selected by a physician.
- the openingis marginally smaller than the bone plug to create proper fixation of the plug and the joint.
- Mechanical advantage created by pressure on the handleis transferred to the punch tips using an “X” type joint 3 .
- FIG. 12illustrates a specially designed osteotome as an embodiment of the invention, which accesses the facet joint through an arthroscopic type portal 5 and is used to make a thin slice into the bone on each of the inner surfaces of the joint to prepare the surface to heal together in a permanent fusion.
- the osteotomeis equipped with a specifically sized single use blade 6 shown in situ in the correct aspect into a facet joint 7 .
- the osteotomeis impacted with a slap-hammer 8 to make the cuts and is properly positioned using a loop 9 on the osteotome shaft.
- a protective stop 10is provided to ensure that the osteotome blade does not penetrate to an unsafe depth.
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Abstract
Description
- This application is continuation of application Ser. No. 11/232,519, filed Sep. 22, 2005, which is a continuation-in-part from application Ser. No. 10/992,720, filed Nov. 22, 2004, now abandoned which is expressly incorporated herein by reference.
- 1. Field of the Invention
- The present invention relates generally to minimally invasive spine surgery and, more particularly, to using an arthroscopic type portal or open facet joint fusion surgical instrumentation for insertion of either pre-made, pre-shaped synthetic cortical bone or harvested and compacted iliac crest grafts, autologous or cadaveric allografts. The graft and fusion system is limited to the forty-eight facet joints located on the spine, C1-C2 through L5-S1.
- 2. Description of the Prior Art
- In the United States alone, about 10% of the entire population will suffer from back pain sometime in the next twelve months. More people will contract back pain in the next year than any other injury or disease except the common cold and flu. About one-third will not recover and have to live with persistent, disabling symptoms. The number is cumulative year after year.
- One of the root causes of back pain, particularly the persistent and disabling kind, are facet joints, small joints located behind adjacent vertebrae in the spine that allow for spinal motion.
- Present surgical solutions available for the millions of people with facet joint dysfunctions are complex, invasive, pedicle screw based high-risk operations with prolonged recovery times, from 6 to 24 months, and uncertain outcomes. High risk equates to frequent litigation, which forces non-surgical symptomatic treatment while the disease or consequences of injury progressively worsen. Some of these efforts provide intervertebral fusion described in U.S. Pat. No. 6,485,518 and U.S. Patent Application Serial Number 2003/0032960. Numerous patents have been granted for general fusion of the spine that may or may not involve the facet joint by proximity or design.
- With the advent of new, safer and less invasive surgical techniques and technology, the growth of spine surgery now outpaces every other orthopedic surgery segment. Its growth is further fueled by an enormous demand.
- The use of pre-shaped, harvested or synthetic bone as a structural fixation for facet joint fusion offers three distinct advantages over pedicle or compression screws, which are presently used in facet fusion procedures; i.e., (1) using bone instead of metal allowing for natural bone ingrowth and a stronger, permanent fusion; and (2) the natural or synthetic graft cannot work its way loose over time, a concern with screw type fixation.
- The grafts and system are specifically designed for use in a minimum invasive or an arthroscopic type portal for stand-alone procedures and provide a stronger, unique and superior fusion when used as an adjunct to instrumented vertebral fusion by greatly reducing risk of facet joint pain resulting from persistent facet joint motion.
- The minimally invasive facet joint fusion for the treatment of a diseased or painful facet joint that is not appropriate for resurfacing or replacement, involves the use of instrumentation and autograft, cadaveric allograft or FDA approved pre-made, pre-shaped synthetic cortical bone graft for use in minimally invasive, outpatient, arthroscopic spine surgery or classic open surgery and, more specifically, to fuse spinal facet joints from C1-C2 through L5-S1. This system serves as a primary or a revision surgery.
- The present invention accomplishes a superior spinal facet joint fusion by providing a grafting alternative to facilitate fusion using arthroscopic portal or open surgical techniques of the C1-C2 through L5-S1 spinal facet joints.
- According to one broad aspect of the present invention, the arthroscopic facet joint fusion system comprises a punch or drill that creates a hole through both sides of the facet joint in a conical pattern. The hole is filled with either the patient's own harvested and compacted bone plug using iliac crest autograft, pre-made, pre-shaped cortical cadaveric allograft (the autograft or allograft formed by bone plug press or machining) or FDA approved pre-made, pre-shaped synthetic grafts.
- The punch or drill includes any number of components capable of performing the creation of a hole through both sides of the spinal facet joint using an arthroscope or similar portal to access the joint or during classic open surgery. By way of example only, the punch/drill includes a hand actuator that will create sufficient pressure to create a specific sized hole through both sides of the spinal facet joint using a mechanical arrangement similar to that of common pliers resized to work through an arthroscopic opening. Additionally, a drill guide can be placed and a specifically sized and shaped drill bit can be used to create the opening, either in a horizontal or vertical direction through the facet joint.
- The bone plug press (graft forming or compression instrument) includes any number of components capable of using harvested autograft, cadaveric allograft cortical bone or a synthetic alternative to match the bone tunnel made by the punch or drill. By way of example only, the bone plug press includes a mechanism similar to common pliers or a more standard hand press that will transfer sufficient force to form bone plugs by squeezing the handles together to form the bone plug and compress the bone or synthetic alternative to the proper density and shape.
- The impactor or tamp includes any number of components capable of pushing and compressing the bone plug into the bone tunnels. A suture or metallic overlay also can be applied to provide additional structural stability to the joint during graft incorporation.
- Many advantages of the present invention will be apparent to those skilled in the art with a reading of this specification in conjunction with the attached drawings, wherein like reference numerals are applied to like elements and wherein:
FIG. 1 shows a frustum shaped bone plug of this invention for employment in a facet joint fusion;FIG. 2 shows a tapered drill used to prepare for the bone plug;FIG. 3 shows a hole prepared for the bone plug;FIG. 4 shows a bone plug inserted in the hole ofFIG. 3 and with an application tube for inserting synthetic or biologic material;FIG. 5 , is a cross-section along line5-5 ofFIG. 4 ;FIG. 6 is a cross-section along line6-6 ofFIG. 4 ;FIG. 7 is a cross-section according toFIG. 6 showing synthetic or biologic material cementing the bone plug in place;FIG. 8 shows a first alternative frustum shaped bone plug;FIG. 9 shows a cross-section of the frustum shaped bone plug ofFIG. 8 along lines9-9; andFIG. 10 shows a second alternative frustum shaped bone plug.FIG. 11 shows an instrument and arthroscopic portal according to an embodiment of the invention.FIG. 12 shows an instrument and arthroscopic portal according to an embodiment of the invention.- Referring to
FIG. 1 , the bone plug of this invention is an inverted frustumshaped device 10 having a verticalcentral channel 12 for insertion of a synthetic or biologic material to assist in fusing thebone plug 10 in place in a spinal joint15. Thebone plug 10 hasmultiple side parts central channel 12. A pair ofopposed flanges bone plug 10 near bottom end22 having a smaller diameter than thetop end 24. - In order to fuse a spinal facet joint, a
tapered drill 26, shown inFIG. 2 , is employed to prepare a hole28 shown inFIG. 3 between twobones drill guide 31 may be used to guide thetapered drill 26 to prepare the hole28 in the correct location.Drill guide 31 may be secured to the facet joint byteeth 33 to prevent displacement during hole preparation. As seen inFIG. 4 , anapplication tube 34 is inserted inchannel 12 to permit insertion of a synthetic orbiologic material 36 intobone plug 10. Thebiologic material 36 flows downchannel 12 as shown inFIG. 5 , and excess biologic material flows out ofside parts channels space 38 between thebones exterior side wall 40 of thebone plug 10. Theflanges bone plug 10 in place within hole28. As seen further inFIG. 7 , thebiologic material 36 flows outwardly fromopenings space 38 to cement theplug 10 in place. - An
alternative plug 10ais shown inFIGS. 8 and 9 . A central channel12afeeds biologic material toside channels biologic material 36 flows out throughopenings flanges flanges 18aand20 a to increase the strength of theplug 10ain the hole28. Side wall40ain like manner to plug10 is narrower in diameter at a bottom end22athan its top end24a. - If the joint is determined to be too badly damaged or diseased for present replacement methods or prospective methods such as facet joint hemi-arthroplasty, minimally invasive facet joint fusion is prospectively a superior alternative for three primary reasons:
- 1. It is minimally invasive surgery that can be performed in an outpatient setting as opposed to major surgery performed in a hospital. This procedure can also be performed during open surgery if the facet joints need to be fused as determined by a physician particularly in conjunction with instrumented vertebral fusion;
- 2. Recovery times are estimated to be a few weeks as opposed to 6 to 12 months; and
- 3. It takes full advantage of advances in biomaterials and synthetic alternatives.
- The present invention is directed at overcoming, or at least improving upon, the disadvantages of the prior art by achieving the following:
- Reversal of the cost/benefit ratio of present procedures versus the invention;
- A minimally invasive procedure versus major open surgery;
- Outpatient versus inpatient surgery (about 20 minutes per joint versus hours). Note: this procedure may also be performed during open surgery at the discretion of the physician;
- Can be used to augment present open fusion techniques to lessen the need for bone stimulation especially in high risk groups such as smokers and multi-level cases;
- Reduced morbidity;
- Reduced blood loss;
- Reduced time under anesthesia;
- Reduced risk;
- Recovery time dramatically reduced;
- Minimal scarring that decreases the risk of failed back syndrome and improves revision surgery outcome;
- Reduced risk of post operative infection by significantly reducing operating room time and soft tissue destruction;
- No preclusion of other surgical or non-invasive treatment options; and,
- Projected high success rate by utilizing accepted arthroscopic procedures employing a new technique and taking advantage of either existing cortical bone harvesting procedures in combination with unique instrumentation to shape and prepare the bone or new pre-shaped, pre-made synthetic cortical bone alternatives as they are made generally available by FDA approval.
- It is anticipated that the availability of this system and graft alternatives will dramatically increase the number of surgeries performed because they offer the first safe outpatient surgical solution to the predominant cause of spinal joint pain. It is expected that virtually all patients receiving this procedure will be able to walk out the same day and be fully functional within a few weeks. Present surgical solutions require hospitalization of about three days and six to twenty-four months recovery.
- Aside from the obvious positive clinical outcome, the significant favorable financial impact on disability, worker's compensation and health care insurers is considerable.
- Spinal facet implant units are calculated per joint. Each patient has two joints per spinal segment and twenty-four segments, C1-C2 through L5-S1 for a total of forty-eight facet joints. Each surgery is likely to involve multiple joints.
- The present invention is directed at overcoming, or at least improving upon, the disadvantages of the prior art.
- In inserting the
plug 10, the tapered drill is specifically used through an arthroscopic type portal allowing access to the joint through a small incision and progressive dilation of the intervening soft tissue. The instrument design does not preclude its use in a classic open surgery or by access to the facet joint through an otherwise limited incision. The opening28 is marginally smaller than thebone plug 10 to create proper fixation of theplug 10 and the joint. - Referring again to
FIGS. 1 and 8 , a fused facetjoint plug plug posterior end 24 or24aof theplug - The frustum shaped
bone graft 10b, as shown inFIG. 10 , can be employed when no additional biologic material is required. FIG. 11 illustrates a bone punch instrument as an embodiment of the invention shown without representation of a press accessory, which can be attached to thepunch tips 4 and used to press a bone plug into place. The instrument is specifically invented to be used through anarthroscopic type portal 1 allowing access to the joint through a small incision and progressive dilation of the intervening soft tissue. In this embodiment,arthroscopic type portal 1 comprises a cylindrical tube configured to provide access to a facet joint during surgery. Thearthroscopic type portal 1 has an outer surface that prevents the encroachment of surrounding biological material into the surgical site at the facet joint and has an inner surface that forms a substantially cylindrical space that provides access to the facet joint for the surgical tools. The instrument design does not preclude its use in a classic open surgery or by access to the facet joint through an otherwise limited incision. A separatinghandle 2 is specifically designed to provide sufficient mechanical advantage to thepunch tips 4. Punch tips of different sizes to create an appropriate opening to receive the sized bone plug selected by a physician. The opening is marginally smaller than the bone plug to create proper fixation of the plug and the joint. Mechanical advantage created by pressure on the handle is transferred to the punch tips using an “X”type joint 3.FIG. 12 illustrates a specially designed osteotome as an embodiment of the invention, which accesses the facet joint through anarthroscopic type portal 5 and is used to make a thin slice into the bone on each of the inner surfaces of the joint to prepare the surface to heal together in a permanent fusion. The osteotome is equipped with a specifically sizedsingle use blade 6 shown in situ in the correct aspect into afacet joint 7. The osteotome is impacted with a slap-hammer 8 to make the cuts and is properly positioned using aloop 9 on the osteotome shaft. Aprotective stop 10 is provided to ensure that the osteotome blade does not penetrate to an unsafe depth.- Other equivalent elements can be substituted for the elements disclosed herein to produce substantially the same results in substantially the same way.
Claims (14)
1-21. (canceled)
22. An arthroscopic type portal facet surgical method comprising:
placing an arthroscopic type portal into a human patient through a minimally invasive incision in the tissue of said human patient;
accessing a facet joint through said portal, wherein said facet joint comprises a first facet joint bone and a second facet joint bone, and wherein said first facet joint bone comprises a first articulated surface and said second facet joint bone comprises a second articulated surface, and wherein said first articulated surface and said second articulated surface face each other at said facet joint;
removing a first portion of the first facet joint bone at the first articulated surface and a second portion of the second facet joint bone at the second articulated surface to create a space between the first and second facet joint bones;
inserting a facet joint fusion plug into said space through said portal; and
pushing said facet joint fusion plug into said space.
23. The method ofclaim 22 , wherein said facet joint fusion plug comprises a material selected from one or more of the group consisting of a synthetic bone substitute, a metal bone substitute, a harvested compacted iliac crest graft, an autologous autograft and a cadaveric allograft.
24. The method ofclaim 22 , wherein after said removal said remaining portions of said bones define said space as conically shaped and
said space has a shape allowing said facet joint fusion plug to be tamped into said hole.
25. The method ofclaim 22 , wherein said step of placing said arthroscopic type portal into said human patient comprises placing a drill guide into said human patient, wherein said drill guide comprises said arthroscopic type portal.
26. The method ofclaim 25 , wherein said drill guide comprises teeth for maintaining the drill guide proximate to said facet joint.
27. The method ofclaim 22 , wherein said facet joint fusion plug comprises a cadaveric allograft.
28. The method ofclaim 22 , wherein said pushing compresses said facet joint fusion plug in said space.
29. The method ofclaim 22 , wherein said facet joint fusion plug comprises a material that can be integrated into said facet joint through bone ingrowth.
30. The method ofclaim 22 , wherein said facet joint fusion plug comprises a material selected from the group consisting of synthetic cortical bone graft and synthetic nonmetallic bone substitute.
31. The method ofclaim 22 , wherein after removal of said first portion and second portion, a diameter of a posterior cross-section of the space is greater than a diameter of a cross-section of the facet joint fusion plug.
32. The method ofclaim 31 , wherein said facet joint fusion plug is fixed in said space by compression of said facet joint fusion plug after said step of pushing said facet joint plug into said space.
33. The method ofclaim 22 , wherein said facet joint fusion plug comprises a flange.
34. The method ofclaim 32 , wherein said facet joint fusion plug further comprises a substantially frustum shaped region, and said flange is disposed on a surface of said substantially frustum shaped region.
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| US12/719,290US20100222829A1 (en) | 2004-11-22 | 2010-03-08 | Spinal plug for a minimally invasive joint fusion system |
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| US11/232,519Expired - Fee RelatedUS7708761B2 (en) | 2004-11-22 | 2005-09-22 | Spinal plug for a minimally invasive facet joint fusion system |
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| US9604040B1 (en) | 2008-10-15 | 2017-03-28 | Nuvasive, Inc. | System and methods for performing spinal fusion surgery |
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| US10022172B2 (en) | 2014-06-25 | 2018-07-17 | Spine Wave, Inc. | Minimally invasive posterolateral fusion |
| US9775723B2 (en) | 2015-06-16 | 2017-10-03 | Spine Wave, Inc. | Instrument and system for placing graft, implant and graft material for minimally invasive posterolateral fusion |
| US12178721B1 (en) | 2021-04-12 | 2024-12-31 | Seaspine, Inc. | Bone joint inserter device and methods of use thereof |
Also Published As
| Publication number | Publication date |
|---|---|
| WO2006057943A2 (en) | 2006-06-01 |
| RU2007123464A (en) | 2008-12-27 |
| EP1814497A4 (en) | 2011-10-19 |
| US20060111779A1 (en) | 2006-05-25 |
| US7708761B2 (en) | 2010-05-04 |
| KR20070088693A (en) | 2007-08-29 |
| MX2007006115A (en) | 2007-10-04 |
| AU2005309758A1 (en) | 2006-06-01 |
| CN101083958A (en) | 2007-12-05 |
| EP1814497A2 (en) | 2007-08-08 |
| WO2006057943A3 (en) | 2007-02-01 |
| ZA200703665B (en) | 2008-06-25 |
| JP2008520377A (en) | 2008-06-19 |
| NO20072727L (en) | 2007-05-29 |
| MA29035B1 (en) | 2007-11-01 |
| CA2586352A1 (en) | 2006-06-01 |
| US20060111782A1 (en) | 2006-05-25 |
| IL182925A0 (en) | 2007-09-20 |
| BRPI0518056A (en) | 2008-10-28 |
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