Method for the endoscopic correction of spinal disease
View Patent ↗An improved method and instrumentation for performing spinal surgery, including discectomy, interbody fusion and rigid internal fixation of the spine, from the lateral aspect of the spine is disclosed. The surgical procedure can be performed through a very small incision. The instrumentation of the present invention, all of which is inserted from a lateral position into the spine in the preferred embodiment, comprises a guide pin, a distractor, an extended outer sleeve, an inner sleeve an adjustable drill and an implant driver. The distractor of the present invention is driven into the disc for spacing apart and realigning the adjacent vertebrae. It further functions as an alignment rod for inserting the extended outer sleeve which is a hollow tubular member capable of maintaining said spacing and alignment of two adjacent vertebrae and defines a protected space through which subsequent instruments which may include, but are not limited to, a drill and a diameter reducing inner sleeve may be passed, as well as a spinal implant. The remainder of the surgical procedure consisting of the removal of spinal material across the disc, fusion, and rigid internal stabilization via the implant may all be performed via the closed space within the extended outer sleeve.
1. A method for performing surgery on a spinal segment including a disc space and two vertebral bodies adjacent the disc space, the method comprising the steps of:
positioning one end of a hollow guard in contact with the adjacent vertebral bodies, said guard having at least one projection extending distally from a distal end of said guard, said distal end adapted to contact each of the vertebral bodies adjacent the disc space to be fused, said at least one projection adapted to penetrate the disc space so as to be located at least in part between the perimeters of the vertebral bodies where adjacent to the disc space, said at least one projection having opposed portions adapted to contact at least a portion of each of the adjacent vertebral bodies, respectively, from within the disc space;
removing, through said guard, bone from the adjacent vertebral bodies to form an opening across the surgically corrected height of the disc space and into a portion of each of the two adjacent vertebral bodies;
inserting, through said guard and into the opening, an implant having opposed surfaces each adapted to contact one each of the adjacent vertebral bodies, each of said opposed surfaces having at least one opening to permit for the growth of bone from adjacent vertebral body to adjacent vertebral body through said implant; and
utilizing an endoscope to visualize the position of at least a portion of at least one of said implant and said guard relative to the vertebral bodies.
2. The method of claim 1 , wherein the utilizing step includes utilizing an endoscope that is a thorascope.
3. The method of claim 1 , wherein the positioning step includes the step of engaging said one end of said guard to the two adjacent vertebral bodies.
4. The method of claim 1 , wherein the positioning step includes the substep of positioning said guard having at least a second projection extending distally from the distal end of said guard, said at least second projection adapted to penetrate the disc space so as to be located at least in part between the perimeters of the vertebral bodies where adjacent the disc space, said at least second projection having opposed portions adapted to contact at least a portion of each of the adjacent vertebral bodies, respectively, from within the disc space.
5. The method of claim 1 , wherein said projection is at least in part co-linear with an outer perimeter of said guard.
6. The method of claim 1 , wherein said projection is a tooth.
7. The method of claim 1 , wherein the positioning step includes the substep of positioning said guard that is a tubular sleeve.
8. The method of claim 1 , further comprising the step of using a distractor to position the adjacent vertebral bodies relative to one another.
9. The method of claim 8 , wherein the utilizing step includes visualizing the position of at least a portion of said distractor with said endoscope relative to the vertebral bodies.
10. The method of claim 1 , wherein the removing step includes the use of a bone removal device to form the opening and the utilizing step includes visualizing the position of at least a portion of said bone removal device with said endoscope relative to the vertebral bodies.
11. The method of claim 1 , wherein the removing step includes the substep of one of milling and drilling the opening.
12. The method of claim 1 , further comprising the step of tapping the opening through said guard and the utilizing step includes visualizing the position of at least a portion of said tap with said endoscope relative to the vertebral bodies.
13. The method of claim 1 , wherein the inserting step includes the substep of screwing said implant into the opening through said guard.
14. The method of claim 1 , wherein the inserting step includes using an insertion instrument to insert said implant into the opening and the utilizing step includes visualizing the position of at least a portion of said insertion instrument with said endoscope relative to the vertebral bodies.
15. The method of claim 1 , wherein the inserting step includes inserting said implant comprising a fusion-promoting substance.
16. The method of claim 1 , wherein said implant includes at least in part one of bone, coral, and artificial material.
17. The method of claim 1 , wherein said implant is in the shape of one of a cylinder, a partial cylinder, and a dowel.
18. The method of claim 1 , further comprising the step of combining said implant with a fusion promoting substance.
19. The method of claim 18 , wherein the fusion promoting substance includes at least one of bone, bone morphogenetic protein, hydroxyapatite, hydroxyapatite tricalcium phosphate, and coral.
20. The method of claim 19 , wherein said implant is at least in part hollow, the step of combining including loading said implant with the fusion promoting substance.
21. The method of claim 19 , wherein the step of combining includes coating said implant with the fusion promoting substance.
22. The method of claim 1 , wherein the method is performed without distracting the adjacent vertebral bodies between the removing step and the inserting step.
23. The method of claim 1 , wherein the method is performed without removing the guard between the positioning step and the inserting step.
24. The method of claim 1 , wherein the inserting step includes the substep of providing said implant having upper and lower portions having at least one protrusion on said upper and lower portions for engaging the adjacent vertebral bodies.
25. The method of claim 24 , wherein said protrusion is at least a portion of a thread.
26. A method for performing surgery on a spinal segment including a disc space and two vertebral bodies adjacent the disc space, the method comprising the steps of:
positioning one end of a hollow guard in contact with the adjacent vertebral bodies said guard having at least one projection extending distally from a distal end of said guard, said distal end adapted to contact each of the vertebral bodies adjacent the disc space to be fused, said at least one projection adapted to penetrate the disc space so as to be located at least in part between the perimeters of the vertebral bodies where adjacent to the disc space, said at least one projection having opposed portions adapted to contact at least a portion of each of the adjacent vertebral bodies, respectively, from within the disc space;
removing, through said guard, bone from the adjacent vertebral bodies to form an opening across the disc space and into a portion of each of the two adjacent vertebral bodies;
inserting, through said guard and into the opening, an implant having rigid opposed surfaces each adapted to contact one each of the adjacent vertebral bodies; and
utilizing an endoscope to visualize the position of at least a portion of at least one of said implant and said guard relative to the vertebral bodies.
27. The method of claim 26 , wherein the utilizing step includes utilizing an endoscope that is a thorascope.
28. The method of claim 26 , wherein the positioning step includes the step of engaging said one end of said guard to the two adjacent vertebral bodies.
29. The method of claim 26 , wherein the positioning step includes the substep of positioning said guard having at least a second projection extending distally from the distal end of said guard, said at least second projection adapted to penetrate the disc space so as to be located at least in part between the perimeters the vertebral bodies where adjacent the disc space, said at least second projection having opposed portions adapted to contact at least a portion of each of the adjacent vertebral bodies, respectively, from within the disc space.
30. The method of claim 26 , wherein said projection is at least in part co-linear with an outer perimeter of said guard.
31. The method of claim 26 , wherein said projection is a tooth.
32. The method of claim 26 , wherein the positioning step includes the substep of positioning said guard that is a tubular sleeve.
33. The method of claim 26 , further comprising the step of using a distractor to position the adjacent vertebral bodies relative to one another.
34. The method of claim 33 , wherein the utilizing step includes visualizing the position of at least a portion of said distractor with said endoscope relative to the vertebral bodies.
35. The method of claim 26 , wherein the removing step includes the use of a bone removal device to form the opening and the utilizing step includes visualizing the position of at least a portion of said bone removal device with said endoscope relative to the vertebral bodies.
36. The method of claim 26 , wherein the removing step includes the substep of one of milling and drilling the opening.
37. The method of claim 26 , further comprising the step of tapping the opening through said guard and the utilizing step includes visualizing the position of at least a portion of said tap with said endoscope relative to the vertebral bodies.
38. The method of claim 26 , wherein the inserting step includes the substep of screwing said implant into the opening through said guard.
39. The method of claim 26 , wherein the inserting step includes using an insertion instrument to insert said implant into the opening and the utilizing step includes visualizing the position of at least a portion of said insertion instrument with said endoscope relative to the vertebral bodies.
40. The method of claim 26 , wherein the inserting step includes inserting said implant comprising a fusion-promoting substance.
41. The method of claim 26 , wherein said implant includes at least in part one of bone, coral, and artificial material.
42. The method of claim 26 , wherein said implant is in the shape of one of a cylinder, a partial cylinder, and a dowel.
43. The method of claim 1 , further comprising the step of combining said implant with a fusion promoting substance.
44. The method of claim 43 , wherein the fusion promoting substance includes at least one of bone, bone morphogenetic protein, hydroxyapatite, hydroxyapatite tricalcium phosphate, and coral.
45. The method of claim 43 , wherein said implant is at least in part hollow, the step of combining including loading said implant with the fusion promoting substance.
46. The method of claim 43 , wherein the step of combining includes coating said implant with the fusion promoting substance.
47. The method of claim 26 , wherein the method is performed without distracting the adjacent vertebral bodies between the removing step and the inserting step.
48. The method of claim 26 , wherein the method is performed without removing the guard between the positioning step and the inserting step.
49. The method of claim 26 , wherein the inserting step includes the substep of providing said implant having upper and lower portions having at least one protrusion on said upper and lower portions for engaging the adjacent vertebral bodies.