Multiple set screw insertion instrument and methods
This disclosure relates generally to surgical instruments used to deliver locking or set screws to secure a rod or spinal fixation element relative to an implanted bone anchor or other spinal fixation construct during spine surgery. In one embodiment, the inserter instrument can include an inner driver shaft, a ratcheted outer sleeve, and a handle configured to receive the shafts therein. The inner driver shaft can receive a plurality of set screws on a distal end thereof. A side latch, pawl, or button can engage with the ratcheted outer sleeve to facilitate step-wise advancement of the sleeve relative to the driver shaft for set screw delivery. Step-wise advancement can be controlled using another button that causes movement of the side latch.
1 . A surgical method, comprising:
delivering a first set screw to a first implanted bone anchor using an inserter;
actuating the inserter to advance a second set screw distally relative to a shaft of the inserter; and
delivering a second set screw to a second implanted bone anchor using the inserter, the first set screw and the second set screw being disposed on the shaft of the inserter at a position that is distal to a first button of the inserter prior to delivering the first set screw to the first implanted bone anchor.
2 . The method of claim 1 , wherein actuating the inserter includes depressing the first button disposed in a handle of the inserter.
3 . The method of claim 2 , wherein the first button does not directly engage the first set screw or the second set screw prior to, during, or after actuation.
4 . The method of claim 1 , wherein actuating the inserter includes advancing a sleeve disposed over the shaft distally to urge the second set screw toward a distal end of the shaft.
5 . The method of claim 1 , further comprising withdrawing the inserter proximally to detach the first set screw from the shaft.
6 . The method of claim 1 , wherein the first button is the first set screw and the second set screw, the at least one of the first set screw or the second set screw during each of delivering the first set screw to the first implanted bone anchor, advancing the second set screw distally relative to the shaft of the inserter, and delivering the second set screw to the second implanted bone anchor.
7 . A surgical method, comprising:
actuating a first button disposed in a handle of an inserter;
sliding a sleeve disposed over a shaft of the inserter proximally; and
advancing a plurality of set screws proximally over a distal portion of the shaft of the inserter such that the plurality of set screws disposed on the shaft are positioned distal to the first button.
8 . The method of claim 7 , wherein the first button is disposed in a side of the handle.
9 . The method of claim 7 , wherein the sleeve slides to abut a proximal wall of a recess formed in the handle.
10 . The method of claim 7 , further comprising positioning a distal-most set screw proximate to a distal tip of the shaft.
11 . The method of claim 10 , further comprising actuating the first button to advance the sleeve relative to the shaft to eject the distal-most set screw from the inserter.
12 . The method of claim 7 , wherein actuating the first button distally advances a distal body of the button within a lumen of the handle.
13 . The method of claim 12 , wherein advancement of the distal body further comprises advancing a pawl that is engaged with a recess of a ratchet portion of the sleeve to urge the sleeve distally along with the pawl and the first button.
14 . The method of claim 13 , wherein distal urging of the sleeve terminates when a distal-facing surface of the button abuts a recess of the handle.
15 . The method of claim 7 , wherein the first button is set apart from the plurality of set screws throughout their advancement over the distal portion of the shaft.
16 . The method of claim 7 , wherein the first button does not directly engage the plurality of set screws to prior, during, or after actuation.
17 . The method of claim 7 , further comprising delivering a set screw of the plurality of set screws to an implanted bone anchor using the inserter.