US20100280560A1 - Reducing Instrument for Spinal Surgery - Google Patents

Abstract

An instrument is provided for use in orthopedic surgery for reduction of a connecting member such as a spinal rod toward an implant such as a bone screw. An embodiment of the instrument includes handle portions that are pivotable relative to each other and biased apart, and arm portions pivotable relative to each other and to the handle portions. Distal portions of the arm portions, which may be offset from the arm portions, provide structure for engaging a connecting member and an implant. Squeezing the handle portions force the distal portions of the arm portions together, forcing together the connecting member and the implant. A toothed bar and pawl may be provided to retain the instrument in a squeezed state.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This application is a continuation in part of and claims priority to U.S. patent application Ser. No. 11/043,318, filed Jan. 26, 2005.
BACKGROUND
• In orthopedic surgical procedures, it is known to implant devices to support bones or other tissue, to correct deformities, to hold tissues in position for healing after injuries or other surgery, and for other purposes relating to orthopedic health. For example, where correction of a scoliotic or other abnormal curvature or misalignment of the spine is desired, a sturdy rod, plate, or other elongated connecting member can be placed along one or more vertebral segments to support or hold the segments in a corrected position. Bone screws, bone hooks or other fixation implants are attached to vertebrae and connected to the connecting member to secure the connecting member along the spinal column.
• Commonly, the fixation implants and the connecting member(s) are placed separately, that is, they are not connected together prior to implantation in the body. For example, bone screws may be implanted into vertebrae first, connectors may be placed on or around the screws (if necessary), and then the connecting member may be placed into the body. The connecting member may be contoured prior to insertion to approximate the curvature desired, or it may be contoured after placement adjacent the spine. In cases where a connecting member and bone screws or other fixation elements are separately placed, the connecting member and screws may be required to be forced toward each other for connection. The process of moving the connecting member and fixation elements toward each other for connection is generally termed “reduction.”
• Reduction can be accomplished by hand, although the environment and close quarters of a surgical site can make reduction by hand quite difficult. While instruments have been developed to provide a mechanical advantage in reducing or positioning the connecting member relative to an anchor, there remains a need for reducing instruments which are maneuverable relative to the anchor and connecting member to facilitate insertion and manipulation of the connecting member and anchor through the incision or portal in which the reducing instrument is positioned.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a perspective view of an embodiment of an instrument according to the present invention.
• FIG. 2 is an exploded perspective view of the embodiment shown inFIG. 1.
• FIG. 3 is another view of the embodiment shown inFIG. 1 in substantially a reverse perspective from that shown inFIG. 1, with certain parts shown in exploded fashion.
• FIG. 4 is a top plan view of an embodiment of an arm portion of the embodiment shown inFIG. 1.
• FIG. 5 is a side plan view of the embodiment shown inFIG. 4.
• FIG. 6 is a partial cross-sectional view of the embodiment shown inFIG. 4, taken along the line6-6 inFIG. 5 and viewed in the direction of the arrows.
• FIG. 7 is a top plan view of an embodiment of an arm portion of the embodiment shown inFIG. 1.
• FIG. 8 is a cross-section view of the embodiment shown inFIG. 7, taken along the line8-8 inFIG. 7 and viewed in the direction of the arrows.
• FIG. 9 is a side plan view of the embodiment shown inFIG. 7.
• FIG. 10 is a bottom plan view of the embodiment shown inFIG. 7.
• FIG. 11 is a side view of an embodiment of an instrument in relation to an orthopedic rod and an orthopedic implant.
• FIG. 12 is a side view of the embodiment shown inFIG. 11 in relation to a reduced orthopedic rod.
• FIG. 13A is a perspective view of arm portions of another embodiment of an instrument according to the present invention in relation to an orthopedic rod and an orthopedic implant.
• FIG. 13B is a side view of the embodiment shown inFIG. 13A in relation to an orthopedic rod and an orthopedic implant.
• FIG. 14A is a perspective view of arm portions of another embodiment of an instrument according to the present invention in relation to an orthopedic rod and an orthopedic implant.
• FIG. 14B is a side view of the embodiment shown inFIG. 14A in relation to an orthopedic rod and an orthopedic implant.
• FIG. 15A is a perspective view of arm portions of another embodiment of an instrument according to the present invention in relation to an orthopedic rod and an orthopedic implant.
• FIG. 15B is a side view of the embodiment shown inFIG. 15A in relation to an orthopedic rod and an orthopedic implant.
• FIG. 16A is a perspective view of arm portions of another embodiment of an instrument according to the present invention in relation to an orthopedic rod and an orthopedic implant.
• FIG. 16B is a side view of the embodiment shown inFIG. 16A in relation to an orthopedic rod and an orthopedic implant.
• FIG. 17 is a side view of another embodiment of an instrument according to the present invention.
• FIG. 18 is a perspective view of an arm portion of another embodiment of an instrument according to the present invention.
• FIG. 19 is side view of arm portions of another embodiment of an instrument according to the present invention in relation to an orthopedic rod and an orthopedic implant.
• FIG. 20 is side view of arm portions of another embodiment of an instrument according to the present invention in relation to an orthopedic rod and an orthopedic implant.
DESCRIPTION OF THE ILLUSTRATED EMBODIMENT
• For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiment 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 thereby intended. Any such alterations and further modifications in the illustrated device, and any such further applications of the principles of the invention as illustrated herein, are contemplated as would normally occur to one skilled in the art to which the invention relates.
• Referring generally to the figures, there is shown a reducinginstrument20 that is removably engageable to an implant (e.g. a bone screw or other anchor) and operable to move a rod or other elongated connecting member and the implant toward each other. Reducinginstrument20 includeshandle portions22 and24,springs26 and28, andarm portions30 and32. Use ofinstrument20 allows good visibility of the implant and remote or sideward positioning of the reducing instrument in alignment with the implant.
• Handle portion22 is generally elongated, having a generallyproximal end40 and a generally distal end42.Proximal end40 may be pivotally connected to atoothed bar44. Toothedbar44 may be pivotally connected at46 to aratchet post48, having aslot49, which is pivotally connected toproximal end40 ofhandle portion22.Handle portion22 may also have a thickenedportion50 to provide a guide for the surgeon's hand, to provide a more stable or secure connection tobar44 and/orratchet post48 if they are present, or for other purposes.Handle portion22 also includeshole52 through whichhandle portion22 can be connected to handleportion24.Hole52 is formed through a part-circular portion53 that extends from an inside surface ofhandle portion22.Portion53 is thinner thanhandle portion22 and is substantially centered onhandle portion22.Hole52 is generally betweenproximal end40 and distal end42; in the illustratedembodiment hole52 is relatively close to or adjacent distal end42. A forkedportion54 is provided at distal end42, for connecting to an arm portion, as further described below. Forkedportion54 includesholes55aand55b, one of which (e.g.55a) may be threaded.
• Handle portion24 is generally elongated, having a generallyproximal end60 and a generallydistal end62.Proximal end60 may include apawl64 for engagingtoothed bar44. Further, arelease lever66 having ahandle68 and acontact surface70 may be pivotally connected toproximal end60. Pressing onhandle68causes lever66 to pivot so thatcontact surface70 pushes againstbar44 to disengagebar44 frompawl64, allowinghandle portions22 and24 to be spaced apart.Handle portion24 also includes agroove72 that makesdistal end62 generally divided or forked.Holes74aand74bthrough which handleportion24 can be connected to handleportion22 are provided generally betweenproximal end60 anddistal end62, and in the illustrated embodiment adjacentdistal end62.Holes74aand74bare formed through part-circular portions76aand76bthat extend from an inside surface ofhandle portion24. Forkeddistal end62 also includesholes78aand78bfor connecting to an arm portion, as further described below. One or both ofholes78aand78b(e.g.78a) may be threaded.
• In the illustrated embodiment, twoleaf springs26 and28 are provided to bias handleportions22 and24 apart.Spring26 is attached at or adjacent to anend90 to handleportion22 relatively close toproximal end40, as by aset screw91 or other connector.Spring28 is attached at or adjacent to anend92 to handleportion24 relatively close toproximal end60, as by aset screw91 or other connector.Springs26 and28 may interengage, for example via a tongue-and-groove type of engagement. In that configuration,spring26 may have atongue portion94 at the end oppositeend90, andspring28 may have agroove96 at the end oppositeend92. When springs26 and28 are attached to handleportions22 and24,tongue94 extends into and/or throughgroove96. In one particular embodiment,spring26 may have atab98 at or adjacent to end90 that can be inserted inslot49 ofratchet post46.Tab98 acts as a spring to apply a force onbar44 to maintainbar44 in contact withpawl64. It will be seen that only one leaf spring, such as spring26 (with or withouttongue94 or tab98) may be provided for biasinghandle portions22 and24 apart, or one or more coil or other springs may be provided, or other appropriate structure for biasinghandle portions22 and24 apart.
• Arm portion30 is an elongated piece having aproximal end110 and adistal end112. A relatively thin part-circular portion114 is provided at or adjacentproximal end110 with ahole116 for connecting to hole54 ofhandle portion22.Arm portion30 also includes a grooved or forkedportion118 generally betweenproximal end110 anddistal end112 and in the illustrated embodiment adjacentproximal end112.Holes120aand120bthrough whicharm portion30 can be connected toarm portion32 are provided in forkedportion118.Holes120aand120bare formed through part-circular portions121aand121bthat extend from an inside surface ofarm portion30. One or both ofholes120aand120b(e.g.120a) may be threaded.
• Distal end112 has a substantiallyU-shaped portion122 havingextension portions124 and126 andcross-pieces128 and130. In the illustrated embodiment,extension portions124 and126 are substantially parallel to each other, and are substantially perpendicular tocross-pieces128 and130.Cross piece128, in one embodiment, is essentially a lateral extension of the main part ofarm portion30, and may have anindentation129 through which a screwdriver or other tool can be extended to reach an implant, as for example to apply a locking member such as a set screw to the implant.Cross-piece130 may include atab132 generally extending towardcross-piece128, which may be at least partially curved, e.g. to provide a surface with a curvature approximating that of an orthopedic rod.Cross-piece130 may also include anindentation131 similar toindentation129 and for a similar purpose.Extension portions124 and126 include substantially part-cylindrical hollows134 and136, respectively.Hollows134 and136 are linear, i.e. the axes of the cylinders of which hollows134 and136 are a part are collinear, and hollows134 and136 may be of a size and curvature to accommodate an orthopedic rod, e.g. forming a substantially semi-circular (180-degree) section. In a particular embodiment,arm portion30 has a longitudinal axis L.U-shaped portion122 is laterally offset from axis L, and may be offset in a direction substantially perpendicular to axis L.U-shaped portion122 may also be angled with respect to axis L, in a particular embodiment so thatU-shaped portion122 bends towardarm portion32. Such an angle α may be about 160 degrees in one embodiment.
• Arm portion32 is an elongated piece having aproximal end140 and adistal end142. A relatively thin part-circular portion144 is provided at or adjacentproximal end140 with ahole145 for connecting toholes78aand78bofhandle portion24.Arm portion30 also includes another relatively thin part-circular portion146 with ahole148 generally betweenproximal end140 anddistal end142 and extending from an inside surface ofarm portion32, and in the illustrated embodiment adjacentproximal end142.Portion146 fits within forkedportion118 ofarm portion30 so thathole148 communicates withholes120aand120b.
• Distal end142 has a substantiallyU-shaped portion152 havingextension portions154 and156 andcross-piece158. In the illustrated embodiment,extension portions154 and156 are substantially parallel to each other, and are substantially perpendicular tocross-piece158.Cross piece158, in one embodiment, is essentially a lateral extension of the main part ofarm portion32.Extension portions154 and156 includeprotrusions160 and162 that may be substantially cylindrical.Protrusions160 and162 may be substantially linear, i.e. the axes ofprotrusions160 and162 are collinear, and may be relatively thin or short.Protrusions160 and162 are for connecting to indentations or hollows in an implant, and therefore they may be configured to accommodate the shape, depth and/or other features of such indentations or hollows.
• In a particular embodiment,arm portion32 has a longitudinal axis M.U-shaped portion152 can be laterally offset from axis M, and may be offset in a direction substantially perpendicular to axis M. As withportion122 ofarm30,U-shaped portion152 could also be angled with respect to axis M in another plane.
• As has been suggested above,instrument20 is assembled generally as follows. Handleportions22 and24 are connected by insertingthin portion53 ofhandle portion22 into groovedportion72 ofhandle portion24 so thathole52 ofhandle portion22 communicates withholes74aand74bofhandle portion24. An axle, for example a rivet, pin or set screw (e.g. setscrews170 inFIG. 3), can be inserted throughholes52,74aand74band secured so thathandle portions22 and24 can pivot with respect to each other around such an axle. In an embodiment in which at least one ofholes52,74aand74bare at least partially threaded, a set screw may be used as the axle, with the relative advantage that the interacting threads tend to retain the set screw within the holes. In other embodiments, a separate retaining piece, such as a ring to fit into a groove of an axle, or an additional step to retain the axle within the holes, such as swaging or peening part of the axle, can be included.
• It will be seen that connection ofhandle portions22 and24 should account for connections of associated parts that may be present. For example, in embodiments in which handleportion22 includestoothed bar44 and handleportion24 includespawl64, connection ofhandle portions22 and24 should ensure thatbar44 andpawl64 connect. Inembodiments including lever66,lever66 should be proximate to orabut bar44. As another example, in embodiments in which handleportions22 and/or24 include springs, connection ofhandle portions22 and24 should ensure that the one or more springs are proximate to or abut each other or the opposing handle portion so that biasing apart of thehandle portions22 and24 occurs. In one particular embodiment, as noted aboveleaf springs26 and28 should be arranged so thattongue94 ofspring26 is at least partially withingroove96 ofspring28.
• Arm portions30 and32 are connected to each other, and each is connected to one of thehandle portions22 and24, substantially as described above.Thin portion146 ofarm portion32 is inserted into groovedportion118 ofarm portion30 so thathole148 ofarm portion32 communicates withholes120aand120bofarm portion30. An axle as described above can be inserted throughholes148,120aand120band secured so thatarm portions22 and24 can pivot with respect to each other around such an axle. A set screw (e.g. setscrews170 inFIG. 3) may be used as such an axle, particularly in embodiments in which at least one ofholes148,120aand120bare at least partially threaded.Arm portion30 is connected to handleportion22 by insertingthin portion114 ofarm portion30 into the forkedend54 ofhandle portion22, so thathole116 ofarm portion30 communicates withholes55aand55bofhandle portion22. An axle as described above can be inserted throughholes116,55aand55band secured so thatarm portion30 and handleportion22 can pivot with respect to each other around such an axle. A set screw (e.g. setscrews170 inFIG. 3) may be used as such an axle, particularly in embodiments in which at least one ofholes116,55aand55bare at least partially threaded.Arm portion32 is connected to handleportion24 by insertingthin portion144 ofarm portion32 into the forked end ofhandle portion24, so thathole145 ofarm portion32 communicates withholes78aand78bofhandle portion24. An axle as described above can be inserted throughholes145,78aand78band secured so thatarm portion32 and handleportion24 can pivot with respect to each other around such an axle. A set screw (e.g. setscrews170 inFIG. 3) may be used as such an axle, particularly in embodiments in which at least one ofholes145,78aand78bare at least partially threaded.
• It will be seen that the several portions of embodiments ofinstrument20 can be connected in a variety of orders. For example,arm portions30 and32 can be connected to each other, then toindividual handle portions22 and24, with the final connection being that betweenhandle portions22 and24. As another example, handleportions22 and24 can be connected together first, then to armportions30 and32, witharm portions30 and32 being either separate or already connected. Theinstrument20 can be assembled as indicated above and inFIGS. 1-3, withdistal portions112 and142 ofarms30 and32 offset to the left whenhandle portion22 is substantially atophandle portion24. That positioning occurs whenhandle portion22 is directly connected toarm30 and handleportion24 is directly connected toarm32.Instrument20 can also be assembled so thatarm30 is directly connected to handleportion24, andarm32 is directly connected to handleportion22. In that case,distal portions112 and142 ofarms30 and32 are offset to the left whenhandle portion24 is substantially atophandle portion22, as inFIGS. 11-12.
• In using the illustrated embodiment ofinstrument20, it will be seen that squeezinghandle portions22 and24 together causes rotation ofhandle portions22 and24 with respect to each other, so that their respective distal ends42 and62 move apart. As distal ends42 and62 move apart, the proximal parts ofarm portions30 and32 also move apart. By virtue of the pivoting connection ofarm portions30 and32, when the proximal parts ofarm portions30 and32 move apart, their respectivedistal portions112 and142 move together. Thus, by squeezinghandle portions22 and24 together, thedistal portions112 and142 are forced together.
• The operation ofinstrument20 to engage an implant and rod or other connecting member and seat the connecting member in the implant anchor will now be described with respect to operation on a spinal column. Alternative uses with respect to other bony structures or other tissues can be made. As with other types of orthopedic surgery, an incision is made and access is gained to the surgical site. The approach to the surgical site can be an open approach, i.e. a relatively long incision with retraction of underlying tissue. The instrument disclosed herein can be used in such an approach, or with other surgical techniques.
• After access to the surgical site has been obtained, anchors such as those including areceiver member180 are inserted into bone tissue. Such anchors may be pre-fitted withreceiver member180 or other receiver member embodiment, and such anchors typically include abone engaging portion182 and achannel183 for accommodating part of rod R. Such achannel183 may point substantially to the side as shown in the figures, or may open to the back of the anchor, or be otherwise oriented. Such receiver members may also be placed on or over engaging portions after engagement of the engaging portions into bone, and may be multi-axial, pivotable or otherwise adjustable with respect to such engaging portions. A connecting member, such as rod R, is inserted into the surgical site, and placed adjacent one or more of the anchors. If not already present,receiver members180 may be loosely placed on the connecting member prior to insertion of the connecting member to the surgical site. The anchors and connecting member are manipulated so that a part of the connecting member is in or near the each of the anchors.Receiver member180 can include a pair ofbranches184 which generally formchannel183 therebetween.Instrument20 may be used with a variety of anchors or implants, including those known previously in the art and those disclosed in U.S. patent application Ser. Nos. 11/000,585 filed on Nov. 30, 2004 and 11/000,846 filed Dec. 1, 2004 and, respectively entitled SIDE-LOADING ADJUSTABLE BONE ANCHOR and SIDE-LOADING BONE ANCHOR, which are incorporated herein by reference in their entireties.
• After engagement of the implant to a vertebra, rod R is positioned adjacent the implant. It is contemplated that a number of implants can be positioned and engaged along the spinal column, and the rod engaged in a channel or other area of one of the implants. Due to misalignment of vertebrae, misalignment of the implants, or other conditions, the rod may not be easily or readily positioned in one or more implants.
• Once the rod is adjacent an implant into which the rod is to be placed or seated,instrument20 may be introduced to reduce or force the rod into the implant. Withhandle portions22 and24 in an unstressed state, i.e. biased away from each other or otherwise spread apart, distal ends112 and142 ofarm portions30 and32 are also spread apart. Distal ends112 and142 are placed around the combination of rod R andreceiver member180, so thatdistal end112 is adjacent to or abutting a surface of rod R relatively distant fromreceiver member180, anddistal end142 is adjacent to or abutting a surface ofreceiver member180 relatively distant from rod R. In the embodiment in whichdistal end142 includes protrusion(s)162, such protrusion(s)162 are inserted or maneuvered into hollow(s) or aperture(s) inreceiver member180. In an alternative embodiment in whichreceiver member180 includes one or more side protrusions rather than hollow(s),distal end142 may be provided with one ormore hollows162′, e.g. inextensions154 and/or156, to accommodate such protrusions.
• Where protrusion(s)162 or hollow(s)162′ are provided and are substantially rounded or cylindrical and fit with corresponding parts ofreceiver member180, as previously described,instrument20 can pivot or rotate with respect toreceiver member180, as seen in one example inFIGS. 11-12. In that example, a distal portion ofarm32 changes angle with respect to the anchor or implant, as inFIG. 11 that portion ofarm32 is at an oblique angle with respect to engagingportion182, and inFIG. 12 that portion ofarm32 is substantially parallel to engagingportion182. The axis of rotation in that example substantially corresponds with protrusion(s)162 or hollow(s)162′, is different from the axes around whicharms22,24,30 and32 pivot, and is substantially parallel to the axis ofchannel183 ofreceiver member180. Such pivoting or rotation around protrusion(s)162 or hollow(s)162′ may force rod R generally toward the bone or substantially perpendicular to a bone surface (downward as seen inFIG. 11) and/or generally towardreceiver member180. In other words, such pivoting may force rod R generally obliquely with respect to a longitudinal axis ofimplant180, or in a direction that has at least a component parallel to a longitudinal axis ofimplant180. Such pivoting or rotation can occur in this embodiment as may be necessary for rod reduction.
• Handleportions22 and24 are then squeezed together, which as discussed above forces distal ends112 and142 ofarm portions30 and32 toward each other. Forcing together distal ends112 and142 causes rod R andreceiver member180 to move relative to each other so that they become nearer to each other. In many cases, the rod will undergo all or substantially all of such relative movement, and the implant (which is anchored to a bone) will remain relatively stationary. However, it will be appreciated that in some uses the surgeon would prefer the bone and implant to undergo movement toward the rod, for example in some cases of significant vertebral misalignment, and thusinstrument20 can cause such movement of the implant, perhaps with direct manipulation of the bone by the surgeon.
• Squeezing ofhandle portions22 and24 is continued until distal ends112 and142 ofarm portions30 and32 force rod R andreceiver member180 together to the extent desired by the surgeon.Toothed bar44 andpawl64 interact to maintainhandle portions22 and24 (and thus armportions30 and32) in a squeezed state, and keeping them from being biased apart if the surgeon's grip should loosen. In this way,instrument20 can maintain pressure on a rod and implant while the surgeon rests his or her hand or performs another task. As rod R entersreceiver member180,distal end112 ofarm portion30 approaches the implant (e.g. generally parallel to a bone or bone surface to which the implant is connected), and specificallybranches184 on either side ofchannel183 or other area that accommodates the rod.Distal end112 ofarm portion30 is configured to be able to force rod R intoreceiver member180 to the greatest degree desired, becausecross pieces128 and130 are spaced apart so as to interfere minimally or not at all withbranches184 ofreceiver member180. Thus, asdistal end112 approachesbranches184 ofreceiver member180,branches184 enter the gaps betweencross pieces128 and130, allowingdistal end112 to press the rod toward or to the back of the implant, if that is desired. Through such squeezing ofinstrument20 or pivoting ofinstrument20 with respect toreceiver member180, or a combination of the two motions, rod R is reduced intochannel183 ofreceiver member180.
• Once the rod is positioned as the surgeon desires in the implant, the rod is locked into the implant using structure (e.g. set screw, cap, clamp) provided with the implant, as for example by inserting the structure and an appropriate tool throughindentations129 and131 to the implant.Instrument20 may be removed from contact with the rod and the implant after such locking, or before if the rod will remain at least approximately in the position desired by the surgeon. When it is desired to remove or loosen the contact ofinstrument20 with the rod and/or the implant, the surgeon may presslever68, which pivots to pushtoothed bar44 away frompawl64.Springs26 and28 then act to pushhandle portions22 and24 apart, per their normal bias, anddistal portions112 and142 ofarm portions30 and32 come away from the rod and the implant. The surgeon may then move to reduction of the rod into another implant, or may removeinstrument20 from the surgical site to perform other tasks or conclude the surgical procedure.
• FIGS. 13A-13B illustrate a portion of a reducinginstrument220 according to another embodiment. In that embodiment,instrument220 includesarm portions30 and232.Instrument220 may further include handle portions and springs (not shown for clarity), similar in structure and function to handleportions22 and24 and springs26 and28, and connected as described in with respect to previous embodiments, as are other embodiments described below. Additionally,instrument220 may include a toothed bar and pawl assembly, as previously described.Arm portion232 is an elongated piece having aproximal end240 and adistal end242. It should be appreciated thatarm portion232 connects with a corresponding handle portion in a substantially similar manner asarm portion32 connects withhandle portion24.
• Distal end242 has anextension portion254.Extension portion254 may generally increase in width from a proximal point254ato adistal point254b. In the illustrated embodiment,extension portion254 includes one section of increasing width; however, it should be appreciated thatextension portion254 can be configured differently.Extension portion254 includes an approximately 90 degree bend in the illustrated embodiment atbend point260 between aproximal portion262 and adistal portion264. Theextension portion254 may bend in a direction toward an anchor, withdistal portion264 being substantially perpendicular toproximal portion262.Distal portion264 includes asection266, which is generally cylindrical in one particular embodiment, atdistal point254b.Section266 can be configured to contact an anchor, such asanchor270. It should be appreciated thatinstrument220 may be used with a variety of anchors or implants. Additionally,section266 can be larger or smaller to fittingly contact various sized channels in various anchors or implants.
• In the illustrated embodiment,anchor270 includes areceiver portion280 and an engagingportion282. In certain embodiments,receiver portion280 includes afirst channel283 and asecond channel284. Part of a rod R can be accommodated in one ofchannels283 or284, depending on which channel is closer to or more exposed to rod R. In the illustrated embodiment, rod R is to be loaded intochannel283, and thereforesection266 ofinstrument220 can be inserted intochannel284 in order to reduce or force rod R toward or intochannel283.Receiver portion280 in the illustrated embodiment is integral with respect to engagingportion282. A threaded cap (not shown) can thread ontoreceiver portion280 to hold rod(s) or other elongated members with respect toreceiver member280.
• FIGS. 14A-14B illustrate a portion ofinstrument220 used in conjunction with ananchor370 including areceiver member380 and an engagingportion382.Anchor370 is substantially similar in structure and function to the anchors previously described herein (e.g. those shown inFIGS. 11-12).Receiver member380 includes afirst channel383 for accommodating part of rod R. Such achannel383 may point substantially to the side as shown in the figures, or may open to the back of a similar anchor, or be otherwise oriented. In certain embodiments,receiver member380 also includes asecond channel384 for accommodating part ofsegment266.
• FIG. 15A-15B illustrate a portion of another embodiment of a reducinginstrument420.Instrument420 includesarm portions30 and432.Instrument420 may further include handle portions and springs (not shown for clarity), similar in structure and function to handleportions22 and24 and springs26 and28. Additionally,instrument420 may include a toothed bar and pawl assembly, as previously described.Arm portion432 is an elongated piece having aproximal portion440 and adistal end442 in the illustrated embodiment. It should be appreciated thatarm portion432 connects with a corresponding handle portion in a substantially similar manner asarm portion32 connects withhandle portion24.
• Distal end442 includes anextension portion454.Extension portion454 may generally increase in width from aproximal point454ato adistal point454b. In the illustrated embodiment,extension portion454 includes one section of increasing width; however, it should be appreciated thatextension portion454 can be configured differently.Extension portion454 includesextension pieces455 and456, and across piece458. In the illustrated embodiment,extension pieces455 and456 are substantially parallel to each other and to the body ofarm432, and are substantially perpendicular tocross-piece458. The extension pieces are connected atdistal point454bwith asection466 that is substantially cylindrical in the illustrated embodiment.Section466 is configured to contact an anchor, such asanchor270.Section466 can be larger or smaller to fittingly contact various sized channels in various anchors or implants.
• In the embodiment illustrated inFIGS. 15A and 15B,instrument420 is used in conjunction with ananchor270 includingreceiver member280 and engagingportion282.Extension pieces455.456,cross-piece458, andsection466 all generally define agap468.Gap468 is sufficiently sized and configured to admit one of the anchor branches definingsecond channel284 ofanchor270.
• FIGS. 16A-16B illustrate a portion ofinstrument420 used in conjunction with ananchor370 includingreceiver member380 and engagingportion382.Receiver member380 also includessecond channel384 for accommodating part ofcylindrical segment466.
• FIG. 17 illustrates another embodiment of a reducinginstrument520.Instrument520 includes handleportions22 and24, springs26 and28, andarm portions530 and532. Additionally,instrument520 may include atoothed bar44 and apawl64, as previously described. It should be appreciated thatarm portions530 and532 connect withhandle portions22 and24, respectively, in a substantially similar manner asarm portions30 and32 connect with the handle portions.Arm portions530 and532 haveproximal ends530aand532a, anddistal ends530band532b, respectively. Additionally,arm portions530 and532 each include sections ofcurvature540 and542, respectively, positioned between the proximal and distal ends. In certain embodiments, the sections of curvature prevent interference with various tissues and/or other structures or materials within or adjacent to the patient or the surgical site. Distal ends530band532bcan be sized and configured in a manner as previously described to contact and engage an anchor and rod or other connecting member and seat the connecting member in the anchor.
• In some embodiments,sections540,542 are generally positioned in the same plane as the handle portions and arm portions. In other words, sections ofcurvature540,542 generally open in a direction from one arm portion to the other arm portion. In the illustrated embodiment,section540 opens towardssection542, and concave portions ofsections540 and542 face in generally the same direction (e.g. the left as shown inFIG. 17). However, it should be appreciated thatsections540,542 can be arranged, oriented or configured differently.
• FIG. 18 illustrates a portion of anarm630 of a reducing instrument in another embodiment.Arm630 includes a proximal end (not shown) that may be similar or identical to ends of arms described above, and adistal end612.Distal end612 includesextension portions624 and626 (similar toextensions134 and136 and those shown inFIGS. 13A,14A,15A and16A), which may include part-cylindrical hollows634 and636, respectively.Hollows634 and636 are linear, e.g. the axes of the cylinders of which hollows634,636 are a part are collinear, and hollows634,636 may be of a size and curvature to accommodate an orthopedic rod R. In the illustrated embodiment, hollows634,636 each form a substantially quarter-circular (90-degree)section640, with an adjacentstraight segment642. The absence of a lower lip on one or bothhollows634,636, as in the illustrated embodiment, can encourage accommodation of an angled rod, e.g. one not perpendicular toextension portions624 and626 when their instrument is inserted to the surgical site, or other elongated members of various configurations.
• FIG. 19 illustrates a portion of a reducinginstrument720 in another embodiment.Instrument720 includesarm portions30 and732.Instrument720 may further include handle portions and springs (not shown for clarity), similar in structure and function to handleportions22 and24 and springs26 and28. Additionally,instrument720 may include a toothed bar and pawl assembly, as previously described.Arm portion732 is an elongated piece having aproximal end740 and adistal end742. It should be appreciated thatarm portion732 connects with a corresponding handle portion in a substantially similar mariner asarm portion32 connects withhandle portion24. Aprotrusion766 is disposed onarm portion732 atdistal end742. In the illustrated embodiment,protrusion766 is spherical; however, it should be appreciated thatprotrusion766 can be configured differently.Protrusion766 is configured to contact ananchor770, similar in configuration to anchor370. In certain embodiments,anchor770 can include a recess configured to receive a portion ofprotrusion766. In one embodiment,protrusion766 extends the width ofarm portion732. In another embodiment,arm portion732 may include two extension portions, and a protrusion such asprotrusion766, disposed on each distal end of the extension portions.
• FIG. 20 illustrates a portion of a reducinginstrument820 according to another embodiment.Instrument820 includesarm portions30 and832.Instrument820 may further include handle portions and springs (not shown for clarity), similar in structure and function to handleportions22 and24 and springs26 and28. Additionally,instrument820 may include a toothed bar and pawl assembly, as previously described.Arm portion832 is an elongated piece having aproximal end840 and adistal end842. It should be appreciated thatarm portion832 connects with a corresponding handle portion in a substantially similar manner asarm portion32 connects withhandle portion24. In the illustrated embodiment, aprotrusion866 is disposed on ananchor870, similar in configuration to anchor370.Protrusion866 is shown to be spherical in one embodiment; however, it should be appreciated thatprotrusion866 can be configured differently.Protrusion866 is positioned on the receiver portion ofanchor870, opposite a channel for receiving a portion of an orthopedic rod R or other elongated member. In certain embodiments, the arm portion includes a recess890 atdistal end842 configured to receive a portion ofprotrusion866.
• In an alternative embodiment,arm portion832 of reducinginstrument820 could include a recess configured to receive a portion of a receiver member of an anchor (e.g. anchor370). In such an embodiment, the recess in the arm portion would fittingly contact a portion of a receiver member of an anchor, the portion being opposite a channel configured to receive an orthopedic rod. In such an embodiment,protrusion866 may be absent and the recess in the arm portion partially surrounds the receiver member of the anchor. The recess may include a generally spherical configuration or another such appropriate configuration. In such an embodiment, the recess in the arm portion, and the portion of the receiver member contacting the recess in the arm portion, would generally include similar degrees of curvature so that the arm portion would fittingly contact the anchor.
• The assembly and operation of reducinginstruments220,420,520,720, and820 is substantially similar to the assembly and operation of reducing instrument120 described above. As an example, the arm portions of the reducinginstruments220,420,520,720, and820 connect to each other in a substantially similar manner asarm portions30 and32 connect together.
• Regarding the operation of embodiments of reducinginstruments220,420,520,720, and820, after access to the surgical site has been obtained, anchors such as those includingreceiver members280 or380 are inserted into bone tissue. Such receiver members may also be placed on or over engaging portions after engagement of the engaging portions into bone, and may be multi-axial, pivotable or otherwise adjustable with respect to such engaging portions. A connecting member, such as rod R, is inserted into the surgical site, and placed adjacent one or more of the anchors. The anchors and connecting member are manipulated so that a part of the connecting member is in or near the each of the anchors, and such manipulation can be accomplished using embodiments of reducing instruments such as those described above. The instruments may be used with a variety of anchors or implants, including those known previously in the art and those described above.
• During operation, the embodiments of reducing instruments described above operate generally similarly to each other, and therefore for simplicity operation of the embodiment ofinstrument220 will be described. These descriptions of operation and those given above apply to other embodiments as well.Instrument220 engages an implant and rod or other connecting member to insert or seat the connecting member in the implant. Such operation can include reducing or forcing the rod into the implant once the rod is positioned adjacent the implant into which the rod is to be placed or seated. The distal ends of the arm portions are placed around the rod and the receiver member of the anchor. The handle portions are squeezed together, forcing the distal ends of the arm portions towards each other, and causing the rod and the receiver member to become nearer to each other and eventually for the rod to be inserted into the receiver member. The toothed bar and pawl assemblies, if present, interact to maintain the handle portions squeezed together. Once the rod is positioned, the rod can be locked into the implant anchor. A lever, if provided, can be pressed to disengage the toothed bar from the pawl, and the handle portions can be moved apart (e.g. by springs, if present) to enable removal ofinstrument220 from the surgical site. Thus, through squeezing of an embodiment of the instrument or pivoting of an embodiment of the instrument with respect to an anchor or a receiver member or portion of an anchor, or a combination of the two motions, a rod may be reduced into a channel of the anchor or its receiver member.
• As described above, the anchors and connecting member may be positioned in or along one or more parts of the spine, including the cervical, thoracic, lumbar and/or sacral portions. Although the use of embodiments of instruments is described in the above context, such embodiments and others could be used with a variety of screws, hooks or other fixation implants, or in connection with orthopedic implants in parts of the body other than the spine.
• The above embodiments and others may be made of stainless steel, certain hard plastics, or other materials that are compatible with surgical procedures and the implants and rods with which they are used. Features particularly described above in connection with one embodiment may be used or incorporated into other embodiments. For example, arm configurations or distal end configurations shown in one figure could be used in connection with apparatus shown in other figures.
• 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 (5)

1-47. (canceled)

48. A method, comprising:

providing an instrument for reducing an elongated member to a channel in an orthopedic implant;

connecting an orthopedic implant having a channel for receiving an elongated member to a bone;

placing an elongated member proximate to said implant;

connecting a first portion of said instrument to said elongated member and a second portion of said instrument to said implant;

pivoting said second portion of said instrument so that said first portion urges said elongated member toward an alignment with said channel of said implant.

49. The method ofclaim 48, further comprising:

causing said first portion and said second portion to move generally toward each other so that said elongated member is forced toward said channel of said implant.

50. The method ofclaim 49, further comprising: forcing said elongated member into said channel; and locking said elongated member with respect to said implant.

51. The method ofclaim 50, further comprising:

disconnecting said instrument from said implant and said elongated member after performing said locking.

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