Surgical file instrument
A reciprocating surgical file system for precisely removing bone and/or other tissue is described. The system allows a user to maneuver the system and navigate into hard-to-access sites under a direct vision mechanism. A transmission mechanism converts rotary motion from a motor into reciprocating motion and provides it to the surgical file for precision removal of bone or other tissue. A pulsatile pump mechanism is operatively coupled with the transmission mechanism and provides irrigating fluid to the surgical site.
1 . A surgical instrument comprising:
a handle assembly; and
a distal assembly connected to said handle assembly, said distal assembly comprising:
a blade having a first width;
a lower blade structure having an upper face which has a second width extending between a first lateral side and a second lateral side, said blade being slidably coupled to said lower blade structure, wherein said first width is equal to or less than said second width.
2 . The surgical instrument of claim 1 , wherein said first width is at least about 95% of said second width.
3 . The surgical instrument of claim 1 , wherein said first width is at least about 80% of said second width.
4 . The surgical instrument of claim 1 , wherein said blade comprises an exposed cutting surface, said cutting surface configured to perform at least one of grinding, filing, and cutting of tissue.
5 . The surgical instrument of claim 1 , wherein said blade is axially movable along said lower blade structure.
6 . The surgical instrument of claim 1 , wherein at least a portion of said lower blade structure is tapered in said distal direction.
7 . The surgical instrument of claim 1 , wherein said distal assembly forms a minimally traumatic tip that is dimensioned so as to fit into a neuroforamen without appreciable trauma to a nerve extending through said neuroforamen.
8 . The surgical instrument of claim 7 , wherein said lower blade structure defines a shield on one side of said distal assembly, and said blade is disposed on another side of said distal assembly.
9 . The surgical instrument of claim 1 , wherein said blade and said upper face are curved about a long axis of said lower blade structure.
10 . The surgical instrument of claim 1 , wherein said lower blade structure defines a fluid delivery channel, said blade is axially moveable between a proximal position and a distal position, a window for expelling fluid at a distal end of said fluid delivery channel, wherein said window is defined between said blade and said lower blade structure when said blade occupies a proximal position.
11 . A surgical instrument having a distal assembly, said distal assembly comprising:
a blade having a first blade edge and a second blade edge; and
a lower blade structure comprising an upper face between a first structure edge and a second structure edge, said blade being positioned upon said upper face and movable relative to said lower blade structure, and said first blade edge proximate to said first structure edge and said second blade edge proximate to said second structure edge.
12 . The surgical instrument of claim 11 , wherein said first blade edge and said second blade edge are opposing, longitudinally extending lateral edges of said blade, said first and second blade edges define a blade width,
wherein said first structure edge and said second structure edge are opposing, longitudinally extending lateral edges of said lower blade structure, said first and second structure edges define a lower blade structure width; and
wherein said blade width is equal to or greater than said lower blade width.
13 . The surgical instrument of claim 11 , wherein a blade width is defined between said first blade edge and said second blade edge, a lower blade structure width is defined between said first structure edge and said second structure edge, wherein said blade width is substantially similar to said lower blade structure width.
14 . The surgical instrument of claim 11 , wherein a periphery of at least a portion of said blade has a similar shape to a periphery of at least a portion of said lower blade structure.
15 . The surgical instrument of claim 11 , wherein at least a portion of a surface of said blade conforms to a periphery of at least a portion of said lower blade structure.
16 . The surgical instrument of claim 11 , wherein said lower blade structure has a shield surface opposing said upper face, and said shield surface forms a tip that curves towards said blade.
17 . The surgical instrument of claim 11 , wherein said lower blade structure has a shield surface opposing said upper face, and at least a portion of said shield surface is convex towards said blade.
18 . The surgical instrument of claim 11 , wherein said lower blade structure has a shield surface opposing said upper face, and at least a portion of said shield surface is concave towards a nerve extending through a neuroforamen, when said lower blade structure is positioned at least partially in said neuroforamen.
19 . The surgical instrument of claim 11 , wherein said lower blade structure has a shield surface opposing said upper face, and at least a portion of said shield surface is concave about a longitudinal axis of said lower blade structure.
20 . The surgical instrument of claim 11 , wherein said lower blade structure has a longitudinally extending fluid delivery channel disposed along said lower blade structure and a plurality of channels in communication with said fluid delivery channel.
21 . The surgical instrument of claim 11 , wherein said blade further comprises a plurality of throughholes, said blade and is movable between a proximal position and a distal position, at least one of said throughholes is positioned near said first structure edge and at least one of said throughholes is positioned near said second structure edge.
22 . The surgical instrument of claim 21 , wherein said lower blade structure further comprises an elongate delivery channel and a plurality of side channels, said elongate delivery channel extending along said lower blade structure, said plurality of side channels in communication with said delivery channel, wherein at least one of said side channels is aligned with at least one of said throughholes in the blade.
23 . The surgical instrument of claim 11 , wherein said distal assembly forms a tip that is dimensioned so as to fit into a neuroforamen without producing appreciable trauma to a nerve extending through said neuroforamen.
24 . An instrument, comprising:
a blade having an upper filing surface; and
a lower blade structure, wherein said blade slidably couples with said lower blade structure, wherein said blade and said lower blade structure are each convex away from said upper filing surface.
25 . The instrument of claim 24 , wherein said distal assembly further comprises a tip, said tip dimensioned so as to fit into a neuroforamen without producing appreciable trauma to a nerve extending through said neuroforamen.
26 . The instrument of claim 24 , wherein said blade has a first transverse width and said lower blade structure has a second transverse width, wherein said first transverse width is about the same as said second transverse width.
27 . The instrument of claim 24 , wherein said blade has a first transverse width and said lower blade structure has a second transverse width, wherein said first transverse width is less than said second transverse width.
28 . The instrument of claim 24 , wherein said blade has a first transverse width and said lower blade structure has a second transverse width, wherein said first transverse width is greater than said second transverse width.
29 . The instrument of claim 24 , wherein said blade has a first transverse width and said lower blade structure has a second transverse width, wherein said first transverse width is less than about 95% of said second transverse width.
30 . A surgical instrument comprising:
a filing surface configured to cut, grind, and/or file tissue;
a shield surface coupled to said filing surface;
wherein said instrument is configured to be positioned at least partially in a neuroforamen having a nerve extending therethrough; and
wherein at least a portion of said shield surface is concave towards said nerve when said instrument is positioned at least partially in said neuroforamen.
31 . A surgical instrument comprising:
a filing surface configured to cut, grind, and/or file tissue; and
a shield surface coupled to said filing surface;
wherein at least a portion of said shield surface is convex towards said filing surface.
32 . The instrument of claim 31 , wherein said instrument is configured to be positioned at least partially in a mammalian neuroforamen having a nerve extending therethrough.
33 . A surgical instrument comprising:
means for grinding a first tissue; and
means for shielding a second tissue from said means for grinding when said second tissue is in proximity to said first tissue;
wherein at least part of said means for shielding is convex towards said means for grinding.
34 . A method of treating a patient comprising:
placing a distal assembly of an instrument at least partially in a neuroforamen having a nerve extending therethrough;
wherein at least a portion of said distal assembly is concave towards said nerve; and
removing tissue from said patient by operating said distal assembly.
35 . The method of claim 34 , wherein said removing of tissue comprises at least one of cutting, filing, and grinding.
36 . The method of claim 34 , further comprising oscillating a blade of said distal assembly to remove said tissue.
37 . The method of claim 34 , further comprising coupling a powered handpiece to said distal assembly of said instrument, and said powered handpiece has a drive system for driving a movable blade of said distal assembly.
38 . The method of claim 37 , wherein said powered handpiece is a rotary handpiece and said instrument further comprises a mechanical transmission that converts rotary motion of said powered handpiece to reciprocating, linear motion.
39 . The method of claim 34 , further comprising positioning an access device in a patient's body, and advancing said distal assembly through said access device until said distal assembly reaches a target location for tissue removal.
40 . The method of claim 34 , wherein tissue is removed by reciprocating a blade while at least a portion of said distal assembly remains in said neuroforamen.
41 . A method of treating a patient, said method comprising:
placing a distal assembly of an instrument at least partially into a neuroforamen between target tissue and a nerve;
removing said target tissue from surrounding tissue with said distal assembly;
after removing said target tissue, drawing said target tissue into said distal assembly; and
moving said target tissue through said distal assembly.
42 . The method of claim 41 , wherein drawing said target tissue into said distal assembly comprises drawing said target tissue through an inlet port of said distal assembly and through a lumen extending from said inlet port through said distal assembly.
43 . The method of claim 41 , further comprising:
delivering irrigation fluid out of said distal assembly as said distal assembly removes said target tissue such that said irrigation fluid is mixed with said target tissue; and
drawing said mixture of target tissue and irrigation fluid into and through said distal assembly.
44 . The method of claim 41 , wherein said distal assembly is substantially L-shaped and has a cutting blade for removing tissue.