Method for accessing a spinal facet joint
A minimally invasive method for accessing a facet joint of the spine is provided. Embodiments of the method include creating a small incision directly over the facet joint and to allow direct access and visualization of the joint. A second incision, which may be a puncture wound, is provided at a distance from the first incision. A path between the second incision and the facet joint is then formed which may be curved or substantially straight. The path is preferably configured to intersect both facet surfaces. The path may be formed using an instrument which can be used to drill a hole across the facets, insert a fastener across the facets, or the like.
1. A method for providing access to a spinal facet joint, the method comprising:
providing a first incision directly over the facet joint, the first incision allowing direct visualization of a superior or an inferior articular process and the facet joint which includes a facet on the superior or the inferior articular process;
retracting sides of the first incision to reveal the facet joint;
creating a second incision at a particular distance from the first incision, wherein the second incision is ipsilateral to the facet joint;
creating a path between the second incision and the facet joint, such that the path intersects an articular surface of each facet of the facet joint, the second incision provided at a distance from the first incision that is not so large that the path from the second incision to the facet joint intersects or penetrates the peritoneum; and
positioning a fastening member across the facet joint.
2. The method of claim 1 , wherein a length of the first incision is less than about 3 cm.
3. The method of claim 2 , wherein a length of the second incision is less than about 5 mm.
4. The method of claim 2 , wherein a length of the second incision is less than about 3 mm.
5. The method of claim 2 , wherein the second incision is a puncture wound.
6. The method of claim 1 , wherein a length of the first incision is less than about 2 cm.
7. The method of claim 1 , wherein the sides are retracted using a tissue retractor.
8. The method of claim 7 , wherein the tissue retractor is at least one of a blade refractor or a tubular retractor.
9. The method of claim 1 , wherein an angle between the path and the articular surface is approximately 90 degrees.
10. The method of claim 1 , wherein an angle between the path and the articular surfaces is greater than about 80 degrees.
11. The method of claim 1 , wherein an angle between the path and the articular surfaces is greater than about 60 degrees.
12. The method of claim 1 , wherein the path is created by inserting an instrument through the second incision until a distal end thereof reaches the facet joint.
13. The method of claim 12 , wherein the instrument is substantially straight along a primary axis thereof.
14. The method of claim 12 , wherein the instrument is curved along a primary axis thereof.
15. The method of claim 12 , wherein the instrument includes a tubular housing.
16. The method of claim 12 , wherein the instrument includes a drill.
17. The method of claim 12 , further comprising the step of generating a hole in at least one facet of the facet joint using the instrument.
18. The method of claim 17 , further comprising the step of inserting an implant within the facet joint.
19. The method of claim 18 , further comprising the step of generating a hole in the implant using the instrument after the implant is inserted in the facet joint.
20. The method of claim 12 , further comprising the step of inserting the fastening member across both facets of the facet joint using the instrument.
21. The method of claim 20 , wherein the fastening member is a screw.
22. The method of claim 1 , wherein the particular distance is between about 2 cm and about 20 cm.
23. The method of claim 1 , wherein the particular distance is between about 2 cm and about 10 cm.
24. A method for treating a spinal facet joint, the method comprising:
providing a first incision directly over the facet joint, the first incision allowing direct visualization of a first articular process and a second articular process of the facet joint;
retracting sides of the first incision to reveal the facet joint;
creating a second incision at a distance from the first incision, wherein the second incision is ipsilateral to the facet joint;
creating a path between the second incision and the facet joint;
creating a hole through the first articular process, through a facet surface of the facet joint, and through the second articular process; and
positioning a fastening member across the facet joint.
25. The method of claim 24 , wherein the second incision is a puncture wound.
26. The method of claim 24 , wherein an angle between the path and the facet surface is approximately 90 degrees.
27. The method of claim 24 , wherein an angle between the path and the facet surfaces is greater than about 60 degrees.
28. The method of claim 24 , wherein the path is created by inserting an instrument through the second incision until a distal end thereof reaches the facet joint.
29. The method of claim 28 , wherein the instrument is substantially straight along a primary axis thereof.
30. The method of claim 28 , wherein the instrument is curved along a primary axis thereof.
31. The method of claim 28 , further comprising the step of inserting an implant within the facet joint.
32. The method of claim 31 , further comprising the step of generating a hole in the implant using the instrument after the implant is inserted in the facet joint.
33. The method of claim 24 , wherein the distance is between about 2 cm and about 20 cm.