Methods and instruments for treating pseudoarthrosis
Methods, instruments, and kits for treating spinal pseudoarthrosis are provided. In one embodiment, a method includes delivering to a location of spinal pseudoarthrosis an effective amount of an osteoinductive composition that includes an injectible osteoinductive composition that includes an injectible osteoinductive composition in a pharmaceutically acceptable carrier. In other embodiments, cannulated drills 10, 10′, 10 ″ and surgical instrument assemblies, 50, 50 ′ including a drill and a syringe 60 and 60 ′ wherein the syringe has a distal end that is matingly engaged to a proximal end of the drill are provided. The drill and other instruments, instrument assemblies, and kits formed therefrom may advantageously be used in a method for treating pseudoarthrosis.
1. A cannulated drill, comprising an elongated member formed of a biocompatible material and having a proximal end, a distal end, an inner cylindrical surface, and an outer surface, said inner cylindrical surface defining a cylindrical lumen having an inner diameter, said cylindrical lumen extending along the length of said elongated member and sized to receive an elongated obturator, said elongated member having a distal cutting portion including a plurality of bone cutting edges extending about and along said distal cutting portion, said cylindrical lumen extending through said distal cutting portion and defining a distal opening at a distal end surface of said distal cutting portion, said elongated member having a connector adjacent said proximal end configured for matingly engaging a distal end portion of a syringe, and further comprising an elongated obturator, said obturator having an outer cylindrical surface defining an outer diameter conforming to said inner diameter of said cylindrical lumen to permit said obturator to be slidably disposed in said cylindrical lumen and wherein a distal-most end of said obturator is positioned at said distal opening to inhibit material from entering said distal opening and into said cylindrical lumen; and
wherein said obturator defines a longitudinal passage that extends from a proximal end of said obturator to said distal end of said obturator; and
further comprising an elongate guide member positioned within said longitudinal passage in said obturator to guide the drill as the drill is axially advanced along said elongate guide member, and a cannula defining an axial lumen extending therethrough from a proximal end to a distal end; and
wherein said elongated member is positioned within said axial lumen with said distal cutting portion positioned beyond said distal end of said cannula.
2. The drill of claim 1 , wherein said outer surface of said elongated member is cylindrical.
3. The drill of claim 1 , wherein said elongated member is formed of a biocompatible metallic material.
4. The drill of claim 1 , wherein said distal end of said obturator is blunt.
5. The drill of claim 1 , wherein said elongated member has a cylindrical shaft that includes said proximal end and a head that includes said distal end, said head having a width larger than the width of said shaft.
6. The drill of claim 1 , further comprising:
a syringe having a housing defining a cavity, said syringe matingly engaged to said elongated member by said connector, said lumen of said elongated member and said cavity of said housing in fluid communication when said syringe is matingly engaged to said elongated member; and
an osteoinductive composition including a bone growth factor positioned in said cavity of said syringe for delivery into said lumen of said elongated member upon actuation of said syringe.
7. The drill of claim 6 , wherein said osteoinductive composition comprises a bone morphogenic protein.
8. The drill of claim 1 , wherein said elongate guide member has a pointed distal end configured to pierce into bone.
9. The drill of claim 1 , wherein said elongate guide member comprises a K-wire.
10. The drill of claim 1 , wherein said inner diameter of said cylindrical lumen is uniform from said distal opening to said proximal end.
11. The drill of claim 1 , wherein said cutting edges comprise helical cutting edges that extend helically about and along said distal cutting portion.
12. The drill of claim 1 , wherein said distal end of said cannula includes a rounded distal end surface.
13. A cannulated drill, comprising an elongated member formed of a biocompatible material and having a proximal end, a distal end, an inner surface, and an outer surface, said inner surface defining a cylindrical lumen, said cylindrical lumen extending along the length of said elongated member and sized to receive an elongated obturator, said distal end of said elongated member having a distal cutting portion including a plurality of cutting edges extending about and along said distal cutting portion, said cylindrical lumen extending through said distal cutting portion and defining a distal opening at a distal end surface of said distal cutting portion, said proximal end of said elongated member having a connector configured for matingly engaging a distal end of a syringe to said proximal end of said elongated member, and further comprising an elongated obturator, said obturator slidably disposed in said cylindrical lumen and wherein a distal-most end of said obturator is positioned at said distal opening of said distal cutting portion to inhibit material from entering said distal opening and into said cylindrical lumen, said obturator having a longitudinal passage extending through the entirety of said obturator; and
an elongate guide member positioned within said longitudinal passage in said obturator to guide the drill as the drill is axially advanced along said elongate guide member; and
a cannula defining an axial lumen extending therethrough from a proximal end to a distal end; and
wherein said elongated member is positioned within said axial lumen with said distal cutting portion positioned beyond said distal end of said cannula.
14. The drill of claim 13 , wherein said cutting edges of said distal cutting portion intersect said distal opening.
15. The drill of claim 13 , wherein said distal cutting portion has a bulbous shape having a first proximal diameter, a second medial diameter that is larger than said first diameter, and a distalmost part having a diameter smaller than said second diameter.
16. The drill of claim 15 , wherein said bulbous shape has a rounded configuration.
17. The drill of claim 13 , further comprising:
a syringe having a housing defining a cavity, said syringe matingly engaged to said elongated member by said connector, said lumen of said elongated member and said cavity of said housing in fluid communication when said syringe is matingly engaged to said elongated member; and
an osteoinductive composition including a bone growth factor positioned in said cavity of said syringe for delivery into said lumen of said elongated member upon actuation of said syringe.
18. The drill of claim 13 , wherein said elongate guide member has a pointed distal end configured to pierce into bone.
19. The drill of claim 13 , wherein said elongate guide member comprises a K-wire.
20. The drill of claim 13 , wherein said cylindrical lumen has an inner diameter that is uniform from said distal opening to said proximal end.
21. The drill of claim 13 , wherein said cutting edges comprise helical cutting edges that extend helically about and along said distal cutting portion.
22. The drill of claim 13 , wherein said distal end of said cannula includes a rounded distal end surface.
23. A cannulated drill, comprising an elongated member formed of a biocompatible material and having a proximal end, a distal end, an inner surface, and an outer surface, said inner surface defining a cylindrical lumen, said cylindrical lumen extending along the length of said elongated member and sized to receive an elongated obturator, said distal end of said elongated member having a distal cutting portion including a plurality of cutting edges extending about and along said distal cutting portion, said cylindrical lumen extending through said distal cutting portion and defining a distal opening at a distal end surface of said distal cutting portion, said proximal end of said elongated member having a connector configured for matingly engaging a distal end of a syringe to said proximal end of said elongated member, and further comprising an elongated obturator, said obturator slidably disposed in said cylindrical lumen, wherein said elongated member has a plurality of apertures extending along its length in communication with said cylindrical lumen, and said obturator has a forwardmost position within said cylindrical lumen at which all of said apertures are blocked by said obturator and wherein a distal-most end of said obturator is positioned at said distal opening of said distal cutting portion to inhibit material from entering said distal opening and into said cylindrical lumen when in said forwardmost position, and withdrawing said obturator from said forwardmost position unblocks said apertures and said distal opening; and
wherein said obturator defines a longitudinal passage along its entire length; and
further comprising an elongate guide member positioned within said longitudinal passage in said obturator to guide the drill as the drill is axially advanced along said elongate guide member, and a cannula defining an axial lumen extending therethrough from a proximal end to a distal end; and
wherein said elongated member is positioned within said axial lumen with said distal cutting portion positioned beyond said distal end of said cannula.
24. The drill of claim 23 , wherein said plurality of apertures include a first set and a second set, said first set of apertures being diametrically opposed to said second set of apertures.
25. The drill of claim 23 , further comprising:
a syringe having a housing defining a cavity, said syringe matingly engaged to said elongated member by said connector, said lumen of said elongated member and said cavity of said housing in fluid communication when said syringe is matingly engaged to said elongated member; and
an osteoinductive composition including a bone growth factor positioned in said cavity of said syringe for delivery into said lumen of said elongated member upon actuation of said syringe.
26. The drill of claim 23 , wherein said elongate guide member has a pointed distal end configured to pierce into bone.
27. The drill of claim 23 , wherein said elongate guide member comprises a K-wire.
28. The drill of claim 23 , wherein said cylindrical lumen has an inner diameter that is uniform from said distal opening to said proximal end.
29. The drill of claim 23 , wherein said cutting edges comprise helical cutting edges that extend helically about and along said distal cutting portion.
30. The drill of claim 23 , wherein said distal end of said cannula includes a rounded distal end surface.